Dissociation and disasters: A systematic review

Abstract

BACKGROUNDDissociation, which is defined as the failure to associate consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior into an integrated whole, has long been assumed to be generated by trauma. If dissociation is a product of trauma exposure, then dissociation would be a major mental health outcome observed in studies of disaster survivors. Although some studies have examined dissociation in disasters, no systematic literature reviews have been conducted to date on the topic.AIMTo systematically evaluate the literature on the association between disaster and dissociation to determine the prevalence and incidence of dissociation after exposure to disaster and further examine their relationship.METHODSEMBASE, Medline, and PsychINFO were searched from inception to January 1, 2019 to identify studies examining dissociative disorders or symptoms related to a disaster in adult or child disaster survivors and disaster responders. Studies of military conflicts and war, articles not in English, and those with samples of 30 or more participants were excluded. Search terms used were “disaster*” and dissociation (“dissociat*,” “multiple personality,” “fugue,” “psychogenic amnesia,” “derealization,” and “depersonalization”). Reference lists of identified articles were scrutinized to identify studies for additional articles.RESULTSThe final number of articles in the review was 53, including 36 articles with samples of adults aged 18 and above, 5 of children/adolescents under age 18, and 12 of disaster workers. Included articles studied several types of disasters that occurred between 1989 and 2017, more than one-third (38%) from the United States. Only two studies had a primary aim to investigate dissociation in relation to disaster and none reported data on dissociative disorders. All of the studies used self-report symptom scales; none used structured interviews providing full diagnostic assessment of dissociative disorders or other psychopathology. Several studies mixed exposed and unexposed samples or did not differentiate outcomes between exposure groups. Studies examining associations between dissociation and disaster exposure have been inconclusive. The majority (75%) of the studies compared dissociation with posttraumatic stress, with inconsistent findings. Dissociation was found to be associated with a wide range of other psychiatric disorders, symptoms, and negative emotional, cognitive, and functional states.CONCLUSIONThe studies reviewed had serious methodological limitations including problems with measurement of psychopathology, sampling, and generation of unwarranted conclusions, precluding conclusions that dissociation is an established outcome of disaster.

Deprem travmasının erken dönem psikolojik etkileri ve olası risk faktörleri

“…Literatürde deprem ya da başka doğal afetler sonrası yaşanan dissosiyasyon ile ilgili çalışmalar yapılmıştır [25][26][27][28] . Haiti 2010 yılı yaşanan deprem sonrası hayatta kalan kişiler ile yapılan bir çalışmada katılımcılara PTSB semptom kontrol listesi ve peritravmatik disosiyasyon ölçeği uygulanmıştır.…”

The Emergence of Dissociative Experiences as a Function of Perceived Stress Among University Students During the COVID-19 Lockdown

“…dictatorships) stress. This is especially noticeable when circumstances and the future are unpredictable, unforeseeable, in which case people are even more precarious in a state of loss of control [15]. For example, Brooks et al [16] found that an o cially ordered quarantine or lockdown may be a measure that signi cantly increases an individual's level of perceived stress, which may affect the experienced dissociative symptoms.…”

Maternal Mental Health after a Wildfire: Effects of Social Support in the Fort McMurray Wood Buffalo Study

“…21,22 Subjective disaster-related stress can be assessed by measuring peritraumatic distress and peritraumatic dissociative experiences. [23][24][25] These responses at the time of the event are often measured retrospectively. 25,26 Peritraumatic dissociation is considered a mechanism intended to cope with severe trauma, shielding the individual from overwhelming emotions during and/or after the traumatic event through derealization and altered awareness.…”

“…27 Both peritraumatic distress and dissociation were found to be robust contributing factors toward the development of post-traumatic stress disorder (PTSD)-like symptoms and depression, two psychopathologies with extensive overlap in symptomatology, risk factors, and comorbidities. 23,25,28 Psychological resilience is thought to be a major moderator of the relationship between the experience of trauma and the development of post-traumatic psychopathology. 29,30 In this context, resilience is thought of as a dynamic process, the capacity to bounce back, cope with, and recover from adverse events.…”

“… 27 Both peritraumatic distress and dissociation were found to be robust contributing factors toward the development of post-traumatic stress disorder (PTSD)-like symptoms and depression, two psychopathologies with extensive overlap in symptomatology, risk factors, and comorbidities. 23 , 25 , 28 …”