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Dissociation in victims of childhood abuse or neglect: a meta-analytic review

Published online by Cambridge University Press:  10 April 2018

Ruben Vonderlin ,
Nikolaus Kleindienst ,
Georg W. Alpers ,
Martin Bohus ,
Lisa Lyssenko  and
Christian Schmahl
Ruben Vonderlin
Affiliation:
Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim J5, D-68159, Germany Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
Nikolaus Kleindienst
Affiliation:
Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim J5, D-68159, Germany
Georg W. Alpers
Affiliation:
Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
Martin Bohus
Affiliation:
Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim J5, D-68159, Germany Department of Health, Antwerp University, Antwerp, Belgium
Lisa Lyssenko*
Affiliation:
Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim J5, D-68159, Germany
Christian Schmahl
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
*
Author for correspondence: Lisa Lyssenko, E-mail: [email protected]
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Abstract

Childhood abuse and neglect are associated with dissociative symptoms in adulthood. However, empirical studies show heterogeneous results depending on the type of childhood abuse or neglect and other maltreatment characteristics. In this meta-analysis, we systematically investigated the relationship between childhood interpersonal maltreatment and dissociation in 65 studies with 7352 abused or neglected individuals using the Dissociative Experience Scale (DES). We extracted DES-scores for abused and non-abused populations as well as information about type of abuse/neglect, age of onset, duration of abuse, and relationship to the perpetrator. Random-effects models were used for data synthesis, and meta-regression was used to predict DES-scores in abused populations from maltreatment characteristics. The results revealed higher dissociation in victims of childhood abuse and neglect compared with non-abused or neglected subsamples sharing relevant population features (MAbuse = 23.5, MNeglect = 18.8, MControl = 13.8) with highest scores for sexual and physical abuse. An earlier age of onset, a longer duration of abuse, and parental abuse significantly predicted higher dissociation scores. This meta-analysis underlines the importance of childhood abuse/neglect in the etiology of dissociation. The identified moderators may inform risk assessment and early intervention to prevent the development of dissociative symptoms.

Keywords

Childhood abusechildhood neglectchildhood traumadissociationmeta-analysis
Type
Review Article
Information
Psychological Medicine , Volume 48 , Issue 15 , November 2018 , pp. 2467 - 2476
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

