The link between childhood trauma and dissociation in frequent users of classic psychedelics and dissociatives, Sascha B. Thal et al., 2019

The link between childhood trauma and dissociation in frequent users of classic psychedelics and dissociatives

Sascha B. Thal, Judith K. Daniels & Henrik Jungaberle

Journal of Substance Use, may 2019



Background : Childhood trauma severity is associated with the level of subsequent substance use as well as with the self-reported severity of dissociation. Classic psychedelics and dissociatives target neurotransmitter systems thought to be involved in the onset of dissociative symptoms and may evoke severe and long-lasting symptoms of depersonalization in some users. However, it is currently unclear whether drug use puts people with a history of childhood trauma at higher risk of developing dissociative symptoms.

Objectives : The current study investigates whether the one-year prevalence of substance use significantly moderates the link between childhood trauma and the severity of depersonalization.

Methods : Participants (n = 297, of which 80.2% were active users) filled out an online self-report questionnaire including the Childhood Trauma Questionnaire (CTQ), the Cambridge Depersonalisation Scale (CDS), and information about their substance use.

Results : Results indicate that childhood trauma and substance use are significant individual predictors of dissociation scores in this sample, but no moderation of substance use on the link between childhood
trauma and depersonalization was established.

Conclusions : It is hypothesized that the quality (particularly the context) of the experience of substance use rather than the sheer quantity may be responsible for the manifestation of depersonalization.

KEYWORDS : Childhood trauma; substance use; dissociation; depersonalization; classic psychedelics; dissociatives


It is well established that the severity of childhood trauma is associated both with levels of substance use and the severity of dissociation (Diseth, 2005; Najavits & Walsh, 2012; Najavits, Weiss, & Shaw, 1997). Three times higher rates of substance abuse in subjects with vs. without a history of childhood trauma have been reported in the general population (Kilpatrick, Saunders, & Smith, 2003), and the severity of childhood trauma is closely linked to the level of substance abuse (Khoury, Tang, Bradley, Cubells, & Ressler, 2010; Scheidell et al., 2018). In addition, subjects with childhood trauma were 1.5 times more likely to report illicit substance use within the past year (Widom, Marmorstein, & White, 2006). However, whether the level of substance use can partly explain the relationship between trauma severity and the severity of subsequent dissociation is currently unknown.

Link between childhood trauma, dissociation, and substance use

Dissociation is defined as a disruption of the normal integration of a person’s conscious and psychological functions and as such can potentially disrupt every area of mental functioning (DSM-5). Most experiences of dissociation entail symptoms of depersonalization, which refers to self-related alterations including emotion processing, perception, and body experience. Dissociation in the form of depersonalization correlates significantly with the levels of reported childhood trauma (Michal et al., 2007; Simeon, Guralnik, Schmeidler, Sirof, & Knutelska, 2001). However, the causal relationships underlying this association have been widely debated (see Dalenberg et al., 2012; Lynn et al., 2014). Some authors have suggested that additional moderators might have to be taken into account, suggesting a multifactorial model of dissociation (Lynn et al., 2014).

The link between childhood trauma, substance use, and dissociative experiences as well as high prevalence rates of comorbid substance use disorders in patients suffering from dissociative disorders (e.g., Dunn, Ryan, Paolo, & Van Fleet, 1995; Karadag et al., 2005) are well-established (Najavits & Walsh, 2012; Schäfer et al., 2010; Van Den Bosch, Verheul, Langeland, & Van Den Brink, 2003). While several psychoactive substances are known to have dissociative properties, others (like benzodiazepines or atypical antipsychotics) might specifically attract users suffering from dissociative experiences due to their anti-dissociative properties. Neurotransmitter systems that are thought to play a role in depersonalization include N-methyl-D-aspartate (NMDA), opium, and serotonin receptors (Simeon, 2004).