New research sheds light on the psychological mechanisms linking anxiety and dissociation in adolescence

A new study sheds light on the psychological mechanisms that serve as a pathway between anxious tendencies and dissociative symptoms among adolescents. The results, published in Research in psychiatryprovide evidence that both cognitive assessments of dissociation and persevering thinking play key roles.

Anxiety disorders are common in adolescents, with prevalence rates of 7.9% in the UK. Previous research has shown a link between anxiety symptoms and dissociative experiences in adults. Dissociation refers to a range of symptoms involving disconnection or detachment, such as feelings of unreality (derealization) or disconnection from one’s body (depersonalization). Recent studies have identified a subset of dissociative experiences characterized by a subjective feeling of strangeness or unfamiliarity, known as the “felt sense of anomaly”.

While dissociation has been observed in adolescents with panic disorder, little is known about its relationship to anxiety symptoms more generally during this developmental stage. Existing evidence-based treatments for adolescent anxiety do not address dissociation symptoms, highlighting the need to identify potential therapeutic targets.

“We were interested in this topic because anxiety and dissociation are both thought to be common in adolescents and investigation into the link between them has not previously been conducted in this age group. Furthermore, dissociation refers to a range of experiences, so assessing two subtypes of dissociation allowed us to assess how these constructs are presented in young people,” explained study author Katie Lofthouse of the University of East Anglia .

In adults, three factors have been implicated in the relationship between anxiety and dissociation: cognitive appraisals, persevering thinking, and bodily vigilance. Cognitive appraisals involve negative interpretations of dissociative experiences, while perseverative thinking refers to rumination on negative thoughts. Body alertness is conscious attention paid to bodily sensations.

For their new study, the researchers conducted an online cross-sectional survey involving 1,211 adolescents aged 13-18 from the UK. Participants completed six self-report questionnaires to measure various psychological constructs, including symptoms of trait anxiety, depersonalization, feeling abnormal, cognitive ratings of dissociation, persevering thinking, and bodily alertness.

The researchers found that trait anxiety was indeed related to depersonalization and feelings of abnormality. This means that individuals with higher levels of anxious tendencies were more likely to experience a sense of detachment from themselves (depersonalization) and a subjective feeling of something strange or unusual.

Next, the researchers explored whether cognitive assessments of dissociation, persevering thinking (repetitive thoughts), and bodily alertness played a role in mediating the relationship between trait anxiety and these forms of dissociation.

Results showed that each of these factors individually mediated the relationship between trait anxiety and depersonalization or the felt sense of abnormality. Considering all variables together, the researchers found several patterns that explained the variance in depersonalization and the felt sense of abnormality.

For depersonalization, the model that included trait anxiety, cognitive appraisals of dissociation, and persevering thinking had the strongest explanatory power. But body alertness did not contribute significantly to the model when other variables were taken into account.

Similarly, for the abnormality felt sense, the model that included trait anxiety, cognitive appraisals of dissociation, and persevering thinking was the most influential. Body alertness lost its significance in predicting felt sense of abnormality when other variables are considered.

“Anxiety was associated with dissociation in a community sample of 13- to 18-year-old adolescents. Cognitive assessments of dissociation (how someone thinks about their dissociative experiences) and persevering thinking (such as worry) mediated the relationship between anxiety and dissociation,” Lofthouse told PsyPost.

“We hypothesized that bodily alertness (paying attention to bodily sensations) would also mediate the relationship between anxiety and dissociation, but this was not the case for either of the two subtypes of dissociation we explored. This suggests that other factors of the cognitive model of dissociation (e.g. cognitive assessments of dissociation) may be more important in maintaining dissociative symptoms than body alertness.

The strengths of the study include studying anxiety and dissociation symptoms in adolescents, exploring two different constructs of dissociation, and recruiting a large and representative community sample. However, there are limitations in terms of generalizability to clinical populations, the use of self-selection in recruitment, and the cross-sectional design that prevents causal conclusions.

“Because this study was cross-sectional, more research using a longitudinal design is needed to assess the directionality of relationships between anxiety, dissociation, and mediating factors,” Lofthouse explained. “Furthermore, the sample was recruited from the community so that future research may involve a sample of clinically anxious participants.”

The study, “Developing an understanding of the relationship between anxiety and dissociation in adolescence,” was written by Katie Lofthouse, Polly Waite, and Emma Cernis.

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