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Dissociation mediates the relationship between childhood trauma and hallucination-proneness

  • F. Varese (a1) (a2), E. Barkus (a3) and R. P. Bentall (a1) (a2)



It has been proposed that the relationship between childhood trauma and hallucinations can be explained by dissociative processes. The present study examined whether the effect of childhood trauma on hallucination-proneness is mediated by dissociative tendencies. In addition, the influence of dissociative symptoms on a cognitive process believed to underlie hallucinatory experiences (i.e. reality discrimination; the capacity to discriminate between internal and external cognitive events) was also investigated.


Patients with schizophrenia spectrum disorders (n=45) and healthy controls (with no history of hallucinations; n=20) completed questionnaire measures of hallucination-proneness, dissociative tendencies and childhood trauma, as well as performing an auditory signal detection task.


Compared to both healthy and non-hallucinating clinical controls, hallucinating patients reported both significantly higher dissociative tendencies and childhood sexual abuse. Dissociation positively mediated the effect of childhood trauma on hallucination-proneness. This mediational role was particularly robust for sexual abuse over other types of trauma. Signal detection abnormalities were evident in hallucinating patients and patients with a history of hallucinations, but were not associated with pathological dissociative symptoms.


These results are consistent with dissociative accounts of the trauma-hallucinations link. Dissociation, however, does not affect reality discrimination. Future research should examine whether other cognitive processes associated with both dissociative states and hallucinations (e.g. deficits in cognitive inhibition) may explain the relationship between dissociation and hallucinatory experiences.


Corresponding author

*Address for correspondence: Dr F. Varese, Institute of Psychology, Health and Society – Division of Mental Health and Behavioural Sciences, Waterhouse buildings, Block B (2nd floor), University of Liverpool, Liverpool, L69 3GB, UK. (Email:


