Relationship between dissociative symptoms with insight in patients with schizophrenia

Objective: Dissociation is frequently associated with psychiatric illness, with a prevalence of up to25% among patients with a psychiatric disorder and a prevalence of up to 60% in cases of schizophrenia. There is a growing awareness of the relationship between psychotic symptoms and dissociation. Studies have found associations between severity of psychotic symptoms and dissociation. Dissociation is often related to psychological stress. These findings call into question the hypothesized direct effects of psychotic symptoms on dissociation. We hypothesized that psychotic symptoms (e.g., hallucination) would cause psychological stress on patients with schizophrenia. We also hypothesized that if patients with schizophrenia show good insight, the psychological stress on schizophrenic patients caused by the psychotic symptoms would be reduced. Reduced psychological stress also decreases the level of dissociation. The aim of this study was to investigate the relationship between psychotic symptoms, dissociation and insight in patients with schizophrenia.

Methods: Forty-six patients with a schizophrenia diagnosis according to DSM-IV TR criteria were recruited into the study. Each subject completed a semi-structured face-to-face interview that included the Scale for Assessment of Positive Symptoms (SAPS), the Scale for Assessment of Negative Symptoms (SANS), Clinical Global İmpressions Severity Scale (CGI-S), and Brown Assessment of Beliefs Scale (BABS). Patients with posttraumatic stress disorder were excluded.

Results: Dissociation was associated with more severe symptoms of schizophrenia. Significant correlation was found between SDQ scores and CGI-S scores (r= 0.37, p0.05). There was a significantly positive correlation between BABS and SANS scores (r=0.56, p0.05).

Conclusion: In the present study, those with more severe schizophrenic symptoms were also characterized by high dissociation. We also indicated that dissociation is associated with positive schizophrenic features. These findings are similar to previously published studies. The previous studies used the Dissociative Experience Scale (DES) which is an instrument unsuitable for dissociative disorders in patients with schizophrenia. In addition, the previous studies have not examined the somatoform manifestation of dissociative processes. In the present study we use the Somatoform Dissociation Questionnaire (SDQ) which includes appropriate measures to cover also somatoform type of dissociative symptoms. Results of the present study are in agreement with previous studies which used DES as an instrument for measuring dissociative symptoms.