The relationship between dissociative and psychotic symptoms: A network analytic study with three undergraduate samples from non-Western settings
E. Lo, A. K. C. Chau, A. E. Z. Lian, M. E. S. Reyes, G. Derin, A. D. Akiş, S. K. K. Lam, H. W. Fung
European Psychiatry June 1, 2026 DOI: 10.1192/j.eurpsy.2026.11093 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cross-sectional network study Peer reviewed |
|---|---|
| Sample size | 609 |
| Population | Undergraduate students in the Philippines, Malaysia, and Turkey |
| Measures | Community Assessment of Psychic Experiences (CAPE-15), Multidimensional Dissociation Inventory (MDI) |
| Key findings | Across three independent non-Western undergraduate samples, the network structure of psychotic and dissociative symptoms was statistically indistinguishable, and the edge between identity dissociation and perceptual abnormalities was consistently the strongest (rs = 0.09–0.27). The authors argue this pattern suggests a close developmental and maintenance relationship between these two symptoms. |
Abstract
Introduction: Robust evidence supports the co-occurrence of dissociation and psychosis and their subclinical manifestations in both clinical and non-clinical populations. However, it remains unclear whether specific dissociative symptoms are uniquely associated with individual psychotic symptoms, particularly within the positive dimension. The network theory of psychopathology offers a useful theoretical framework for understanding the co-occurrence of these phenomena, proposing that psychiatric symptoms interact with and reinforce one another as a dynamic network. Network modeling facilitates the investigation of the complex and interactive relationships between psychotic and dissociative symptoms, and these findings warrant replication across independent samples, particularly in non-Western contexts.
Objectives: We compared the psychopathological network of dissociative and psychotic symptoms across three independent samples of undergraduates recruited in the Philippines, Malaysia and Turkey.
Methods: Undergraduate students from the Philippines (N = 219), Malaysia (N = 240), and Turkey (N = 150) completed the 15-item Community Assessment of Psychic Experiences (CAPE-15) and the Multidimensional Dissociation Inventory (MDI) as measures of psychotic (i.e., persecutory ideation, bizarre experiences, perceptual abnormalities) and dissociative (i.e., disengagement, depersonalization, derealization, emotional constriction, memory disturbance, and identity dissociation) symptoms, respectively. Gaussian graphical models were estimated separately for each sample, with psychotic and dissociative symptoms as nodes. Edges in the models represented unique associations between nodes. Network comparison tests were conducted to examine the invariance of network structure across the different samples.
Results: The networks of psychotic and dissociative symptoms of each sample are shown in Figure 1. There were no differences in network structure across samples after correction for multiple comparisons. The edge weights between facets of psychotic and dissociative symptoms did not differ significantly across samples. Among these edges, the connection between identity dissociation and perceptual abnormalities was consistently identified as the strongest across samples (rs = 0.09–0.27). Image 1: Image 1: Long description.
Conclusions: The network models revealed interactive relationships between specific psychotic and dissociative symptoms that are consistent across the three non-Western samples. The three samples provide corroborative evidence for a unique association between identity dissociation and perceptual abnormalities, suggesting a close relationship in their development and maintenance. Disclosure of Interest None Declared