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Aleman, A, Larøi, F (2008). Hallucinations: The Science of Idiosyncratic Perception. American Psychological Association: Washington, DC.
Allen, JG, Coyne, L, Console, DA (1997). Dissociative detachment relates to psychotic symptoms and personality decompensation. Comprehensive Psychiatry 38, 327334.
Altman, H, Collins, M, Mundy, P (1997). Subclinical hallucinations and delusions in nonpsychotic adolescents. Journal of Child Psychology and Psychiatry 38, 413420.
Ammons, RB, Ammons, CH (1962). The Quick Test (QT): provisional manual. Psychological Reports 11, 111161.
Andrew, EM, Gray, NS, Snowden, RJ (2008). The relationship between trauma and beliefs about hearing voices: a study of psychiatric and non-psychiatric voice hearers. Psychological Medicine 38, 14091417.
Anketell, C, Dorahy, MJ, Shannon, M, Elder, R, Hamilton, G, Corry, M, MacSherry, A, Curran, D, O'Rawe, B (2010). An exploratory analysis of voice hearing in chronic PTSD: potential associated mechanisms. Journal of Trauma and Dissociation 11, 93–107.
Badcock, JC, Waters, FAV, Maybery, MT, Michie, PT (2005). Auditory hallucinations: failure to inhibit irrelevant memories. Cognitive Neuropsychiatry 10, 125136.
Baker, AJL, Festinger, T (2011). Adult recall of childhood psychological maltreatment: a comparison of five scales. Journal of Aggression, Maltreatment & Trauma 20, 7089.
Barkus, E, Smallman, R, Royle, N, Barkus, C, Lewis, S, Rushe, T (2011). Auditory false perceptions are mediated by psychosis risk factors. Cognitive Neuropsychiatry 16, 289302.
Barkus, E, Stirling, J, Cavill, J (2010). Suggestibility, dissociation and positive schizotypy. Clínica y Salud 21, 38.
Barkus, E, Stirling, J, Hopkins, R, McKie, S, Lewis, S (2007). Cognitive and neural processes in non-clinical auditory hallucinations. British Journal of Psychiatry 191, s76s81.
Bendall, S, Jackson, HJ, Hulbert, CA, McGorry, PD (2008). Childhood trauma and psychotic disorders: a systematic, critical review of the evidence. Schizophrenia Bulletin 34, 568579.
Bentall, RP (1990). The illusion of reality: a review and integration of psychological research on hallucinations. Psychological Bulletin 107, 8295.
Bentall, RP, Fernyhough, C (2008). Social predictors of psychotic experiences: specificity and psychological mechanisms. Schizophrenia Bulletin 34, 10121020.
Bentall, RP, Slade, P (1985 a). Reality testing and auditory hallucinations: a signal detection analysis. British Journal of Clinical Psychology 24, 159169.
Bentall, RP, Slade, P (1985 b). Reliability of a scale measuring disposition towards hallucination: a brief report. Personality and Individual Differences 6, 527529.
Bernstein, EM, Putnam, FW (1986). Development, reliability and validity of a dissociation scale. Journal of Nervous and Mental Disease 174, 727735.
Cardena, E, Spiegel, D (1993). Dissociative reactions to the San Francisco Bay Area earthquake of 1989. American Journal of Psychiatry 150, 474478.
Darves-Bornoz, JM, Lemperiere, T, Degiovanni, A, Gaillard, P (1995). Sexual victimization in women with schizophrenia and bipolar disorder. Social Psychiatry and Psychiatric Epidemiology 30, 7884.
Delespaul, P (1995). Assessing Schizophrenia in Daily Life: The Experience Sampling Method. Universitaire Pers Maastricht: Maastricht, the Netherlands.
Ditman, T, Kuperberg, GR (2005). A source-monitoring account of auditory verbal hallucinations in patients with schizophrenia. Harvard Review of Psychiatry 13, 280299.
Dorahy, MJ, Green, M (2008). Cognitive perspectives on dissociation and psychosis: differences in the processing of threat? In Psychosis, Trauma And Dissociation: Emerging Perspectives on Severe Psychopathology (ed. Moskowitz, A.Schäfer, I and Dorahy, M. J.), pp. 191207. Wiley-Blackwell: Chichester, UK.
Dorahy, MJ, Shannon, C, Seagar, L, Corr, M, Stewart, K, Hanna, D, Mulholland, C, Middleton, W (2009). Auditory hallucinations in dissociative identity disorder and schizophrenia with and without a childhood trauma history. Journal of Nervous and Mental Disease 197, 892898.
