Prospective investigation of positive psychotic symptoms, dissociative symptoms, and metacognitive dysfunctions in a non-clinical population

Abstract

The frequent co-occurrence of positive psychotic and dissociative symptoms in both clinical and non-clinical populations underscores the importance of understanding their interplay for early intervention. However, their longitudinal dynamics and shared risk factors in non-clinical individuals are poorly understood. This prospective study investigated the reciprocal relationship between positive psychotic and dissociative symptoms and the role of metacognitive dysfunction in 2,360 adults without psychiatric diagnoses (age 18-65). Participants completed online questionnaires at baseline and at six months, reporting levels of positive psychotic and dissociative symptoms, maladaptive metacognitive beliefs and metacognitive functioning. Longitudinal structural equation modelling, controlling for autoregressive effects, assessed the variables' cross-lagged associations. Results showed that baseline positive psychotic symptoms predicted dissociative symptoms at six months, and vice versa. Maladaptive metacognitive beliefs (lower cognitive self-consciousness) and poorer metacognitive functioning (self-reflectivity) at baseline predicted increased dissociative symptoms, but not positive psychotic symptoms, at six months. Higher baseline dissociative symptoms reciprocally predicted poorer metacognitive functioning at six months. Our findings support the mutual influence between positive psychotic and dissociative symptoms, and the specific association of metacognitive factors with dissociative symptoms, independent of co-occurring positive psychotic symptoms. Future research should extend these findings with longer follow-up periods and in clinically diverse groups.

Keywords: Cross-lagged panel model; Dissociation; Metacognition; Psychosis; Psychotic experiences; Structural equation modelling.

Fig. 1

Consort diagram of the sampling procedure.

Fig. 2

Final structural equation model of positive psychotic and dissociative symptoms across time points. The diagram represents model A3 (see Table 2). Values given represent standardised coefficients. T1  baseline; T2  6 months. PSY Positive psychotic symptoms; PI Persecutory ideation; BE Bizarre experiences; PA Perceptual abnormalities; DISS Dissociative symptoms; Unreal Unreality; Numb Numbness/disconnectedness; Mem Memory blanks; Vivid Vivid internal world. Only significant paths are shown (ps < 0.050).

Fig. 3

Final structural equation model of positive psychotic symptoms, dissociative symptoms, and maladaptive metacognitive beliefs across time points. The diagram represents model B4 (see Table 2). Values given represent standardised coefficients. Autoregressive paths of other dimensions of the Metacognition Questionnaires-Short Form (positive beliefs about worry, uncontrollability and danger of thoughts, need to control thoughts, cognitive confidence) that did not have cross-lagged associations with symptoms are not shown in this figure for cleaner presentation. T1  baseline, T2  6 months.  PSY Positive psychotic symptoms; PI Persecutory ideation; BE Bizarre experiences; PA Perceptual abnormalities; DISS Dissociative symptoms; Unreal Unreality; Numb Numbness/disconnectedness; Mem Memory blanks; Vivid Vivid internal world; CSC Cognitive self-consciousness. Only significant paths are presented (ps < 0.050).

Fig. 4

Final structural equation model of positive psychotic symptoms, dissociative symptoms, and metacognitive functioning across time points. The diagram represents model C5 (see Table 2). Values given represent standardised coefficients. Covariance paths among latent variables are not shown in this figure for cleaner presentation. T1  baseline, T2  6 months. PSY Positive psychotic symptoms; PI Persecutory ideation; BE Bizarre experiences; PA Perceptual abnormalities; DISS Dissociative symptoms; Unreal Unreality; Numb Numbness/disconnectedness; Mem Memory blanks; Vivid Vivid internal world; SELF Self-reflectivity; CrDis Critical distance; UOM Understanding other’s mind; MAST Mastery. Only significant paths are presented (ps < 0.050).