*

These authors contributed equally to this work

References

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Anda, RF, et al. (2006) The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience 256, 174–186.Google Scholar
Bae, H, Kim, D and Park, YC (2016) Dissociation predicts treatment response in eye-movement desensitization and reprocessing for posttraumatic stress disorder. Journal of Trauma & Dissociation 17, 112–130.Google Scholar
Bal, S, et al. (2004) Differences in trauma symptoms and family functioning in intra-and extrafamilial sexually abused adolescents. Journal of Interpersonal Violence 19, 108–123.Google Scholar
Becker-Blease, KA, et al. (2004) A genetic analysis of individual differences in dissociative behaviors in childhood and adolescence. Journal of Child Psychology and Psychiatry 45, 522–532.Google Scholar
Beitchman, JH, et al. (1992) A review of the long-term effects of child sexual abuse. Child Abuse & Neglect 16, 101–118.Google Scholar
Berkey, CS, et al. (1995) A random-effects regression model for meta-analysis. Statistics in Medicine 14, 395–411.Google Scholar
Bernstein, DP, et al. (2003) Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect 27, 169–190.Google Scholar
Bernstein, EM and Putnam, FW (1986) Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease 174, 727–735.Google Scholar
Borenstein, M, et al. (2009) Independent subgroups within a study. In Borenstein, M, Hedges, LV, Higgins, JPT and Rothstein, HR (eds). Introduction to Meta-Analysis. Chichester, UK: John Wiley & Sons, Ltd, pp. 217–223.Google Scholar
Boysan, M, et al. (2009) Relations among anxiety, depression, and dissociative symptoms: the influence of abuse subtype. Journal of Trauma & Dissociation 10, 83–101.Google Scholar
Butler, LD, et al. (1996) Hypnotizability and traumatic experience. The American Journal of Psychiatry 153, 42–63.Google Scholar
Campbell, LM (1999) Dissociative tendencies and violent behavior in a male forensic psychiatric population. Doctoral Dissertation, Retrieved from ProQuest Dissertation Publishing (UMI Microform 9941933), Ann Arbor, USA.Google Scholar
Cecil, CA, et al. (2017) Disentangling the mental health impact of childhood abuse and neglect. Child Abuse & Neglect 63, 106–119.Google Scholar
Cheung, MWL (2014) Modeling dependent effect sizes with three-level meta-analyses: a structural equation modeling approach. Psychological Methods 19, 211–229.Google Scholar
Clemmons, JC, et al. (2007) Unique and combined contributions of multiple child abuse types and abuse severity to adult trauma symptomatology. Child Maltreatment 12, 172–181.Google Scholar
Cochran, WG (1954) The combination of estimates from different experiments. Biometrics 10, 101–129.Google Scholar
Cohen, J (1992) A power primer. Psychological Bulletin 112, 155–159.Google Scholar
Dalenberg, CJ, et al. (2012) Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological Bulletin 138, 550–588.Google Scholar
Danese, A and Baldwin, JR (2017) Hidden wounds? Inflammatory links between childhood trauma and psychopathology. Annual Review of Psychology 68, 517–544.Google Scholar
Dannlowski, U, et al. (2012) Limbic scars: long-term consequences of childhood maltreatment revealed by functional and structural magnetic resonance imaging. Biological Psychiatry 71, 286–293.Google Scholar
Darves-Bornoz, J-M, Degiovanni, A and Gaillard, P (1999) Validation of a French version of the Dissociative Experiences Scale in a rape-victim population. The Canadian Journal of Psychiatry 44, 271–275.Google Scholar
Davis, JL, Petretic-Jackson, PA and Ting, L (2001) Intimacy dysfunction and trauma symptomatology: long-term correlates of different types of child abuse. Journal of Traumatic Stress 14, 63–79.Google Scholar
DeBellis, MD, et al. (1999) Developmental traumatology part I: biological stress systems. Biological Psychiatry 45, 1259–1270.Google Scholar
Dong, M, et al. (2004) The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect 28, 771–784.Google Scholar
Dorahy, MJ, et al. (2017) Shame, dissociation, and complex PTSD symptoms in traumatized psychiatric and control groups: direct and indirect associations with relationship distress. Journal of Clinical Psychology 73, 439–448.Google Scholar
Draijer, N (1989) Structured Trauma Interview. Amsterdam: Free University.Google Scholar
Draijer, N and Langeland, W (1999) Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients. American Journal of Psychiatry 156, 379–385.Google Scholar
