Psychological processes mediating the association between developmental trauma and specific psychotic symptoms in adults: a systematic review and meta‐analysis

Experiencing psychological trauma during childhood and/or adolescence is associated with an increased risk of psychosis in adulthood. However, we lack a clear knowledge of how developmental trauma induces vulnerability to psychotic symptoms. Understanding the psychological processes involved in this association is crucial to the development of preventive interventions and improved treatments. We sought to systematically review the literature and combine findings using meta‐analytic techniques to establish the potential roles of psychological processes in the associations between developmental trauma and specific psychotic experiences (i.e., hallucinations, delusions and paranoia). Twenty‐two studies met our inclusion criteria. We found mediating roles of dissociation, emotional dysregulation and post‐traumatic stress disorder (PTSD) symptoms (avoidance, numbing and hyperarousal) between developmental trauma and hallucinations. There was also evidence of a mediating role of negative schemata, i.e. mental constructs of meanings, between developmental trauma and delusions as well as paranoia. Many studies to date have been of poor quality, and the field is limited by mostly cross‐sectional research. Our findings suggest that there may be distinct psy­chological pathways from developmental trauma to psychotic phenomena in adulthood. Clinicians should carefully ask people with psychosis about their history of developmental trauma, and screen patients with such a history for dissociation, emotional dysregulation and PTSD symptoms. Well conducted research with prospective designs, including neurocognitive assessment, is required in order to fully understand the biopsychosocial mechanisms underlying the association between developmental trauma and psychosis.     

Paranoia in dreams and the classification of typical dreams.

The present study was geared toward expanding the previous evidence for the thematic similarities between dreaming and psychosis. Themes derived from delusions that characterize psychotic and schizophrenia-spectrum disorders, together with the modified Typical Dream Questionnaire, were administered to 280 Chinese participants from Hong Kong. These delusional themes served as some continuous variables for evaluating the degree to which the narrative contents of dreaming can be compared with those of psychotic and schizophrenia-spectrum disorders. It was found that delusions of various types, with various levels of bizarreness, could be observed in dreams. This was particularly true for themes involving paranoid suspiciousness, such as blaming others for making troubles and feeling that others are not giving proper credit for one’s achievements, which were dreamed by a majority of the participants. The current findings generated by the exploratory factor analyses precisely replicated Yu’s (2009) previous delusional model that classified dream themes into the Ego Ideal, Grandiosity, and Persecution categories. Moreover, the present study expanded the Ego Ideal category, developed measures for assessing the delusional inclination during dreaming, and discussed the reciprocal, triadic dynamics between the three major categories of dream themes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Other faces in the mirror: a perspective on schizophrenia

A patient with schizophrenia may generate an action (whether manual or verbal), but not attribute the generation of that action to himself. We distinguish self-monitoring and attribution of agency, relating only the former to forward models and the mirror system. We suggest that alien hand experiences occur when an action progresses through hand control pathways with no record of disinhibition having been kept and is then seen but dismissed as external. Analogously, auditory pathways are active during verbal hallucinations and produce a subvocal verbal process, but since no record is kept of the words being created, they are treated as external. The subject then proceeds to confabulate, to provide an account for the agency.     

Recurrence of typical dreams and the instinctual and delusional predispositions of dreams.

The present study investigated the recurrence of typical dreams and refined Yu's measures for assessing the delusional inclination during dreaming. The Dream Themes Inventory, which consists of typical, delusional, appetitive-instinctual dream themes, was administered to 608 participants. The results indicate that some dream motifs are not only shared by a majority of people but also regularly recur within a person. Moreover, this study demonstrates that virtually all types of delusions and paranoid suspiciousness—including grandiose, persecutory, religious, somatic, jealous, and erotomanic delusions—can be observed in dreams. In addition to fine-tuning Yu's previous Ego Ideal, Grandiosity, and Persecution scales, Erotomania, Appetite-instinct, and Sensorimotor Excitement scales were developed to supplement the assessment of the intrinsic predispositions that modulate dream content. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delusions and the factor structure of typical dreams.

The present study was geared toward generating a parsimonious factor model of typical dreams. Moreover, the hypothesis that themes typically manifest in psychotic delusions also prevail in normal people's dreams was examined. The modified Typical Dreams Questionnaire was administered to a sample of 348 university students from Hong Kong. The factor solutions generated by the current analyses indicate that typical dreams can be classified into three primary categories or six subcategories according to the two-tier model. Consistent with the homology between dreaming and psychosis, the first two categories of the upper tier are, in essence, characterized by the two classic psychotic themes—the grandiose and persecutory delusions. The third category of dream themes consists in the distinctive affective experience that can be, one way or another, attributed to the function of the ego ideal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pain in the mind: Neuroticism, defense mechanisms, and dreaming as indicators of hysterical conversion and dissociation.

This study examined the extent to which the intrinsic predispositions that modulate dream content serve as indicators of the hysterical tendency to conversion and dissociation. The Dream Themes Inventory, Dream Intensity Scale, Limbic System Checklist-33, Dissociative Experiences Scale, Eysenck Personality Questionnaire Revised-Short Form, Boundary Questionnaire-18, and scales for evaluating defense mechanisms were administered to 585 Chinese participants. The findings indicate that the intensity of dream experiences and the narrative content of dreams are useful for identifying individuals with clinically significant hysterical symptoms. Hysterical dissociation is better predicted by the Ego Ideal, Appetite-Instinctual, and Sexual scales of the Dream Themes Inventory, whereas hysterical conversion is better indicated by the Persecution scale. This finding is discussed in relation to the neuropsychological mechanisms of dreaming and delusions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)