Anna Dunalska, Andrzej Jakubczyk, Agata Szulc, Natalia Szejko
Dissociative symptoms are increasingly recognized beyond trauma-related and dissociative disorders, yet their role in depressive and anxiety disorders remains understudied, particularly in routine clinical settings. This cross-sectional study examined the prevalence and clinical correlates of dissociative symptoms in 133 adult outpatients with depressive and/or anxiety disorders prior to pharmacological treatment. Dissociation was assessed using the Dissociative Experiences Scale-Revised (DES-R) and the Somatoform Dissociation Questionnaire-20 (SDQ-20), distinguishing between psychoform and somatoform dissociation subtypes. Clinically significant dissociation was observed in 12 % of participants (DES-R) and 18.8 % (SDQ-20). Preoccupation and imaginal involvement were the most common psychoform symptoms, whereas somatoform symptoms were widespread, with no significant difference between the positive and negative subtypes. Somatoform dissociation showed a moderate correlation with anxiety, especially somatic anxiety, whereas psychoform dissociation was only weakly associated with anxiety severity. Interaction and mediation analyses revealed distinct pathways: psychoform dissociation was independently associated with both depression and anxiety, and the nonlinear interaction suggested a saturation effect at high levels of depression. In contrast, somatoform dissociation was indirectly associated with depression via anxiety, suggesting a mediating role. These findings support the disconnection and compartmentalization theory and indicate that dissociative symptoms, even in the absence of trauma, can complicate the clinical presentation of depressive and anxiety disorders. Given that more than 10 % of participants met criteria for both severe depressive and anxiety symptoms and pathological dissociation, routine screening for dissociation seems warranted in psychiatric assessment and treatment planning.