Figure - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Summarising the average causal effects between dissociation and all other variables (Percentages to 2 d.p., causal effects & CIs to 2 s.f.).
Source publication
A large number of mechanisms, many relating to the processing of affect, have been proposed to cause dissociation. The aim of this study was to use network analyses to identify psychological processes most closely connected with ‘felt sense of anomaly’ dissociative experiences. Both an undirected model and a partially directed network model were es...
Contexts in source publication
Context 1
... on the variable of FSA-dissociation within the network in order to identify potential causal factors, Table 2 summarises the directions of relationships between dissociation and all other variables. The table can be interpreted as with the following example: from general self-efficacy (GSE) to dissociation, there was a pathway (direct or indirect) present in 57.96% of the 50,000 DAGs sampled -that is, GSE influences dissociation in 57.96% of the 50,000 sampled graphs. ...Context 2
... was present, and this had an average strength of less than 0.01. In the opposite direction, from dissociation to GSE (bottom half of Table 2), there was a pathway present in 27.45% of the 50,000 sampled graphs, and the average strength of this effect was 0.27 (CI = 0.38 to 0.035). Again, 48.98% of the 27.45% of sampled DAGs contained a direct pathway (edge) from dissociation to GSE. ...Citations
... Cognitive appraisals of dissociation was a partial mediator of the longitudinal relationship between dissociation and panic symptoms at Time 2. Greater levels of dissociation at the first time point were correlated with more catastrophic appraisals (e.g., 'I can't trust my own mind'), which in turn were positively associated with more severe panic symptoms. These results align with models proposed by Clark (1986;panic), Hunter et al. (2003;depersonalisation), and Černis et al. (2022a;FSA-dissociation), which highlight the role of negative appraisals in the maintenance of psychopathological symptoms. For example, at the centre of Clark's cognitive model of panic (1986) is the misinterpretation of internal sensations as inherently dangerous. ...
... Greater dissociative symptoms at the first time point related to less cognitive reappraisal, which in turn was associated with more severe panic symptoms at the second time point. Thus, when individuals prone to dissociation fail to reappraise their symptoms in a way that reduces their negative impact, the resulting escalation of anxiety may heighten the feared dissociation sensation(Hunter et al., 2003;Černis et al., 2022a, 2022b) and panic symptoms.Notably, however, the mediating effects of cognitive appraisals of dissociation and cognitive reappraisal were no longer significant when baseline panic symptoms were controlled for in the analyses. This may be explained by the stability of symptoms across the two time points (evidenced by the strong correlation between Time 1 and Time 2 PDSS-A scores; r > .80). ...
Background
Dissociative experiences have been linked to panic symptoms in adolescents, yet the nature of the association remains unclear.
Methods
In the present study, we investigated the longitudinal relationship between dissociative experiences (focusing on the felt sense of anomaly subtype) and panic, as well as the potential mediating roles of emotion regulation strategies (expressive suppression and cognitive reappraisal), alexithymia, and cognitive appraisals of dissociation. Four thousand five hundred one adolescents aged 13–18 years were recruited via social media advertising to take part in an online survey at two timepoints, 1 month apart.
Results
Analysis of 421 datasets found a significant positive relationship between initial dissociative experiences and panic symptoms reported 1 month later. This was mediated by the emotion regulation strategy of cognitive reappraisal, and cognitive appraisals of dissociation. These two variables were no longer significant mediators when controlling for panic symptoms at the first time point, likely due to the stability of panic symptoms across both assessments. Neither alexithymia nor expressive suppression were significant mediators.
Conclusions
Thus, dissociative experiences that are persistently misinterpreted in a catastrophic manner may lead to escalating anxiety and panic symptoms, which could in turn heighten and maintain the feared dissociation sensation. These results indicate that dissociative experiences are associated with panic symptoms in adolescence, with cognitive appraisals of dissociation and cognitive reappraisal playing a role in this relationship.
... Perseverative thinking, i.e., the tendency to ruminate upon (negative) thoughts, may also mediate the relationship between anxiety and dissociative symptoms, but again this has not been tested in adolescents. It is proposed that perseverative thinking about the negative cognitive appraisals of dissociative experiences contributes to a prolonged experience of dissociation symptoms in adults (Černis et al., 2022;Hunter et al., 2003). Freeman et al. (2013) have provided experimental evidence supporting this by demonstrating that inducing worry in adults with persecutory delusions resulted in an increase in depersonalisation symptoms, whereas a worry reduction condition led to a reduction in symptoms of dissociation. ...
... The moderate associations between trait anxiety and dissociation symptoms found in this age group are consistent with previous theory and research in adult clinical and nonclinical groups (Černis et al., 2022;Hunter et al., 2003), including supporting the proposed overlap between depersonalisation and felt sense of anomaly (Černis, Beierl, et al., 2021). This finding is also consistent with research on adolescents with panic disorder that shows around ANXIETY AND DISSOCIATION IN ADOLESCENCE 13 50% of adolescents experience symptoms of dissociation (Kearney et al., 1997). ...
