Are dissociative psychosis and dissociative schizophrenia reality?

Abstract

Even if dissociation has various facets, it is clear that knowledge of dissociative psychosis and a dissociative schizophrenia-based viewpoint may provide new perspectives on mental disorders. Many researchers screening for comorbid symptoms of “childhood traumatic experiences” and “dissociation”, where specific characteristics are significant to the presence of psychosis and schizophrenia, may lead to an acceptable definition. In recent years, researchers have also reported crucial advances in the understanding of dissociative psychosis and dissociative schizophrenia. Although clinical studies in this area have been ongoing for a long time, research has not demonstrated that a clear and valid relationship exists between dissociation, childhood traumatic experiences, and schizophrenia or psychotic spectrum disorders. However, some results of statistical comparisons have supported the existence of the clinical manifestation known as dissociative psychosis and dissociative schizophrenia. Dissociation, childhood traumatic experiences, and positive psychotic symptoms may be a prominent part of dissociative psychosis and schizophrenia. The intense presence of negative symptoms may indicate classical schizophrenia. In research and clinical practice, researchers and clinicians may use psychometric tests to detect symptoms of dissociative psychosis. Psychotic persons with traumatic experiences likely benefit from treatment focused on trauma symptomatolgy.

Key Words: Dissociation; Childhood trauma; Psychotic spectrum; Psychosis; Schizophrenia

Core Tip: Many researchers have suggested that an acceptable definition might be achieved by analysis screened for comorbid symptoms of “childhood traumatic experiences” and “dissociation”. Dissociation, childhood traumatic experiences, and positive psychotic symptoms may be a prominent part of dissociative psychosis and schizophrenia. The intense presence of negative symptoms may indicate classical schizophrenia.

INTRODUCTION

Dissociation pertains to a constellation of symptoms; experts have characterized dissociation as a disturbance or discontinuity in the typical integration of consciousness, memory, identity, emotion, perception, corporeal representation, motor function, and behavior[1,2]. Corresponding occurrence sequence from moderate manifestations, such as failing to recognize seeing oneself in the mirror, to more pronounced occurrences, such as becoming wholly engrossed in a literary work or cinematic presentation[3]. Moderate types of absorption wherein an individual concentrates on a singular aspect of experience while simultaneously inhibiting awareness of others-are frequently linked to broader experiential patterns[4]. While experts have established the severity of symptoms based on specific criteria, the diagnostic and statistical manual of mental disorders-5 classifications of dissociative disorders encapsulate more pronounced dissociative phenomena: Dissociative amnesia is the inability to remember personal details; Depersonalization/derealization disorders include a sense of estrangement or disassociation from one’s body, thoughts, or emotions; and distorted, unreal, or visually altered perceptions of one’s surroundings[1].

Many researchers have identified that dissociation and dissociative disorders are often the result of traumatic experiences that occur in childhood and adulthood. Authorities have widely accepted this relationship. Consequently, specialists within the discipline currently posit that dissociative manifestations are evident in additional disorders conventionally regarded as related to trauma, such as borderline personality disorder and post-traumatic stress disorder[1]. As trauma is progressively perceived as a contributory risk factor for the onset of psychosis, scholars have increasingly scrutinized the interplay between dissociative experiences and psychosis[5]. Indeed, some have gone so far as to suggest that experiences of dissociative experiences, particularly auditory hallucinations, and delusions of control or passive affect, are better classified as dissociative rather than psychotic[5,6].

