Dissociation as a marker of emotion dysregulation: An examination in adolescent psychiatric inpatients using ecological momentary assessment.

BACKGROUND: Dissociation is a transdiagnostic symptom and hypothesized to serve as a short-term regulatory mechanism in response to emotional stress. The present study examined the momentary dynamics between dissociation, negative affect, and cortisol in the day-to-day lives of adolescent psychiatric inpatients. METHODS: Forty-eight adolescents (mean age: 15.85 years, SD: 1.15, 81% female) were recruited from psychiatric inpatient units. Following a diagnostic baseline assessment, participants completed twelve signal-contingent ecological momentary assessments per day over five consecutive days, each separated by one hour, reporting on dissociation and negative affect. Salivary cortisol was sampled concurrently. Data were analysed using Residual Dynamic Structural Equation Modelling. RESULTS: No significant cross-lagged effects between dissociation and negative affect emerged. However, a significant contemporaneous association indicated that these variables co-occurred (st.est. = 0.236, 95%-CI: 0.191-0.280). Neither emotion regulation difficulties, borderline personality disorder nor childhood trauma assessed at baseline significantly moderated the cross-lagged or contemporaneous effects. A small cross-lagged effect of the cortisol × dissociation interaction on negative affect emerged (st.est. = -0.056, 95%CI: -0.081 to -0.028), indicating that higher levels of dissociation in combination with elevated cortisol levels predicted lower subsequent negative affect. DISCUSSION: These findings provide partial support for theoretical conceptualization of dissociation as a marker for emotion dysregulation and underscore the need for studies employing combined psychological and biological assessments with higher sample frequencies than a one-hour interval to more precisely capture the short-lived temporal dynamics among dissociation, affect, and endocrine stress responses.