Severe dissociation is trauma-related, but a range of dissociative experiences are also prevalent in clinical populations that are not necessarily trauma-based (e.g., depression, anxiety disorders, and obsessive–compulsive disorders). These remain poorly understood as the dominant etiological model for dissociation relies on trauma. Importantly, dissociation in such samples predicts poor prognosis and high drop-out rates. We set out to better understand the aetiology of dissociative experiences in a mixed clinical (anxiety and depression) and community sample by exploring between- and within-subjects effects of two domains: psychological distress or negative affectivity (operationalized as anxiety and depression symptoms), and poor sleep quality, including disturbed dreaming. The idea that negative affectivity triggers dissociation (Distress Model) is inspired by the trauma model. The idea that poor sleep and unusual dreaming underlie dissociation (Sleep Model) has been suggested as a competing theory. We examined both models by exploring which domains oscillate alongside dissociative experiences. N = 98 adults, half of them diagnosed with depression and anxiety and half community controls, underwent a structured clinical interview and completed questionnaires monthly for 6 months. Support was found for both models in that each domain had a unique explanatory contribution. Distress evinced consistent effects that could not be explained by sleep or dreaming, both between individuals and across time. Oscillations in dissociation across months, when taking psychological distress into account, were better explained by unusual dreaming than traditional sleep quality measures. These findings cannot be generalized to highly-traumatized samples. A complex, integrated etiological model for dissociative experiences is warranted.

中文翻译：

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解离体验之路：不同病因模型的直接比较

严重的分离与创伤有关，但在不一定基于创伤的临床人群中也普遍存在一系列分离体验（例如，抑郁症、焦虑症和强迫症）。这些仍然知之甚少，因为分离的主要病因模型依赖于创伤。重要的是，这些样本中的解离预示着预后不良和高辍学率。我们着手通过探索两个领域的受试者之间和受试者内部的影响来更好地了解混合临床（焦虑和抑郁）和社区样本中分离体验的病因：心理困扰或负面情感（作为焦虑和抑郁症状进行操作），和睡眠质量差，包括做梦不安。负面情感触发分离（遇险模型）的想法受到创伤模型的启发。睡眠不足和不寻常的梦是分离（睡眠模型）的基础的想法被认为是一种竞争理论。我们通过探索哪些域与分离体验一起振荡来检查这两种模型。N  = 98 名成年人，其中一半被诊断出患有抑郁症和焦虑症，一半被诊断为社区控制者，他们接受了结构化的临床访谈并在 6 个月内每月完成问卷调查。两种模型都得到了支持，因为每个领域都有独特的解释性贡献。痛苦表现出持续的影响，无法通过睡眠或做梦来解释，无论是在个人之间还是跨时间。当考虑到心理困扰时，跨月的分离波动可以通过不寻常的梦境来解释，而不是传统的睡眠质量指标。这些发现不能推广到高度创伤的样本。需要一个复杂的、综合的分离体验病因模型。