Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Oct 19, 2019; 9(6): 83-98
Published online Oct 19, 2019. doi: 10.5498/wjp.v9.i6.83
Dissociation and disasters: A systematic review
Fatih Canan, Carol S North
Fatih Canan, Carol S North, The Altshuler Center for Education & Research at Metrocare Services, Dallas, TX 75390, United States
Fatih Canan, Carol S North, Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
Author contributions: Canan F and North CS were responsible for the study conception and design and writing of the manuscript.
Conflict-of-interest statement: The authors report having no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Fatih Canan, MD, Postdoctoral Fellow, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Suite NE5.102, Dallas, TX 75390, United States.
Telephone: +1-214-6485378 Fax: +1-214-6485599
Received: April 9, 2019
Peer-review started: April 12, 2019
First decision: June 6, 2019
Revised: July 3, 2019
Accepted: August 21, 2019
Article in press: August 21, 2019
Published online: October 19, 2019

Dissociation, which is defined as the failure to associate consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior into an integrated whole, has long been assumed to be generated by trauma. If dissociation is a product of trauma exposure, then dissociation would be a major mental health outcome observed in studies of disaster survivors. Although some studies have examined dissociation in disasters, no systematic literature reviews have been conducted to date on the topic.


To systematically evaluate the literature on the association between disaster and dissociation to determine the prevalence and incidence of dissociation after exposure to disaster and further examine their relationship.


EMBASE, Medline, and PsychINFO were searched from inception to January 1, 2019 to identify studies examining dissociative disorders or symptoms related to a disaster in adult or child disaster survivors and disaster responders. Studies of military conflicts and war, articles not in English, and those with samples of 30 or more participants were excluded. Search terms used were “disaster*” and dissociation (“dissociat*,” “multiple personality,” “fugue,” “psychogenic amnesia,” “derealization,” and “depersonalization”). Reference lists of identified articles were scrutinized to identify studies for additional articles.


The final number of articles in the review was 53, including 36 articles with samples of adults aged 18 and above, 5 of children/adolescents under age 18, and 12 of disaster workers. Included articles studied several types of disasters that occurred between 1989 and 2017, more than one-third (38%) from the United States. Only two studies had a primary aim to investigate dissociation in relation to disaster and none reported data on dissociative disorders. All of the studies used self-report symptom scales; none used structured interviews providing full diagnostic assessment of dissociative disorders or other psychopathology. Several studies mixed exposed and unexposed samples or did not differentiate outcomes between exposure groups. Studies examining associations between dissociation and disaster exposure have been inconclusive. The majority (75%) of the studies compared dissociation with posttraumatic stress, with inconsistent findings. Dissociation was found to be associated with a wide range of other psychiatric disorders, symptoms, and negative emotional, cognitive, and functional states.


The studies reviewed had serious methodological limitations including problems with measurement of psychopathology, sampling, and generation of unwarranted conclusions, precluding conclusions that dissociation is an established outcome of disaster.

Keywords: Dissociation, Dissociative disorders, Disaster, Systematic review, Methodology, Diagnostic validity, Psychopathology, Normative response, Posttraumatic stress, Association vs causation

Core tip: Almost all existing studies of dissociation in relation to disaster have not focused specifically on this purpose but rather on the relationship of dissociation to other disaster outcomes. Instead of dissociative disorders, broadly defined dissociative phenomena have been examined in disaster survivors. The literature uniformly contains unsurmountable methodological limitations such as reliance on nondiagnostic dissociation measures, lack of temporal specificity to postdisaster time frames, and problems with disaster exposure issues pertaining to sampling, measurement, and analysis. It cannot be concluded from the research that dissociation is an established outcome of disasters.