Systematic Review: Are Complex Posttraumatic Stress Disorder and Dissociation Associated With Early-Onset Psychosis?

Early-onset psychosis (EOP) is associated with greater functional impairment and poorer outcomes than adult-onset psychosis. Accumulating evidence implicates trauma-related mechanisms, particularly complex posttraumatic stress disorder (cPTSD) and dissociation, in the emergence of psychotic symptoms during adolescence. However, an integrative association with EOP remains unclear. This systematic review examined the relationships between cPTSD, dissociation, and EOP to clarify the nuances of these trauma-related processes and their associations with specific psychotic symptoms.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, database searches were conducted across MEDLINE (PubMed), PsycINFO, and Scopus, yielding 3,636 records. After screening, 21 studies were included. Both cross-sectional and longitudinal studies of children and adolescents were reviewed.

Across 16 studies assessing dissociation, all reported significant positive associations with psychotic experiences (r = 0.34-0.80). Dissociation correlated most strongly with positive psychotic symptoms, but not with negative psychotic symptoms. However, longitudinal findings indicated concurrent rather than predictive associations, although most longitudinal studies did not control for baseline psychosis. Across 9 studies that examined cPTSD symptoms, affect dysregulation and disturbances in relationships symptom clusters were most consistently linked to psychosis. Only 4 studies examined both constructs concurrently, suggesting overlapping but distinct contributions to psychotic vulnerability. Given substantial heterogeneity across studies and overall low quality ratings, findings require nuanced interpretation.

Dissociation and cPTSD symptom clusters, particularly affect dysregulation and interpersonal disturbances, were positively associated with EOP. Methodological heterogeneity and limited longitudinal data underscore the need for unified measurement frameworks to clarify trauma-psychosis mechanisms and to inform early intervention.

Are complex PTSD and dissociation associated with early-onset psychosis? A systematic review; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251053963.