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

Figures & data

Table 1. Sample characteristics (N = 468).

Variables	Mean	SD	Frequency (%)
Age (range = 18 to 65)	25.6	8.56
Gender (Female)			91.0%
Marital status (married)			18.4%
Education level (Bachelor’s degree or above)			42.5%
Being unemployed			41.0%
Financially dependent on partners, friends, family or other people			52.1%
Financially dependent on social welfare			14.5%
Ever seen a psychiatrist			Used to = 36.1%; Current = 23.1%
Ever been hospitalized for mental health issues			21.4%
Types of childhood trauma (BBTS)	3.05	2.28
Types of adulthood trauma (BBTS)	2.73	2.25
Depressive symptoms (PHQ-9)	17.68	6.25	87.6% PHQ-9 ≥ 10
Re-experiencing (ITQ)	4.07	2.45	75.2%^a
Avoidance (ITQ)	5.11	2.40	85.3%^a
Sense of current threat (ITQ)	4.99	2.59	82.3%^a
Affective dysregulation (ITQ)	5.68	1.80	94.7%^a
Negative self-concept (ITQ)	5.64	2.42	87.4%^a
Disturbances in relationships (ITQ)	5.90	2.05	92.7%^a
Disengagement (MDI)	15.55	5.12	64.7%^b
Depersonalization (MDI)	12.27	5.80	66.9%^b
Derealization (MDI)	12.68	5.57	52.4%^b
Emotional Constriction (MDI)	13.98	6.33	54.9%^b
Memory Disturbance (MDI)	11.61	5.24	51.3%^b
Identity Dissociation (MDI)	7.22	4.07	15.0%^b
Somatoform dissociative symptoms (SDQ-5)	6.63	2.32	25.4%^c
Positive Symptoms of Psychotic Disorders (CAPE-P total score)	1.75	0.53	64.1%^d
Delusional ideations (CAPE-P)	2.08	0.64
Bizarre experiences (CAPE-P)	1.60	0.63
Perceptual anomalies (CAPE-P)	1.24	0.50
Negative Symptoms of Psychotic Disorders (CAPE-N)	2.59	0.64

Remarks.

^aEndorsement of a complex PTSD symptom cluster was defined as a score of 2 (Moderately) or above on the ITQ.

^bEndorsement of a psychoform dissociative symptom cluster was defined according to the MDI Manual (Briere, 2002). The raw cutoff score for each of the six subscales was ≥ 14, ≥9, ≥12, ≥13, ≥11, and ≥ 10, respectively.

^cThe cutoff score for the SDQ-5 was ≥ 8 (Nijenhuis, 2010).

^dThe cutoff score for CAPE-P total score was ≥ 1.47 (Bukenaite et al., 2017).

Table 2. Summary of the centrality measures.

	Strength (Centrality)	Closeness	Betweenness
Depression (PHQ)	0.96	0.004	22
Re-experiencing (ITQ)	0.80	0.004	10
Avoidance (ITQ)	0.80	0.004	6
Sense of current threat (ITQ)	0.76	0.004	20
Affective dysregulation (ITQ)	0.90	0.004	16
Negative self-concept (ITQ)	0.77	0.004	0
Disturbances in relationships (ITQ)	0.85	0.004	8
Disengagement (MDI)	1.00	0.005	28
Depersonalization (MDI)	1.23	0.005	40
Derealization (MDI)	1.12	0.005	36
Emotional Constriction (MDI)	0.92	0.005	36
Memory Disturbance (MDI)	1.14	0.005	34
Identity Dissociation (MDI)	0.72	0.004	24
Somatoform dissociative symptoms (SDQ-5)	0.55	0.003	0
Negative Symptoms of Psychotic Disorders(CAPE-N)	0.97	0.005	40
Delusional ideations (CAPE-P)	0.90	0.004	30
Bizarre experiences (CAPE-P)	0.95	0.004	6
Perceptual anomalies (CAPE-P)	0.76	0.004	2

Table 3. Edge weight matrix.