... There will also be other potential moderators that could explain the large amounts of variance unaccounted for by trait anxiety and the mediating variables in our models. For example, research with large adult non-clinical community and psychosis patient samples (Černis, Evans, et al., 2021;Černis et al., 2022) have found direct relationships linking felt sense of anomaly with alexithymia and affect intolerance. In addition, since a high level of state anxiety may escalate beyond the common fight or flight response into a state of experiencing dissociation (Schauer & Elbert, 2015), future research may wish to explore the relationship between state anxiety and dissociation symptoms in adolescents and to compare the constructs of state and trait anxiety. ...
Anxiety is a common problem in adolescence and is hypothesised to be associated with dissociation, a range of distressing symptoms associated with reduced psychosocial functioning and increased clinical complexity. Yet, to date, research into the mechanisms of dissociation in adolescents has been limited. The present study investigated the link between trait anxiety and dissociative experiences (depersonalisation and ‘felt sense of anomaly’) using an online survey. Cognitive appraisals of dissociation, perseverative thinking, and body vigilance were assessed as potential mediating factors of this relationship. 1211 adolescents aged 13-18 years were recruited via social media advertisements and local schools. Linear regression showed a moderate positive relationship between trait anxiety and both dissociation constructs. Hierarchical regression indicated that cognitive appraisals of dissociation and perseverative thinking mediated the relationship between trait anxiety and both dissociation constructs, but body vigilance only mediated the relationship for depersonalisation. The final models accounted for 56.9% of variance in depersonalisation and 68.5% of variance in felt sense of anomaly. These results support the hypothesis that dissociation is associated with anxiety in adolescence. Importantly for future work in this field, they also demonstrate that dissociation constructs are separable, and that cognitive-behavioural conceptualisations may be valid for understanding dissociation in adolescence.
Dissociative symptoms and disorders of dissociation are characterised by disturbances in the experience of the self and the surrounding world, manifesting as a breakdown in the normal integration of consciousness, memory, identity, emotion, and perception. This paper aims to provide insights into dissociative symptoms from the perspective of interoception, the sense of the body’s internal physiological state, adopting a transdiagnostic framework.
Dissociative symptoms are associated with a blunting of autonomic reactivity and a reduction in interoceptive precision. In addition to the central function of interoception in homeostasis, afferent visceral signals and their neural and mental representation have been shown to shape emotional feeling states, support memory encoding, and contribute to self-representation. Changes in interoceptive processing and disrupted integration of interoceptive signals into wider cognition may contribute to detachment from the body and the world, blunted emotional experience, and altered subjective recall, as experienced by individuals who suffer from dissociation.
A better understanding of the role of altered interoceptive integration across the symptom areas of dissociation could thus provide insights into the neurophysiological mechanisms underlying dissociative disorders. As new therapeutic approaches targeting interoceptive processing emerge, recognising the significance of interoceptive mechanisms in dissociation holds potential implications for future treatment targets.
Background:Dissociation may be important across many mental health disorders, but has been variously conceptualised and measured. We introduced a conceptualisation of a common type of dissociative experience, ‘felt sense of anomaly’ (FSA), and developed a corresponding measure, the Černis Felt Sense of Anomaly (ČEFSA) scale.
Aims:We aimed to develop a short-form version of the ČEFSA that is valid for adolescent and adult respondents.
Method:Data were collected from 1031 adult NHS patients with psychosis and 932 adult and 1233 adolescent non-clinical online survey respondents. Local structural equation modelling (LSEM) was used to establish measurement invariance of items across the age range. Ant colony optimisation (ACO) was used to produce a 14-item short-form measure. Finally, the expected test score function derived from item response theory modelling guided the establishment of interpretive scoring ranges.
Results:LSEM indicated 25 items of the original 35-item ČEFSA were age invariant. They were also invariant across gender and clinical status. ACO of these items produced a 14-item short-form (ČEFSA-14) with excellent psychometric properties (CFI=0.992; TLI=0.987; RMSEA=0.034; SRMR=0.017; Cronbach’s alpha=0.92). Score ranges were established based on the expected test scores at approximately 0.7, 1.25 and 2.0 theta (equivalent to standard deviations above the mean). Scores of 29 and above may indicate elevated levels of FSA-dissociation.
Conclusions:The ČEFSA-14 is a psychometrically valid measure of FSA-dissociation for adolescents and adults. It can be used with clinical and non-clinical respondents. It could be used by clinicians as an initial tool to explore dissociation with their clients.
