Association Between Psychotic and Dissociative Symptoms: Further Investigation Using Network Analysis

J Trauma Dissociation. 2024 Mar-Apr;25(2):279-296. doi: 10.1080/15299732.2023.2293776. Epub 2023 Dec 20.


The association and overlap between psychotic and dissociative phenomena have been increasingly recognized. Previous studies found that psychotic symptoms are closely associated with post-traumatic and dissociative symptoms and that these trauma-related phenomena may mediate the relationship between trauma and psychotic symptoms. It remained less explored which specific post-traumatic and dissociative symptom clusters are particularly associated with psychotic symptoms. This cross-sectional study used a data-driven approach (network analysis) to explore the associations among different psychotic and post-traumatic/dissociative symptom clusters in an online convenience predominantly female sample (N = 468)(59.2% had ever seen a psychiatrist). Participants completed well-established multidimensional measures that assessed different symptom clusters of psychosis, dissociation, and PTSD. In addition, multiple mediation analysis was conducted to examine which post-traumatic/dissociative symptoms could mediate the relationship between childhood and adulthood trauma and different psychotic symptoms. Our results confirmed previous findings that PTSD and dissociative symptoms are closely associated with psychotic symptoms. More importantly, both data-driven and multiple mediation analysis results indicated that identity dissociation was particularly associated with perceptual anomalies and bizarre experiences, while emotional constriction was particularly associated with negative symptoms. It is important to screen for trauma and dissociation and provide trauma-and dissociation-informed care when working with people at risk of or experiencing psychosis. Further longitudinal studies using more representative samples are needed.

Keywords: Complex post-traumatic stress disorder (PTSD); Trauma; depression; dissociation; psychosis.

MeSH terms

  • Child
  • Cross-Sectional Studies
  • Dissociative Disorders / psychology
  • Female
  • Humans
  • Male
  • Psychotic Disorders* / psychology
  • Stress Disorders, Post-Traumatic* / psychology
  • Syndrome