School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
Acta Psychiatr Scand. 2018 Dec;138(6):509-525. doi: 10.1111/acps.12969. Epub 2018 Oct 18.
Several studies have observed that dissociative experiences are frequently reported by individuals with severe mental illness (SMI), especially amongst patients that report a history of adverse/traumatic life experiences. This review examined the magnitude and consistency of the relationship between childhood adversity (sexual abuse, physical abuse, emotional abuse, neglect, bullying, natural disasters and mass violence) and dissociation across three SMI diagnostic groups: schizophrenia, bipolar disorder and personality disorders.
A database search (EMBASE, PubMed and PsycINFO) identified 30 eligible empirical studies, comprising of 2199 clinical participants. Effect sizes representing the relationship between exposure to childhood adversity and dissociation were examined and integrated using a random-effects meta-analysis.
The results indicated that exposure to childhood trauma was associated with heightened dissociation across SMIs. Positive significant associations were also found between specific childhood adversities and dissociation, with aggregated effect sizes in the small-to-moderate range.
These findings support calls for the routine assessment of traumatic experiences in clients with SMIs presenting with dissociative symptoms and the provision of adequate therapeutic support (e.g. trauma-focused therapies) to manage and resolve these difficulties.
多项研究发现，严重精神疾病（SMI）患者经常报告分离体验，尤其是那些报告有不良/创伤性生活经历的患者。本综述考察了童年逆境（性虐待、身体虐待、情感虐待、忽视、欺凌、自然灾害和大规模暴力）与精神分裂症、双相情感障碍和人格障碍这三种 SMI 诊断组之间分离的关系的强度和一致性。
数据库检索（EMBASE、PubMed 和 PsycINFO）确定了 30 项符合条件的实证研究，包含 2199 名临床参与者。使用随机效应荟萃分析检查和综合了代表童年逆境暴露与分离之间关系的效应量。
结果表明，童年创伤暴露与 SMI 中的分离程度升高有关。还发现特定的童年逆境与分离之间存在正相关关系，聚合的效应量处于小到中等范围。
这些发现支持了在出现分离症状的 SMI 患者中常规评估创伤经历，并提供足够的治疗支持（例如，以创伤为中心的治疗）以管理和解决这些困难的呼吁。
