Dissociation in a Developmental Psychopathology Framework: Predictors and Outcomes Among a Clinical Sample of Trauma-Impacted Adolescents

Objective: A confirmatory factor analysis (CFA) of the Adolescent Dissociative Experiences Scale (A-DES) that found a best-fitting three-factor model for a trauma-exposed sample was recently replicated; however, a post hoc bifactor CFA model fit the data better and identified a strong general factor. Only the general factor was associated with cumulative trauma exposure, but this association was small. Method: Structural equation modeling (SEM) and regression analyses were applied to the best-fitting three-factor bifactor model of dissociation found in the same sample of 1,157 treatment-seeking adolescents, most with high levels of trauma exposure, to further elucidate dissociation's construct validity and dimensionality. Results: The general factor was positively yet differentially associated with psychosocial outcomes. A dissociation by age interaction emerged for internalizing problems, demonstrating that the positive association was stronger for older participants. Also, an age of trauma exposure onset by dissociation interaction emerged predicting depression, such that later trauma onset produced a stronger association between dissociation and depression. Conclusions: Traumas occurring in later adolescence may confer greater risk of dissociation. Differential psychosocial outcomes also reinforce why approaching dissociation from a developmental psychopathology lens is important, enhancing the model's generalizability. Clinical Impact Statement This study examined predictors and outcomes of dissociation to better understand its etiology and impact as a function of development in adolescents with trauma. Although recent research supports a unidimensional conceptualization of dissociation, divergent psychosocial outcomes and age-related differences in dissociation were demonstrated in this study. This suggests that further context is needed in dissociation's conceptualization, including its developmental function for the trauma-impacted.