Escher, S, Romme, M, Buiks, A, Delespaul, P, van Os, J (2002 a). Formation of delusional ideation in adolescents hearing voices: a prospective study. American Journal of Medical Genetics (Neuropsychiatric Genetics) 114, 913920.
Escher, S, Romme, M, Buiks, A, Delespaul, P, van Os, J (2002 b). Independent course of childhood auditory hallucinations: a sequential 3-year follow up study. British Journal of Psychiatry 181, s10s18.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). Biometrics Research: New York.
Fisher, HL, Craig, TK, Fearon, P, Morgan, K, Dazzan, P, Lappin, J, Hutchinson, G, Doody, GA, Jones, PB, McGuffin, P, Murray, RM, Leff, J, Morgan, C (2011). Reliability and comparability of psychosis patients' retrospective reports of childhood abuse. Schizophrenia Bulletin 37, 546553.
Ford, JM, Mathalon, DH (2005). Corollary discharge dysfunction in schizophrenia: can it explain auditory hallucinations? International Journal of Psychophysiology 58, 179189.
Ford, JM, Mathalon, DH, Whitfield, S, Faustman, WO, Roth, WT (2002). Reduced communication between frontal and temporal lobes during talking in schizophrenia. Biological Psychiatry 51, 485492.
Frith, C (1992). The Cognitive Neuropsychiatry of Schizophrenia. Lawrence Erlbaum: Hove, UK.
Giesbrecht, T, Lynn, SJ, Lilienfeld, SO, Merckelbach, H (2008). Cognitive processes in dissociation: an analysis of the core theoretical assumptions. Psychological Bulletin 134, 617647.
Glicksohn, J, Barrett, TR (2003). Absorption and hallucinatory experience. Applied Cognitive Psychology 17, 833849.
Goff, DC, Brotman, AW, Kindlon, D, Waites, M, Amico, E (1991). Self-report of childhood abuse in chronically psychotic patients. Psychiatry Research 37, 7380.
Goodman, LA, Thompson, KM, Weinfurt, K, Corl, S, Acker, P, Mueser, KT, Rosenberg, SD (1999). Reliability of reports of violent victimization and posttraumatic stress disorder among men and women with serious mental illness. Journal of Traumatic Stress 12, 587599.
Hammersley, P, Dias, A, Todd, G, Bowen-Jones, K, Reilly, B, Bentall, RP (2003). Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation. British Journal of Psychiatry 182, 543547.
Hardy, A, Fowler, D, Freeman, D, Smith, B, Steel, C, Evans, J, Garety, PA, Kuipers, E, Bebbington, PE, Dunn, G (2005). Trauma and hallucinatory experiences in psychosis. Journal of Nervous and Mental Disease 193, 501507.
Holowka, DW, King, S, Saheb, D, Pukall, M, Brunet, A (2003). Childhood abuse and dissociative symptoms in adult schizophrenia. Schizophrenia Research 60, 8790.
Honig, A, Romme, M, Ensink, B, Escher, S, Pennings, M, DeVries, M (1998). Auditory hallucinations: a comparison between patients and nonpatients. Journal of Nervous and Mental Disease 186, 646651.
Imai, K, Keele, L, Tingley, D (2010 a). A general approach to causal mediation analysis. Psychological Methods 15, 309334.
Imai, K, Keele, L, Tingley, D, Yamamoto, T (2010 b). Casual mediation analysis using R. In Advances in Social Science Research Using R (ed. Vinod, H. D.), pp. 129154. Springer: New York.
Joesting, J, Joesting, R (1972). Quick Test validation: scores of adults in a welfare setting. Psychological Reports 30, 537538.
Johns, LC, Nazroo, JY, Bebbington, PE, Kuipers, E (2002). Occurrance of hallucinatory experiences in a community sample and ethnic variations. British Journal of Psychiatry 180, 174178.
Kay, SR, Fiszbein, A, Opler, LA (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 12, 261276.
Kay, SR, Opler, LA, Lindenmayer, JP (1988). Reliability and validity of the positive and negative syndrome scale for schizophrenics. Psychiatry Research 23, 99–110.
Kent, A, Waller, G (1998). The impact of childhood emotional abuse: the extension of the Child Abuse and Trauma Scale. Child Abuse and Neglect 22, 393399.
Kilcommons, AM, Morrison, AP (2005). Relationships between trauma and psychosis: an exploration of cognitive and dissociative factors. Acta Psychiatrica Scandinavica 112, 351359.
