The relationship between childhood adversities and dissociation in severe mental illness: a meta-analytic review

Acta Psychiatr Scand. 2018 Dec;138(6):509-525. doi: 10.1111/acps.12969. Epub 2018 Oct 18.


Objective: Several studies have observed that dissociative experiences are frequently reported by individuals with severe mental illness (SMI), especially amongst patients that report a history of adverse/traumatic life experiences. This review examined the magnitude and consistency of the relationship between childhood adversity (sexual abuse, physical abuse, emotional abuse, neglect, bullying, natural disasters and mass violence) and dissociation across three SMI diagnostic groups: schizophrenia, bipolar disorder and personality disorders.

Method: A database search (EMBASE, PubMed and PsycINFO) identified 30 eligible empirical studies, comprising of 2199 clinical participants. Effect sizes representing the relationship between exposure to childhood adversity and dissociation were examined and integrated using a random-effects meta-analysis.

Results: The results indicated that exposure to childhood trauma was associated with heightened dissociation across SMIs. Positive significant associations were also found between specific childhood adversities and dissociation, with aggregated effect sizes in the small-to-moderate range.

Conclusion: These findings support calls for the routine assessment of traumatic experiences in clients with SMIs presenting with dissociative symptoms and the provision of adequate therapeutic support (e.g. trauma-focused therapies) to manage and resolve these difficulties.

Keywords: bipolar disorder; dissociation; personality disorder; schizophrenia; trauma.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Adult
  • Adverse Childhood Experiences / statistics & numerical data*
  • Bipolar Disorder / epidemiology*
  • Child
  • Child Abuse / statistics & numerical data*
  • Dissociative Disorders / epidemiology*
  • Humans
  • Personality Disorders / epidemiology*
  • Psychological Trauma / epidemiology*
  • Schizophrenia / epidemiology*