The dissociative architecture of delusions: Investigating the relationship between trauma, dissociation and delusions in first episode psychosis

Objectives Dissociation is a well‐established mediator of the relationship between trauma and psychosis. Despite identified phenomenological similarities, there is limited research regarding the nature of the relationship between dissociation and delusions. The study aimed to identify dissociative experiences within delusions and examine whether these are associated with childhood trauma and its psychological sequelae. Methods Sixty‐four young people were recruited from an early psychosis service and completed a cross‐sectional assessment of childhood trauma, psychosis, PTSD and dissociation. A coding frame was developed to identify dissociative detachment and compartmentalisation within descriptions of delusions. Group comparisons were conducted to examine differences in the severity and frequency of trauma, PTSD, dissociation and psychosis between those with and without dissociative delusions. Results Thirty‐four participants (59%) had at least one delusion that clearly included dissociative content. Compartmentalisation was identified in the descriptions of delusions for 25 participants (43%), and detachment was identified in the descriptions of delusions for 12 participants (21%). Three participants (5%) described a delusion that contained both compartmentalisation and detachment. All participants described at least one delusion without compartmentalisation or detachment. Those with dissociative delusions had a significantly higher frequency of PTSD diagnoses ( χ 2 (1) = 5.32, p = .02, ϕ c = 0.31). Conclusion Dissociative experiences are prevalent amongst those with early psychosis and can be reliably identified in the descriptions of delusions. It is likely that dissociation is phenomenologically important for the experience of some delusions.