Childhood experiences and dissociation among high school students in China: Theoretical reexamination and clinical implications

• Published in: International journal of social psychiatry Vol. 69; no. 8; pp. 1949 - 1957
• Main Authors: Fung, Hong Wang, Geng, Fulei, Yuan, Danyan, Zhan, Nalan, Lee, Vincent Wan Ping
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-12-2023; Sage Publications Ltd
• Subjects: Adverse childhood experiences; Anxiety; Childhood experiences; Dissociation; Dissociative disorders; Mental depression; Mental disorders; Mental health; Psychopathology; Secondary school students; Secondary schools; Symptoms; Trauma; childhood trauma; dissociative disorders; cross-cultural psychiatry; Dissociation; mental health
• ISSN: 0020-7640; 1741-2854
• DOI: 10.1177/00207640231181528

Background:
Dissociation remains a controversial topic in terms of its prevalence, cross-cultural validity, and relationship with childhood trauma and adversities.
Aims:
This study investigated the prevalence of dissociative symptoms and probable dissociative disorders among Chinese high school students and tested the trauma model of dissociation.
Methods:
A total of N = 1,720 high school students completed standardized measures of positive and adverse childhood experiences (PCEs and ACEs), dissociation, depression, and anxiety.
Results:
The prevalence rates of dissociative symptoms and (probable) DSM-5 dissociative disorders (DDs) were 11.2% and 6.9%, respectively. Dissociation was a reliable construct (ICC = .682 to .752, p < .001) and was moderately correlated with general psychopathology (r = .424 with depressive symptoms, r = .423 with anxiety symptoms). Participants with a probable DD reported more ACEs, fewer PCEs, and more mental health symptoms than those without a probable DD. ACEs were significantly associated with dissociative symptoms (β = .107, p < .001) even after controlling for age, depressive, and anxiety symptoms. PCEs moderated the relationship between ACEs and dissociative symptoms.
Conclusions:
This is the first report of the prevalence of dissociative symptoms and probable DSM-5 DDs among nonclinical children. We provide cross-cultural evidence that dissociation is a reliable and valid clinical phenomenon associated with psychopathology in children across cultures. The findings partly support the trauma model of dissociation. This study contributes to the limited literature on dissociation in children. It also offers empirical data to facilitate the ongoing controversy about (childhood) trauma and dissociation. Our findings imply that dissociation is cross-culturally associated with childhood adversities, but trauma is not the only, sufficient cause. Theoretical and clinical implications are discussed.