Ducharme, J, Koverola, C and Battle, P (1997) Intimacy development: the influence of abuse and gender. Journal of Interpersonal Violence 12, 590–599.Google Scholar
Ebner-Priemer, UW, et al. (2009) Emotional learning during dissociative states in borderline personality disorder. Journal of Psychiatry & Neuroscience 34, 214–222.Google Scholar
Eisen, ML and Carlson, EB (1998) Individual differences in suggestibility: examining the influence of dissociation, absorption, and a history of childhood abuse. Applied Cognitive Psychology 12, 47–61.Google Scholar
Ellason, JW, et al. (1994) Convergent validity of the new form of the DES. Dissociation: Progress in the Dissociative Disorders 7, 101–103.Google Scholar
Espírito-Santo, H and Abreu, JLP (2009) Portuguese validation of the dissociative experiences scale (DES). Journal of Trauma & Dissociation 10, 69–82.Google Scholar
Fergusson, DM, McLeod, GF and Horwood, LJ (2013) Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand. Child Abuse & Neglect 37, 664–674.Google Scholar
Finkelhor, D, et al. (2015) Prevalence of childhood exposure to violence, crime, and abuse: results from the national survey of children's exposure to violence. JAMA Pediatrics 169, 746–754.Google Scholar
Freyd, JJ (1994) Betrayal trauma: traumatic amnesia as an adaptive response to childhood abuse. Ethics & Behavior 4, 307–329.Google Scholar
Glaser, D (2002) Emotional abuse and neglect (psychological maltreatment): a conceptual framework. Child Abuse & Neglect 26, 697–714.Google Scholar
Green, JG, et al. (2010) Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. Archives of General Psychiatry 67, 113–123.Google Scholar
Gregory-Bills, T and Rhodeback, M (1995) Comparative psychopathology of women who experienced intra-familial versus extra-familial sexual abuse. Child Abuse & Neglect 19, 177–189.Google Scholar
Hall, JM (2003) Dissociative experiences of women child abuse survivors: a selective constructivist review. Trauma, Violence & Abuse 4, 283–308.Google Scholar
Hedges, L and Olkin, I (1985) Statistical Methods for Meta Analysis. Orlando, Florida: Academic Press.Google Scholar
Heim, C, et al. (2000) Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA 284, 592–597.Google Scholar
Higgins, JP and Green, S (2008) Cochrane Handbook for Systematic Reviews of Interventions. Chicester, UK: John Wiley & Sons Ltd.Google Scholar
Higgins, JP and Thompson, SG (2002) Quantifying heterogeneity in a meta-analysis. Statistics in Medicine 21, 1539–1558.Google Scholar
Hillberg, T, Hamilton-Giachritsis, C and Dixon, L (2011) Review of meta-analyses on the association between child sexual abuse and adult mental health difficulties: a systematic approach. Trauma, Violence & Abuse 12, 38–49.Google Scholar
Hulme, PA (2004) Retrospective measurement of childhood sexual abuse: a review of instruments. Child Maltreatment 9, 201–217.Google Scholar
Jang, KL, et al. (1998) Twin study of dissociative experience. Journal of Nervous and Mental Disease 186, 345–351.Google Scholar
Kaplan, ML, et al. (1995) Suicidal behavior and abuse in psychiatric outpatients. Comprehensive Psychiatry 36, 229–235.Google Scholar
Kaplow, JB and Widom, CS (2007) Age of onset of child maltreatment predicts long-term mental health outcomes. Journal of Abnormal Psychology 116, 176–187.Google Scholar
Kirby, JS, Chu, JA and Dill, DL (1993) Correlates of dissociative symptomatology in patients with physical and sexual abuse histories. Comprehensive Psychiatry 34, 258–263.Google Scholar
Kisiel, CL and Lyons, JS (2001) Dissociation as a mediator of psychopathology among sexually abused children and adolescents. American Journal of Psychiatry 158, 1034–1039.Google Scholar
Kleindienst, N, et al. (2011) Dissociation predicts poor response to Dialectial Behavioral Therapy in female patients with Borderline Personality Disorder. Journal of Personality Disorders 25, 432–447.Google Scholar
Kleindienst, N, et al. (2016). State dissociation moderates response to dialectical behavior therapy for posttraumatic stress disorder in women with and without borderline personality disorder. European Journal of Psychotraumatology 7, 1. doi: 10.3402/ejpt.v7.30375.Google Scholar
Krause-Utz, A, et al. (2017) Dissociation and alterations in brain function and structure: implications for borderline personality disorder. Current Psychiatry Reports 19, 6.Google Scholar
Landolt, MA, et al. (2016) The harm of contact and non-contact sexual abuse: health-related quality of life and mental health in a population sample of Swiss adolescents. Psychotherapy and Psychosomatics 85, 320–322.Google Scholar