Many findings from dissociation and dissociative disorders indicate that the etiopathogenesis and comorbidity of pathological processes are intertwined. The features of pathological dissociative processes are related to their psychotraumatic properties and their relevance to other psychiatric comorbidities. Authors have defined complex dissociative disorders as a chronic, post-traumatic process associated with traumatic events throughout childhood[7]. There have been notable developments in the understanding of the coexistence of dissociation and psychosis. Some authors have also suggested that psychotic individuals may experience extreme distress, overwhelm, and worsening of their psychotic symptoms as a result of dissociative experiences[8-10]. However, the evolutionary line in the development of the coexistence of psychosis and dissociation is not clear. Numerous researchers highlight the parallels, causal connections, and overlaps between psychotic and dissociative symptoms[11]. Such a hypothesis aims to provide a connectional model of dissociative symptoms for psychotic disorders. According to a study, first-rank psychotic symptoms in individuals with schizophrenia spectrum disorder and other psychoses are directly correlated with depersonalization and derealization symptoms[12]. The connection between trauma and dissociation has been the subject of some research. Positive psychotic symptoms upon admission and childhood sexual abuse have been shown to predict dissociative symptoms by Schäfer et al[13]. Schalinski et al[14] have examined the relationship between childhood trauma, dissociation, and psychotic symptoms. The association between childhood trauma and psychotic symptoms was found to be mediated by dissociative symptoms. Evidence of the direct relationship between dissociation, psychosis, and schizophrenic symptoms exists, the concept of dissociation and psychotic disorders or symptoms interconnection may provide the basis for “dissociative psychosis” or “dissociative schizophrenia”. The idea that mental illnesses are distinct “disease entities” with unique biological or genetic causes that only affect people who fit specific criteria is, nevertheless, coming under growing scrutiny from researchers[15]. Additionally, there is strong evidence that psychosis, like dissociative experiences, represents a spectrum of normal functioning and that its manifestation transcends diagnostic divisions without being a pathognomonic feature of any specific condition[16].

However, it is also essential to discuss the relationship between dissociation, psychosis, and schizophrenia phenomenologically. This approach may be beneficial in practical and theoretical applications.

THE CONCEPT OF DISSOCIATIVE SCHIZOPHRENIA

The main descriptive features of dissociative psychosis and the researchers have not usually described schizophrenia separately although to some extent this becomes in discussing the indications for dissociative schizophrenia. However, other scholars made the strong argument that “traumatic” and “dissociative” schizophrenia might potentially be read differently. Some authors have proposed the existence of this clinical description, despite the fact that it is not generally acknowledged[17]. Key terms in this discussion are “childhood trauma” and “dissociative symptoms”. Ross[18] has proposed that a clinical phenomenology known as the “dissociative subtype of schizophrenia” could provide a clinically acceptable description, given the traumatic character of illness and clinical phenomenology. According to Sar et al[17], patients with high levels of dissociation and traumatic childhood events can be diagnosed with sequential dissociative schizophrenia, which has the same diagnostic value as concurrent symptomatology. Sar et al[17] have suggested that their study findings support the existence of such a subtype of schizophrenia. They have also proposed the traumatic neurodevelopmental model to explain a potential relationship. Again, in this study, the authors have emphasized that childhood traumatic experiences in schizophrenia are associated with severe schizophrenic symptoms. In contrast, the increase in dissociation in this group of patients is considered basic to the rise in symptom load[17].

Dissociation encompasses a variety of phenomena, such as experiences with different types of “psychological disengagement” (depersonalization, derealization, etc.) and mental experience compartmentalization (identity disorders, dissociative amnesia, etc.)[19]. Importantly, researchers have confirmed that dissociation is at high levels in individuals diagnosed with schizophrenia spectrum disorders in meta-analytic studies[20,21]. Previous studies have documented an overlap between borderline personality disorder and dissociative disorders, including a high frequency of reported childhood trauma[22]. In a study of patients with schizophrenia, the authors found a strong association between higher levels of borderline personality traits and reports of childhood sexual abuse[23]. In these patients, high levels of borderline personality disorder symptoms may not represent a personality disorder but may be a reflection of trauma-related dissociative symptoms in patients with schizophrenia. Childhood traumas may have caused biologically based neurocognitive damage. Overlapping phenomenology may have emerged through this mechanism. Extensive research on this topic may reveal interesting results. While such classifications are particularly useful to the researchers, in the clinical field it needs to be used carefully as it is not easy to derive the current clinical phenomena because scientific data has not yet accumulated sufficiently.