Accumulating evidence suggests that substance addictive behaviors are associated with traumatic experiences, emotion dysregulation, and psychopathological symptoms. Emotion dysregulation may contribute to initiating and sustaining addictive behaviors, as a way to cope with interpersonal trauma. However, the interplay between interpersonal trauma, emotion dysregulation, and substance addictive behaviors is still understudied. An online survey was disseminated via snowball sampling. One thousand four hundred and forty-six individuals from the Italian general population were assessed for substance addictive behaviors, interpersonal trauma, emotion dysregulation, and psychopathological symptoms. A correlation network approach was used to examine the associations among these variables. Positive relationships were found between interpersonal trauma, emotion dysregulation, and substance addictive behaviors. Emotional neglect bridged the other types of trauma with substance use and psychopathology. Among psychopathological variables, depression, anxiety, and impaired personality functioning symptoms had the highest strength. Emotion dysregulation had the highest bridging. The findings suggest that psychopathological symptoms, emotion dysregulation, and emotionally traumatic experiences play a significant role in the activation of the addictive behavior network. Promoting emotion regulation strategies might be part of preventative actions and early intervention programs for substance addictive behaviors.
Individuals with autism spectrum disorder (ASD) often show limited empathy (poor recognition of others' emotions) and high alexithymia (poor recognition of own emotions and external thinking), which can negatively impact their social functioning. Previous experimental studies suggest that alterations in cognitive flexibility play key roles in the development of these characteristics in ASD. However, the underlying neural mechanisms that link cognitive flexibility and empathy/alexithymia are still largely unknown. In this study, we examined the neural correlates of cognitive flexibility via functional magnetic resonance imaging during perceptual task-switching in typical development (TD) adults and adults with ASD. We also investigated associations between regional neural activity and psychometric empathy and alexithymia scores among these populations. In the TD group, stronger activation of the left middle frontal gyrus was associated with better perceptual switching and greater empathic concern. Among individuals with ASD, stronger activation of the left inferior frontal gyrus was associated with better perceptual switching, greater empathy, and lower alexithymia. These findings will contribute to develop a better understanding of social cognition, and could be informative for the development of new ASD therapies.
Anxiety is a common problem in adolescence which is hypothesised to be associated with dissociation, a range of distressing symptoms linked to reduced psychosocial functioning. Yet, to date, research into the mechanisms of dissociation in adolescents has been limited. The present study investigated the link between trait anxiety and dissociative experiences (depersonalisation and 'felt sense of anomaly') using an online survey. Cognitive appraisals of dissociation, perseverative thinking, and body vigilance were assessed as potential mediating factors of this relationship. 1211 adolescents aged 13-18 years were recruited via social media advertisements and local schools. Linear regression showed a moderate positive relationship between trait anxiety and both dissociation constructs. Hierarchical regression indicated that cognitive appraisals of dissociation and perseverative thinking mediated the relationship between trait anxiety and both dissociation constructs, but trait anxiety was a significant predictor for felt sense of anomaly but not depersonalisation after including the mediators. The final models accounted for 58.7% of variance in depersonalisation and 68.4% of variance in felt sense of anomaly. These results support the hypothesis that dissociation is associated with anxiety in adolescence. They also demonstrate that cognitive-behavioural conceptualisations may be valid for understanding dissociation in adolescence.
Dissociation is problematic in its own right for patients with psychosis but may also contribute to the occurrence of psychotic experiences. We therefore set out to estimate in a large cohort of patients with psychosis the prevalence of dissociative experiences, and assess using network models the relationships between dissociation, its potential maintenance mechanisms, and mental health symptoms.
902 patients with non-affective psychosis attending UK mental health services participated. Both an undirected model and a partially directed network model were estimated to identify potential relationships between ‘felt sense of anomaly’ dissociative experiences, paranoia, hallucinations, psychological wellbeing, sleep, and six potential maintenance mechanisms (affect intolerance, perseverative thinking, general self-efficacy, alexithymia, cognitive appraisals, and cognitive-behavioural responses to dissociation).
617 patients (65.4%) had experienced at least one dissociative symptom regularly over the past fortnight, with the average number experienced being 8.9 (SD = 8.0). Dissociation had direct relationships with paranoia, hallucinations, low psychological wellbeing, cognitive appraisals, cognitive-behavioural responses to dissociation, perseverative thinking, and low alexithymia. Dissociation was a probable cause of hallucinations (94.21% of 50,000 sampled directed acyclic graphs), with a trend towards also being a cause of paranoia (86.25% of 50,000 sampled directed acyclic graphs).
Approximately two-thirds of patients with psychosis experience regular dissociative experiences. Dissociation is associated with low psychological wellbeing, and it is likely to have a direct causal influence on psychotic symptoms. Catastrophic cognitive appraisals, cognitive-behavioural responses to dissociation, factors related to affect sensitivity, and perseverative thinking may contribute to the occurrence of dissociation.