Lucenko, BA, Gold, SN and Cott, MA (2000) Relationship to perpetrator and posttraumatic symptomatology among sexual abuse survivors. Journal of Family Violence 15, 169–179.Google Scholar
Lyssenko, L, et al. (2017) Dissociation in psychiatric disorders: a meta-analysis of studies using the dissociative experiences scale. American Journal of Psychiatry 175, 37–46.Google Scholar
Maaranen, P, et al. (2005) Factors associated with pathological dissociation in the general population. Australian and New Zealand Journal of Psychiatry 39, 387–394.Google Scholar
MacMillan, HL, et al. (2001) Childhood abuse and lifetime psychopathology in a community sample. American Journal of Psychiatry 158, 1878–1883.Google Scholar
Maniglio, R (2009) The impact of child sexual abuse on health: a systematic review of reviews. Clinical Psychology Review 29, 647–657.Google Scholar
Maughan, B and Rutter, M (1997) Retrospective reporting of childhood adversity: issues in assessing long-term recall. Journal of Personality Disorders 11, 19–33.Google Scholar
McCrory, E, De Brito, SA and Viding, E (2012) The link between child abuse and psychopathology: a review of neurobiological and genetic research. Journal of the Royal Society of Medicine 105, 151–156.Google Scholar
McLaughlin, KA, Sheridan, MA and Lambert, HK (2014) Childhood adversity and neural development: deprivation and threat as distinct dimensions of early experience. Neuroscience & Biobehavioral Reviews 47, 578–591.Google Scholar
Medford, N, et al. (2006) Emotional memory in depersonalization disorder: a functional MRI study. Psychiatry Research: Neuroimaging 148, 93–102.Google Scholar
Merckelbach, H, Muris, P and Rassin, E (1999) Fantasy proneness and cognitive failures as correlates of dissociative experiences. Personality and Individual Differences 26, 961–967.Google Scholar
Michelson, L, et al. (1998) The role of trauma and dissociation in cognitive-behavioral psychotherapy outcome and maintenance for panic disorder with agoraphobia. Behaviour Research and Therapy 36, 1011–1050.Google Scholar
Moher, D, et al. & The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine 151, 264–269.Google Scholar
Molnar, BE, Buka, SL and Kessler, RC (2001) Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American Journal of Public Health 91, 753–760.Google Scholar
Mullen, PE, et al. (1996) The long-term impact of the physical, emotional, and sexual abuse of children: a community study. Child Abuse & Neglect 20, 7–21.Google Scholar
Naughton, AM, et al. (2013) Emotional, behavioral, and developmental features indicative of neglect or emotional abuse in preschool children: a systematic review. JAMA Pediatrics 167, 769–775.Google Scholar
Oberoi, J, Panda, A and Garg, I (2016) Effect of hypnosis during administration of local anesthesia in six-to 16-year-old children. Pediatric Dentistry 38, 112–115.Google Scholar
Pekala, RJ, Angelini, F and Kumar, V (2001) The importance of fantasy-proneness in dissociation: a replication. Contemporary Hypnosis 18, 204–214.Google Scholar
Perry, BD, et al. (1995) Childhood trauma, the neurobiology of adaptation, and “use dependent” development of the brain: how “states” become “traits”. Infant Mental Health Journal 16, 271–291.Google Scholar
Philip, NS, et al. et al. (2016) Exposure to childhood trauma is associated with altered n-back activation and performance in healthy adults: implications for a commonly used working memory task. Brain Imaging and Behavior 10, 124–135.Google Scholar
Pieper, S, et al. (2011) Behavioral and molecular genetics of dissociation: the role of the serotonin transporter gene promoter polymorphism (5-HTTLPR). Journal of Traumatic Stress 24, 373–380.Google Scholar
Pierucci, JM, et al. (2014) Fantasy orientation constructs and related executive function development in preschool: developmental benefits to executive functions by being a fantasy-oriented child. International Journal of Behavioral Development 38, 62–69.Google Scholar
Platt, MG and Freyd, JJ (2015) Betray my trust, shame on me: shame, dissociation, fear, and betrayal trauma. Psychological Trauma: Theory, Research, Practice, and Policy 7, 398–404.Google Scholar
Putnam, FW (1989) Pierre Janet and modern views of dissociation. Journal of Traumatic Stress 2, 413–429.Google Scholar
Putnam, FW (1997) Dissociation in Children and Adolescents: A Developmental Perspective. New York, NY: Guilford Press.Google Scholar