DISSOCIATIVE PSYCHOSIS AS A GENERAL CLINICAL PHENOMENON

Many significant results have emerged from the area of dissociative psychosis indicating that childhood traumatology, dissociation, and psychosis for the understanding of its description and psychopathological process. It is still unclear if dissociation, childhood trauma, and schizophrenia or psychotic spectrum disorders are clearly and validly related, even though clinical research in this field has been ongoing for a long time. There appears to be an optimal level of this relationship between psychotic and dissociative symptoms that is much clearer for psychotic disorders[11,13,24]. Any dissociative symptoms that influence the psychotic process can be regarded as different dimensions of a singular disorder. Research on the relationship between dissociation, psychotic spectrum, schizophrenia, and childhood traumas is quite impressive. Some researchers have suggested that some factors may be involved in the effects of various dissociative symptoms and childhood traumatic experiences on psychotic disorder. The findings together with the documentation of positive and negative symptoms in the psychotic spectrum, provide a rationale for clinical rationality of the dissociation and traumatic experiences in patients with the psychotic spectrum. Studies with psychotic patients have demonstrated that dissociation can affect the positive symptoms process. There is also considerable evidence that childhood traumatic experiences can influence positive symptoms. In a meta-analysis in this field, authors have concentrated on dissociative symptoms and negative, and positive symptoms of psychotic disorders. They discovered weak and occasionally nonsignificant correlations between negative symptoms and dissociative symptoms. Overall, these results have demonstrated that dissociative experiences are less strongly linked to negative symptoms and more strongly linked to various positive symptoms, in addition to hallucinations. According to the authors’ findings, some psychotic symptoms might be better understood as dissociative, which could help create therapies that focus on dissociation in the formulation and treatment of psychotic experiences[24]. Studies investigating the relationships between phenomena are valuable in what could be called the “dissociative psychosis” in patients. Childhood trauma and dissociative symptoms are more strongly correlated in chronic and first-episode psychotic patients than in non-psychotic control participants, according to Braehler et al[25]. Additionally, the scientists discovered that emotional abuse has a significant role in explaining dissociation variability, particularly in chronic patients[25]. According to Ross[18], schizo-dissociative disorder, dissociative identity disorder, non-dissociative schizophrenia, and the dissociative subtype of schizophrenia are all part of a continuum. In a recent study, researchers compared both patients with schizophrenia and those with other psychotic disorders. They compared the patients on childhood trauma, dissociation, and negative-positive symptoms. To draw clear conclusions, the researchers separated the patients into two groups: Those with schizophrenia and those with psychotic disorders not otherwise defined (PNOS). The positive and negative syndrome scale (PANSS), the childhood trauma questionnaire (CTQ), and the dissociation questionnaire (DIS-Q) were used by the researchers to evaluate the subjects. According to this study, patients with PNOS scored higher than those with schizophrenia on measures of dissociation and traumatic childhood experiences. They also scored higher on measures of physical abuse, emotional abuse, emotional neglect, sexual abuse, and physical neglect. The PANSS general psychopathology, PANSS negative, and PANSS total scores were considerably lower in the PNOS group than in the schizophrenia group. PNOS was also significantly predicted by the overall scores of the CTQ and DIS-Q. Instead of dissociative schizophrenia, the researchers found that their findings supported the presence of the clinical phenomenology known as dissociation psychosis[26].

These studies may be employed in more thorough research if they show that the reliability of this viewpoint may be predicted. However, the pathological psychotic process and positive symptoms in schizophrenia may be influenced by dissociation symptoms and traumatic experiences during infancy. It is yet unknown how childhood trauma and dissociative symptoms relate to unfavorable symptoms of schizophrenia. Positive psychotic symptoms, early trauma, and dissociation may all play a significant role in dissociative psychosis and schizophrenia. The intense presence of negative symptoms may indicate classical schizophrenia.

CONCLUSION

This brief review has presented a frame of the relevant areas of investigation in that psychotic symptoms, schizophrenia, dissociation, and childhood traumatic experiences are extensively interconnected. Although the dissociation and childhood traumatic experiences in the psychotic spectrum do not explain all clinical reality, it is very encouraging to find that so much data on similar clinical profiles may have significant effects on positive symptoms. However, the intense presence of negative symptoms may indicate classical schizophrenia. Some studies may have reached important conclusions. Clinically, dissociative symptoms in psychosis may provide other perspectives. Some unwanted results and adequate responses to treatment may be related to dissociative symptoms and childhood traumatic experiences. In research and clinical practice, researchers and clinicians may use tests such as DIS-Q, CTQ, and PANSS to detect symptoms of dissociative psychosis. Psychotic persons with traumatic experiences likely benefit from treatment focused on trauma symptomatology. Scientific research on this topic needs larger samples. Neurobiology and cultural factors may play an important role in psychological traumatic reactions that escalate to the level of psychosis. New research should also focus on these issues.