Kilcommons, AM, Morrison, AP, Knight, A, Lobban, F (2008). Psychotic experiences in people who have been sexually assaulted. Social Psychiatry and Psychiatric Epidemiology 43, 602611.
Kroll, J, Fiszdon, J, Crosby, RD (1996). Childhood abuse and three measures of altered states of consciousness (dissociation, absorption and mysticism) in a female outpatient sample. Journal of Personality Disorders 10, 345354.
Larøi, F, Woodward, TS (2007). Hallucinations from a cognitive perspective. Harvard Review of Psychiatry 15, 109117.
Lawrence, C, Jones, J, Cooper, M (2010). Hearing voices in a non-psychiatric population. Behavioural and Cognitive Psychotherapy 38, 363373.
Mayer, JL, Farmer, RF (2003). The development and psychometric evaluation of a new measure of dissociative activities. Journal of Personality Assessment 80, 185196.
Merckelbach, H, Muris, P (2001). The causal link between self-reported trauma and dissociation: a critical review. Behaviour Research and Therapy 39, 245254.
Morgan, C, Fisher, H (2007). Environmental factors in schizophrenia: childhood trauma – a critical review. Schizophrenia Bulletin 33, 3–10.
Morgan, CAI, Hazlett, G, Wang, S, Greer Richardson, E, Schnurr, P, Southwick, SM (2001). Symptoms of dissociation in humans experiencing acute, uncontrollable stress: a prospective study. American Journal of Psychiatry 158, 12391247.
Morrison, AP, Petersen, T (2003). Trauma, metacognition and predisposition to hallucinations in non-patients. Behavioural and Cognitive Psychotherapy 31, 235246.
Moskowitz, A, Barker-Collo, S, Ellson, L (2005). Replication of dissociation-psychosis link in New Zealand students and inmates. The Journal of Nervous and Mental Disease 193, 722727.
Moskowitz, A, Corstens, D (2007). Auditory hallucinations: psychotic symptom or dissociative experience. The Journal of Psychological Trauma 6, 3563.
Moskowitz, A, Read, J, Farrelly, S, Rudegeair, T, Williams, O (2009). Are psychotic syptoms traumatic in origin and dissociative in kind? In Dissociation and Dissociative Disorders: DSM-V and Beyond (ed. Dell, P. and O'Neil, J.). Routledge: New York.
Offen, L, Waller, G, Thomas, G (2003). Is reported childhood abuse associated with the psychopathological characteristics of patients who experience auditory hallucinations? Child Abuse and Neglect 27, 919927.
Opler, LA, Kay, SR, Lindenmayer, JP, Fishbein, A (1992). Structured Clinical Interview for the Positive and Negative Symptom Scale. Multi-Health Systems: Toronto.
Perona-Garcelán, SP, Cuevas-Yust, C, García-Montes, JM, Pérez-Alvarez, M, Ductor-Recuerda, MJ, Salas-Azcona, R, Gómez-Gómez, MT, Rodríguez-Martín, B (2008). Relationship between self-focused attention and dissociation in patients with and without auditory hallucinations. Journal of Nervous and Mental Disease 196, 190197.
Perona-Garcelán, SP, García-Montes, JM, Cuevas-Yust, C, Pérez-Álvarez, M, Ductor-Recuerda, MJ, Salas-Azcona, R, Gómez-Gómez, MT (2010). A preliminary exploration of trauma, dissociation and positive psychotic symptoms in a Spanish sample. Journal of Trauma and Dissociation 11, 284292.
Perry, D (2004). The ISSTD DES Taxon calculator. ( Accessed 16 January 2011.
Pope, CA, Kwapil, T (2000). Dissociative experiences in hypothetically psychosis-prone college students. Journal of Nervous and Mental Disease 188, 530536.
Rankin, ME (1999). Construct validation of the Child Abuse and Trauma Scale: comparison to data obtained from a structured interview. Dissertations collection for the University of Connecticut. ( Accessed 15 June 2011.
Rankin, PM, O'Carroll, PJ (1995). Reality discrimination, reality monitoring and disposition towards hallucination. British Journal of Clinical Psychology 34, 517528.
Read, J, Agar, K, Argyle, N, Aderhold, V (2003). Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychology and Psychotherapy: Theory, Research and Practice 76, 122.
Read, J, Argyle, N (1999). Hallucinations, delusions and thought disorder among adult psychiatric inpatients with a history of child abuse. Psychiatric Services 50, 14671472.
