Pathological Dissociation in The National Comorbidity Survey Replication (NCS-R): Prevalence, Morbidity, Comorbidity, and Childhood Maltreatment

About 4.1% of U.S. adults meet criteria for pathological dissociation likely indicating a dissociative disorder. People with pathological dissociation have worse physical and mental health, high rates of most major psychiatric disorders, and are often hospitalized for psychiatric reasons. Over half have attempted suicide—significantly more than those with lifetime major depression. Childhood maltreatment—including physical abuse, witnessing domestic violence, physical neglect, emotional abuse, and emotional neglect—each uniquely and additively predicts the severity of pathological dissociation and its three core experiences: amnesia, depersonalization/derealization, and identity alteration. Maltreatment levels in the pathological dissociation group exceed those in major depression and match those in PTSD, underscoring the need for better diagnosis and treatment of these common and debilitating conditions.

Study at a glance

Abstract

ABSTRACT Our aim was to examine U.S. national prevalence of pathological dissociation (PD) likely indicative of dissociative disorder, and associated morbidity, comorbidity, and childhood maltreatment. PD was assessed in 6,644 participants in the National Comorbidity Survey Replication, a nationally representative adult survey. Seven of the eight pathological dissociation taxon items were inquired about over the past month and scored on a 4-point scale. A conservative PD cutoff score was applied, with 100% specificity against healthy individuals and 84% sensitivity for Depersonalization Disorder which lies at the less severe end of the dissociative disorder spectrum; it yielded a national PD prevalence of 4.1%. The PD group had diminished physical and mental health, marked comorbidity with most major psychiatric disorders, and high likelihood of psychiatric hospitalization. Over half of PD members had attempted suicide, significantly more than individuals with lifetime major depression. Childhood maltreatment was quantified for physical abuse, witnessing domestic violence, physical neglect, emotional abuse, and emotional neglect. Total childhood trauma significantly positively predicted PD severity, as well as severity of all three pathological dissociative experiences (amnesia, depersonalization / derealization, identity alteration). Furthermore, each childhood trauma category significantly predicted PD severity uniquely and additively. Childhood maltreatment in the PD group was significantly greater than in lifetime major depression, except for similar emotional neglect, and was comparable to lifetime PTSD. The study reinforces the validity of prior PD findings across clinical and community samples, and highlights the need for increased attention toward diagnosing and treating these quite common and highly morbid disorders and their traumatic antecedents.