Assessing dissociation: A systematic review and evaluation of existing measures
Sorawit Wainipitapong, L. S. Merritt Millman, Xi Huang, Lillian Wieder, Devin B. Terhune, Susannah Pick
Abstract
This review aimed to assess the psychometric properties and methodological quality of existing dissociation measures. MEDLINE, Embase, and PsycINFO were searched in May 2023 using comprehensive search terms for ‘dissociation’ combined with terms for ‘measurement’ and ‘psychometric properties’. The review was registered with PROSPERO (CRD42023423485) and followed PRISMA and COSMIN guidelines. We assessed content validity, structural validity, cross-cultural validity, and different indices of reliability comprising 1) reliability (test-retest, inter-rater, intra-rater), 2) internal consistency, and 3) measurement error. Of 7570 studies, 170 were eligible, revealing 44 measures of dissociation (86% trait dissociation, 14% state dissociation) and their 14 adapted versions. None of the measures met all COSMIN criteria for good psychometric properties and high methodological quality. Overall, methodological quality was rated as follows: ‘doubtful’ for content validity, ‘adequate’ for measurement error and cross-cultural validity, and ‘very good’ for structural validity and internal consistency. Most included studies did not assess the reliability of investigated measures. The Dissociative Experiences Scale (DES), adolescent DES, Peritraumatic Dissociative Experiences Questionnaire, Somatoform Dissociation Questionnaire-20, and Cambridge Depersonalisation Scale demonstrated strong evidence for measuring general, child/adolescent, trauma-related (state) or somatoform dissociation, and depersonalisation, respectively. Future research should refine or develop dissociation measures following COSMIN guidelines to ensure robust methodology and psychometric properties. • We reviewed the properties and quality of existing dissociation measures. • 44 measures and 14 adapted versions were found, most assessing trait dissociation. • Only one measure for adolescent dissociation (A-DES) met all COSMIN psychometric and quality criteria. • The Dissociative Experiences Scale is the strongest measure of trait dissociation. • Further validation and development of dissociation measures is warranted.