Putnam, FW, Helmers, K and Trickett, PK (1993) Development, reliability, and validity of a child dissociation scale. Child Abuse & Neglect 17, 731–741.Google Scholar
R Development Core Team (2016) R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing.Google Scholar
Repetti, RL, Taylor, SE and Seeman, TE (2002) Risky families: family social environments and the mental and physical health of offspring. Psychological Bulletin 128, 330–366.Google Scholar
Resnick, HS, et al. (1993) Trauma Assessment for Adults. Charleston, SC: Medical University of South Carolina.Google Scholar
Rueda, MR, Posner, MI and Rothbart, MK (2005) The development of executive attention: contributions to the emergence of self-regulation. Developmental Neuropsychology 28, 573–594.Google Scholar
Rufer, M, et al. (2006) Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder. Psychotherapy and Psychosomatics 75, 40–46.Google Scholar
Schauer, M and Elbert, T (2010) Dissociation following traumatic stress. Zeitschrift für Psychologie/Journal of Psychology 218, 109–127.Google Scholar
Shapero, BG, et al. (2014) Stressful life events and depression symptoms: the effect of childhood emotional abuse on stress reactivity. Journal of Clinical Psychology 70, 209–223.Google Scholar
Somer, E, Dolgin, M and Saadon, M (2001) Validation of the Hebrew version of the Dissociative Experiences Scale (H-DES) in Israel. Journal of Trauma & Dissociation 2, 53–65.Google Scholar
Spitzer, C, et al. (2007) Dissociation predicts symptom-related treatment outcome in short-term inpatient psychotherapy. Australian and New Zealand Journal of Psychiatry 41, 682–687.Google Scholar
Spitzer, C, et al. (1998) Adaptation and psychometric properties of the German version of the Dissociative Experience Scale. Journal of Traumatic stress 11, 799–809.Google Scholar
Teicher, MH and Samson, JA (2013) Childhood maltreatment and psychopathology: a case for ecophenotypic variants as clinically and neurobiologically distinct subtypes. American Journal of Psychiatry 170, 1114–1133.Google Scholar
Teicher, MH, et al. (2016) The effects of childhood maltreatment on brain structure, function and connectivity. Nature Reviews Neuroscience 17, 652–666.Google Scholar
Terock, J, et al. (2016) From childhood trauma to adult dissociation: the role of PTSD and alexithymia. Psychopathology 49, 374–382.Google Scholar
Terrin, N, et al. (2003) Adjusting for publication bias in the presence of heterogeneity. Statistics in Medicine 22, 2113–2126.Google Scholar
Turner, HA, Finkelhor, D and Ormrod, R (2010) Poly-victimization in a national sample of children and youth. American Journal of Preventive Medicine 38, 323–330.Google Scholar
Tyler, KA, Cauce, AM and Whitbeck, L (2004) Family risk factors and prevalence of dissociative symptoms among homeless and runaway youth. Child Abuse & Neglect 28, 355–366.Google Scholar
van den Noortgate, W, et al. (2013) Three-level meta-analysis of dependent effect sizes. Behavior Research Methods 45, 576–594.Google Scholar
van Houwelingen, HC, Arends, LR and Stijnen, T (2002) Advanced methods in meta-analysis: multivariate approach and meta-regression. Statistics in Medicine 21, 589–624.Google Scholar
van Ijzendoorn, MH and Schuengel, C (1996) The measurement of dissociation in normal and clinical populations: meta-analytic validation of the Dissociative Experiences Scale (DES). Clinical Psychology Review 16, 365–382.Google Scholar
Ventus, D, Antfolk, J and Salo, B (2017) The associations between abuse characteristics in child sexual abuse: a meta-analysis. Journal of Sexual Aggression 23, 167–180.Google Scholar
Viechtbauer, W (2005) Bias and efficiency of meta-analytic variance estimators in the random-effects model. Journal of Educational and Behavioral Statistics 30, 261–293.Google Scholar
Viechtbauer, W (2010) Conducting meta-analyses in R with the metafor package. Journal of Statistical Software 36, 1–48.Google Scholar
Wolf, EJ, Lunney, CA and Schnurr, PP (2016) The influence of the dissociative subtype of posttraumatic stress disorder on treatment efficacy in female veterans and active duty service members. Journal of Consulting and Clinical Psychology 84, 95–100.Google Scholar
Xiao, Z, et al. (2006) Trauma and dissociation in China. American Journal of Psychiatry 163, 1388–1391.Google Scholar
Yargic, LI, Tutkun, H and Sar, V (1995) Reliability and validity of the Turkish version of the Dissociative Experiences Scale. Dissociation: Progress in the Dissociative Disorders 8, 10–13.Google Scholar
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