Read, J, Fink, PJ, Rudegeair, T, Felitti, VJ, Whitfield, CL (2008). Child maltreatment and psychosis: a return to a genuinely integrated bio-psycho-social model. Clinical Schizophrenia and Related Psychoses 2, 235254.
Read, J, Goodman, L, Morrison, AP, Ross, CA, Aderhold, V (2004). Childhood trauma, loss and stress. In Models of Madness (ed. Read, J.Mosher, LR and Bentall, R. P.), pp. 223252. Routledge: Hove.
Read, J, van Os, J, Morrison, AP, Ross, CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Neuropsychiatrica Scandinavica 112, 330350.
Sanders, B, Becker-Launsen, E (1995). The measurement of psychological maltreatment: early data on the Child Abuse and Trauma Scale. Child Abuse and Neglect 19, 315323.
Schäfer, I, Aderhold, V, Fryberger, HJ, Spitzer, RL (2008). Dissociative symptoms in schizophrenia. In Psychosis, Trauma and Dissociation: Emerging Perspectives on Severe Psychopathology (ed. Moskowitz, A.Schäfer, I and Dorahy, M. J.), pp. 149163. Wiley-Blackwell: Chichester, UK.
Shelvin, M, Dorahy, M, Adamson, G (2007). Childhood traumas and hallucinations: an analysis of the National Comorbidity Survey. Journal of Psychiatric Research 41, 222228.
Startup, M (1999). Schizotypy, dissociative experiences and childhood abuse: relationships among self-reported measures. British Journal of Clinical Psychology 38, 333344.
Steinberg, M (1994). Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). American Psychiatric Press: Washington, DC.
Thompson, A, Nelson, B, McNab, C, Simmons, M, Leicester, S, McGorry, PD, Bechdolf, A, Yung, AR (2010). Psychotic symptoms with sexual content in the ‘ultra high risk’ for psychosis population: frequency and association with sexual trauma. Psychiatry Research 177, 8491.
van Ijzendoorn, MH, Schuengel, C (1996). The measurement of dissociation in normal and clinical populations: meta-analytic validation of the Dissociative Experiences Scale (DES). Clinical Psychology Review 16, 365382.
van Os, J, Kenis, G, Rutten, BPF (2010). The environment and schizophrenia. Nature 468, 203212.
Varese, F, Barkus, E, Bentall, RP (2011 a). Dissociative and metacognitive factors in hallucination-proneness when controlling for comorbid symptoms. Cognitive Neuropsychiatry 16, 193217.
Varese, F, Udachina, A, Myin-Germeys, I, Oorschot, M, Bentall, RP (2011 b). The relationship between dissociation and auditory verbal hallucinations in the flow of daily life of patients with psychosis. Psychosis: Psychological, Social and Integrative Approaches 3, 1428.
Vercammen, A, de Haan, EHF, Aleman, A (2008). Hearing a voice in the noise: auditory hallucinations and speech perception. Psychological Medicine 38, 11771184.
Waller, NG, Putman, FW, Carlson, EB (1996). Types of dissociation and dissociative types: a taxometric analysis of dissociative experiences. Psychological Methods 1, 300321.
Waller, NG, Ross, CA (1997). The prevalence and biometric structure of pathological dissociation in the general population: taxometric and behavior genetic findings. Journal of Abnormal Psychology 106, 499510.
Waters, FAV, Badcock, JC, Maybery, MT, Michie, PT (2003). Inhibition in schizophrenia: association with auditory hallucinations. Schizophrenia Research 62, 275280.
Waters, FAV, Badcock, JC, Michie, PT, Maybery, MT (2006). Auditory hallucinations: intrusive thoughts and forgotten memories. Cognitive Neuropsychiatry 11, 6583.
Whitfield, CL, Dube, SR, Felitti, VJ, Anda, RF (2005). Adverse childhood experiences and hallucinations. Child Abuse and Neglect 29, 797810.
Yoshizumi, T, Murase, S, Honjo, S, Kaneko, H, Murakami, T (2004). Hallucinatory experiences in a community sample of Japanese children. Journal of the American Academy of Child & Adolescent Psychiatry 43, 10301036.


Dissociation mediates the relationship between childhood trauma and hallucination-proneness

  • F. Varese (a1) (a2), E. Barkus (a3) and R. P. Bentall (a1) (a2)


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