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
Research background

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.

Research motivation

Although some studies have investigated dissociation in disaster survivors, no prior reviews have been published specifically on dissociation associated with disasters.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.