	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18
(1) Depression (PHQ)	1.00	0.02	0.01	0.02	0.13	0.40	0.03	0.16	0.00	0.00	0.01	0.04	0.00	0.00	0.15	0.00	0.00	0.00
(2) Re-experiencing (ITQ)	0.02	1.00	0.29	0.27	0.02	0.00	0.00	0.00	0.03	0.00	0.00	0.09	0.00	0.00	0.00	0.02	0.00	0.06
(3) Avoidance (ITQ)	0.01	0.29	1.00	0.19	0.09	0.04	0.07	0.00	0.05	0.00	0.04	0.00	0.00	0.01	0.00	0.00	0.00	0.00
(4) Sense of current threat (ITQ)	0.02	0.27	0.19	1.00	0.08	0.00	0.00	0.00	0.00	0.10	0.00	0.01	0.00	0.00	0.00	0.09	0.00	0.00
(5) Affective dysregulation (ITQ)	0.13	0.02	0.09	0.08	1.00	0.15	0.19	0.08	0.02	0.00	0.12	0.00	0.00	0.00	0.02	0.00	0.00	0.00
(6) Negative self-concept (ITQ)	0.40	0.00	0.04	0.00	0.15	1.00	0.11	0.00	0.02	0.00	0.00	0.00	0.00	0.00	0.06	0.00	0.00	0.00
(7) Disturbances in relationships (ITQ)	0.03	0.00	0.07	0.00	0.19	0.11	1.00	0.05	0.02	0.00	0.08	0.00	0.00	0.01	0.21	0.00	−0.03	−0.03
(8) Disengagement (MDI)	0.16	0.00	0.00	0.00	0.08	0.00	0.05	1.00	0.19	0.14	0.00	0.32	0.00	0.00	0.06	0.00	0.00	0.00
(9) Depersonalization (MDI)	0.00	0.03	0.05	0.00	0.02	0.02	0.02	0.19	1.00	0.52	0.14	0.02	0.16	0.03	0.00	0.00	0.03	0.00
(10) Derealization (MDI)	0.00	0.00	0.00	0.10	0.00	0.00	0.00	0.14	0.52	1.00	0.06	0.12	0.00	0.12	0.01	0.00	0.01	0.03
(11) Emotional Constriction (MDI)	0.01	0.00	0.04	0.00	0.12	0.00	0.08	0.00	0.14	0.06	1.00	0.17	0.00	0.03	0.24	0.00	0.00	0.02
(12) Memory Disturbance (MDI)	0.04	0.09	0.00	0.01	0.00	0.00	0.00	0.32	0.02	0.12	0.17	1.00	0.12	0.05	0.01	0.09	0.05	0.04
(13) Identity Dissociation (MDI)	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.16	0.00	0.00	0.12	1.00	0.06	0.00	0.00	0.17	0.21
(14) Somatoform dissociative symptoms (SDQ-5)	0.00	0.00	0.01	0.00	0.00	0.00	0.01	0.00	0.03	0.12	0.03	0.05	0.06	1.00	0.04	0.06	0.05	0.09
(15) Negative Symptoms of Psychotic disorders(CAPE-N)	0.15	0.00	0.00	0.00	0.02	0.06	0.21	0.06	0.00	0.01	0.24	0.01	0.00	0.04	1.00	0.11	0.06	0.00
(16) Delusional ideations (CAPE-P)	0.00	0.02	0.00	0.09	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.09	0.00	0.06	0.11	1.00	0.40	0.13
(17) Bizarre experiences (CAPE-P)	0.00	0.00	0.00	0.00	0.00	0.00	−0.03	0.00	0.03	0.01	0.00	0.05	0.17	0.05	0.06	0.40	1.00	0.16
(18) Perceptual anomalies (CAPE-P)	0.00	0.06	0.00	0.00	0.00	0.00	−0.03	0.00	0.00	0.03	0.02	0.04	0.21	0.09	0.00	0.13	0.16	1.00

Table 4. Direct, indirect effects, and total effects of the network paths.

	Direct Effect	Indirect Effect	Total Effect
Derealization → Delusional Ideations	0.49**	/	0.49**
Derealization → Delusional Ideations → Somatoform Dissociation → Memory Disturbance → Depression	/	0.08**	0.08**
Somatoform Dissociation → Memory Disturbance	0. 71**	/	0. 71**
Sense Of Current Threat → Negative Symptoms of Psychotic disorders	0. 75**	/	0. 75**
Sense Of Current Threat → Negative Symptoms of Psychotic disorders → Disturbance In Relationships → Derealization → Delusional Ideations	/	0.04**	0.04**
Depression → Disengagement → Identity Dissociation → Negative Self-Concept →Negative Symptoms of Psychotic disorders	/	0.03**	0.03**
Depression → Disengagement → Identity Dissociation → Negative Self-Concept → Negative Symptoms of Psychotic disorders → Bizarre Experience	/	0.02**	0.02**
Re-Experiencing → Affective Dysregulation → Negative Symptoms of Psychotic disorders	/	0.33**	0.33**
Re-Experiencing → Affective Dysregulation →Negative Symptoms of Psychotic disorders → Bizarre Experience	/	0.15**	0.15**
Re-Experiencing → Emotional Constriction → Delusional Ideations	/	0.19**	0.19**
Perceptual Anomalies → Re-Experiencing	0.68**	/	0.68**

**p < .001.

Table 5. Multiple Mediation Analysis Path (direct, indirect and total effect) (top 3 mediators).

Paths	Direct Effect	Indirect Effect	Total Effect
Childhood Trauma → Negative Symptoms of Psychotic Disorders	−0.01	0.06*	0.3
Through Emotional Constriction		0.104*
Through Negative Self-Concept		0.055*
Through Disturbance In Relationships		0.044*
Childhood Trauma → Delusional Ideations	0.16*	0.06*	0.21*
Through Memory Disturbance		0.086*
Through Sense Of Current Threat		0.052*
Through Identity Dissociation		0.049*
Childhood Trauma → Bizarre Experience	0.06	0.24	0.3
Through Identity Dissociation		0.101*
Through Memory Disturbance		0.076*
Through Somatoform Dissociation		0.035*
Childhood Trauma → Perceptual Anomalies	0.11*	0.21*	0.32*
Through Identity Dissociation		0.122*
Through Somatoform Dissociation		0.122*
Through Derealization		0.051*
Adulthood Trauma → negative symptoms of psychotic disorders	0.21	0.16*	0.21
Through Emotional Constriction		0.065*
Through Disturbance In Relationships		0.032*
Through Re-Experiencing		−0.03*
Adulthood Trauma → Delusional Ideations	0.12*	0.19*	0.31*
Through Memory Disturbance		0.07*
Through Sense Of Current Threat		0.051*
Through Identity Dissociation		0.04*
Adulthood Trauma → Perceptual Anomalies	0.06	0.19*	0.25
Through Identity Dissociation		0.113*
Through Somatoform Dissociation		0.036*
Through Derealization		0.034*
Adulthood Trauma → Bizarre Experience	0.02	0.21*	0.23
Through Identity Dissociation		0.09*
Through Memory Disturbance		0.062*
Through Derealization		0.016*

*p < .05.

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Data availability statement

Data that support the findings of this study are available from the corresponding authors upon reasonable request.