Published online Oct 19, 2019. doi: 10.5498/wjp.v9.i6.83
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
Trauma has long been assumed to be causally associated with the development of dissociation. If trauma causes dissociation, then dissociation would be expected to emerge in disaster-exposed populations.
Although some studies have investigated dissociation in disaster survivors, no prior reviews have been published specifically on dissociation associated with disasters.
This review aimed to systematically evaluate existing studies on dissociation in disaster-exposed populations and to examine the relationship between dissociation and exposure to disaster.
A systematic search was performed using Embase, Medline, and PsychINFO databases to identify studies reporting on dissociative disorders or symptoms after disasters in adult or child disaster survivors and rescue/recovery workers. The search used the following key terms: “disaster*,” “dissociat*,” “multiple personality,” “fugue,” “psychogenic amnesia,” “derealization,” and “depersonalization”. Only studies in English and those with a sample size of 30 or more were considered. Studies of military conflicts and war were excluded.
The final review contained 53 articles, more than two-thirds (68%) reporting dissociation in adults, about one-tenth (9%) in children or adolescents, and about one-fourth (23%) in rescue/recovery workers, involving many different types of disasters. None of the included studies assessed or provided data on dissociative disorders; all used self-report symptom scales. Only two studies focused primarily on dissociation as a disaster outcome. Many of the samples had no disaster trauma exposures or only some members with exposures, and some studies did not differentiate exposure to disaster trauma from other disaster-related stressors. Most of the disaster studies compared dissociation with posttraumatic stress and did not find consistent associations between these two entities. A wide range of other psychiatric disorders, symptoms, and negative emotional, cognitive, and functional states were found to be associated with dissociation in disaster-exposed populations.
The existing body of research on dissociation as an outcome of disaster is fraught with serious methodological limitations in sampling, assessment of dissociation and other psychopathology, and unwarranted causal assumptions. The magnitude of these limitations precludes definitive conclusions regarding whether dissociation is an established outcome of disaster.
Methodologically rigorous research that provide systematic diagnostic assessment of dissociative disorders such as structured interviews is needed to determine the prevalence of dissociative phenomena after disasters and their relationship to trauma exposure. Further nosological research is needed to adequately differentiate between benign/normative and pathological dissociative responses to disaster trauma exposure. Also, important methodological limitations identified in the studies reviewed should be addressed in future research on the relationship of dissociation and disasters.