Abstract
Catastrophic cognitive appraisals, similar to those in anxiety disorders, are implicated in depersonalisation, a form of dissociation. No scales exist to measure appraisals of dissociative experiences. Dissociation is common in psychosis. Misinterpretations of dissociative experiences may maintain psychotic symptoms. Therefore, assessing appraisals in this context may be valuable. The primary aim was to develop a measure of key appraisals of dissociation in psychosis. Secondary aims were to test the relationship between appraisals and psychotic experiences (paranoia and hallucinations), and determine whether appraisals explain additional variance in psychotic symptoms above dissociative symptoms. Fifty items were generated from transcripts of interviews with patients. The measure was developed and psychometrically validated via factor analysis of data from 9902 general population participants and 1026 patients with psychosis. Convergent validity, test-re-test reliability, and internal reliability were assessed. Regression analyses tested relationships with psychotic symptoms. A 13-item single-factor measure was developed. Factor analysis indicated good model fit [χ2(65) = 247.173, comparative fit index (CFI) = 0.960, root mean square error of approximation (RMSEA) = 0.052]. The scale had good convergent validity with a rumination (non-clinical: r = 0.71; clinical: r = 0.73) and dissociation measure (r = 0.81; r = 0.80), high internal consistency (α = 0.93; α = 0.93), and excellent 1-week test-re-test reliability [intraclass correlation (ICC) = 0.90]. It explained variance in psychotic symptoms (paranoia: 36.4%; hallucinations: 35.0%), including additional variance compared with dissociation alone (paranoia: 5.3%; hallucinations: 2.3%). The Cognitive Appraisals of Dissociation in Psychosis (CAD-P) measure is a psychometrically robust scale identifying appraisals of dissociative experiences in psychosis and is associated with the presence of psychotic experiences. It is likely to prove useful for clinical assessment and research.
Highlights
Dissociation is characterised by experiences of disconnection or alteration, such as feeling detached from one’s own thoughts and emotions, finding one’s own reflection unfamiliar, or seeing the world as ‘flat’ or unreal (Kennedy et al, 2013)
Dissociative experiences are being recognised as important transdiagnostic phenomena, occurring in diagnoses other than post-traumatic stress disorder (PTSD) (Lyssenko et al, 2018), and as important clinical phenomena in their own right
The depersonalisation disorder (DPD) group were found to endorse catastrophic appraisals about mental illness or brain dysfunction in a manner similar to an anxiety disorder comparison group. Both these findings support the hypothesis that anxiety-like cognitive appraisals may be important in this form of dissociation: they do not identify cognitive appraisals that are specific to dissociative experiences
Summary
Dissociation is characterised by experiences of disconnection or alteration, such as feeling detached from one’s own thoughts and emotions, finding one’s own reflection unfamiliar, or seeing the world as ‘flat’ or unreal (Kennedy et al, 2013). The scale had good convergent validity with a rumination (non-clinical: r = 0.71; clinical: r = 0.73) and dissociation measure (r = 0.81; r = 0.80), high internal consistency (α = 0.93; α = 0.93), and excellent 1-week test–re-test reliability [intraclass correlation (ICC) = 0.90]. It explained variance in psychotic symptoms (paranoia: 36.4%; hallucinations: 35.0%), including additional variance compared with dissociation alone (paranoia: 5.3%; hallucinations: 2.3%). It is likely to prove useful for clinical assessment and research
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