A new study sheds light on the psychological mechanisms that serve as a pathway between anxious tendencies and dissociative symptoms among adolescents. The findings, published in Psychiatry Research, provide evidence that both cognitive appraisals of dissociation and perseverative thinking play a key role.
Anxiety disorders are common in adolescents, with prevalence rates of 7.9% in the United Kingdom. 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 a “felt sense of anomaly.”
While dissociation has been observed in adolescents with panic disorder, little is known about its relationship with anxiety symptoms more broadly during this developmental stage. Existing evidence-based treatments for adolescent anxiety do not address dissociation symptoms, highlighting the need to identify potential treatment targets.
“We were interested in this topic because anxiety and dissociation are both thought to be common in adolescents and investigation of the link between them hasn’t previously been conducted in this age range. In addition, dissociation refers to a range of experiences, so assessing two subtypes of dissociation allowed us to evaluate how these constructs are presented in youth,” 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, perseverative thinking, and body vigilance. Cognitive appraisals involve negative interpretations of dissociative experiences, while perseverative thinking refers to rumination on negative thoughts. Body vigilance is the conscious attention paid to bodily sensations.
For their new study, the researchers conducted a cross-sectional online survey involving 1,211 adolescents aged 13-18 years from the United Kingdom. The participants completed six self-report questionnaires to measure various psychological constructs, including symptoms of trait anxiety, depersonalization, felt sense of anomaly, cognitive appraisals of dissociation, perseverative thinking, and body vigilance.
The researchers found that trait anxiety was indeed related to depersonalization and the felt sense of anomaly. 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 being strange or unusual.
Next, the researchers explored whether cognitive appraisals of dissociation, perseverative thinking (repetitive thoughts), and body vigilance played a role in mediating the relationship between trait anxiety and these forms of dissociation.
The results showed that each of these factors individually mediated the relationship between trait anxiety and depersonalization or the felt sense of anomaly. When considering all the variables together, the researchers found different models that explained the variance in depersonalization and the felt sense of anomaly.
For depersonalization, the model including trait anxiety, cognitive appraisals of dissociation, and perseverative thinking had the strongest explanatory power. But body vigilance did not significantly contribute to the model when other variables were taken into account.
Similarly, for the felt sense of anomaly, the model including trait anxiety, cognitive appraisals of dissociation, and perseverative thinking was the most influential. Body vigilance lost its significance in predicting the felt sense of anomaly when considering the other variables.
“Anxiety was found to be associated with dissociation in a community sample of adolescents aged 13-18 years. Cognitive appraisals of dissociation (how someone thinks about their dissociative experiences) and perseverative thinking (e.g. worry) mediated the relationship between anxiety and dissociation,” Lofthouse told PsyPost.
“We hypothesised that body vigilance (paying attention to bodily sensations) would also be a mediator of the relationship between anxiety and dissociation, but this was not the case for either subtype of dissociation we explored. This suggests that other factors from the cognitive model of dissociation (e.g. cognitive appraisals of dissociation) may be more important in maintaining dissociative symptoms than body vigilance.”
The study’s strengths include investigating anxiety symptoms and dissociation in adolescents, exploring two different constructs of dissociation, and recruiting a large and representative sample from the community. However, there are limitations in terms of generalizability to clinical populations, the use of self-selection in recruitment, and the cross-sectional design preventing causal conclusions.
“As this study was cross-sectional, further research using a longitudinal design is required to assess the directionality of the relationships between anxiety, dissociation, and the mediating factors,” Lofthouse explained. “In addition, the sample was recruited from the community so future research could involve a sample of clinically anxious participants.”
The study, “Developing an understanding of the relationship between anxiety and dissociation in adolescence,” was authored by Katie Lofthouse, Polly Waite, and Emma Cernis.