Dissociation, Childhood Trauma, and Emotion Processing in Individuals with Elevated Psychosis-like Experiences: A Theoretical Framework of Cognitive Integration

Abstract

Highlights What are the main findings? Individuals who may be at elevated risk for psychosis spectrum illnesses demonstrate greater childhood trauma and dissociation, poorer social cognition, and lower psychosocial functioning than healthy controls. Dissociation moderates the relationship between psychometrically defined elevated psychosis-like symptoms and emotion processing, suggesting that disrupted cognitive integration amplifies social cognitive impairment. What are the implications of the main findings? Disrupted cognitive integration represents a clinically meaningful vulnerability factor linking trauma-related processes with emotion processing deficits in individuals with distressing psychosis-like experiences. Trauma-informed interventions targeting emotion processing and social cognition may improve functional outcomes and strengthen early intervention strategies for individuals who may be at elevated risk for psychosis. Abstract Background: Childhood trauma and dissociation have each been associated with psychosis-spectrum symptoms, yet their combined relationships with social cognition and psychosocial functioning remain poorly understood. Guided by a theoretical framework of cognitive integration, the present study examined whether trauma and dissociation are associated with psychosis-like symptom severity, social cognition, and psychosocial functioning, and whether dissociation moderates the relationship between psychosis-like symptoms and emotion processing. Methods: A community sample of 128 adults (65 individuals with psychometrically defined elevated psychosis-like experiences; 63 healthy comparison participants) completed measures of childhood trauma, dissociation, psychosis-like experiences, social cognition (emotion processing and theory of mind), and psychosocial functioning. The study employed two complementary analytic approaches: (1) categorical group comparisons to characterize clinically meaningful group differences, and (2) dimensional analyses across the full analytic sample examining associations between trauma, dissociation, and social cognition with psychosis-like symptoms and functioning, including a moderation analysis evaluating whether dissociation altered the relationship between psychosis-like symptoms and emotion processing. Results: Compared with healthy comparison participants, individuals with elevated psychosis-like experiences reported significantly greater childhood trauma and dissociation, poorer emotion processing and theory of mind, and lower psychosocial functioning. Across the full analytic sample, childhood trauma and dissociation were independently associated with greater psychosis-like symptom severity and poorer psychosocial functioning. Dissociation, but not childhood trauma, was associated with poorer emotion processing. Moderation analyses further demonstrated that dissociation strengthened the relationship between psychosis-like symptom severity and emotion processing, such that greater symptom severity was associated with poorer emotion processing only at higher levels of dissociation. This moderation effect was specific to emotion processing and was not observed for theory of mind after correction for multiple comparisons. Conclusions: These findings suggest that dissociative experiences represent an important factor associated with poorer emotion processing and psychosocial functioning among individuals reporting elevated psychosis-like experiences. Dissociation is interpreted within a theoretical framework in which disruptions in cognitive integration may contribute to social cognitive impairment. The findings support trauma-informed assessment and intervention strategies targeting emotion processing and dissociation as potential avenues for improving functional outcomes in individuals with elevated psychosis-like experiences.