I don’t feel like myself: mapping dissociative symptoms across depression severity in a clinical population

Abstract This study examined the relationship between depression and dissociation by assessing how specific dissociative symptoms vary with depression severity in a large Australian clinical sample. A total of 5,384 adults receiving mental health care completed the Depression Anxiety Stress Scales-21 (DASS-21) and the Multidimensional Inventory of Dissociation-60 (MID-60). Analyses included Welch’s one-way ANOVA to assess the effect of depression severity on dissociation, as well as correlation and odds ratio analyses to explore associations between depression and dissociative phenomena. Dissociation was strongly correlated with depression severity ( r = .50, p < .001). Individuals with moderate-or-above depression had fivefold greater odds of clinically significant dissociation than those with normal/mild depression (OR = 5.05, 95% CI [4.45, 5.75]). Among clients with moderate-or-above depression, 61.7% scored at or above the MID-60 clinical threshold and 68.8% met a probable MID-60 symptom profile suggestive of a DSM-5-TR dissociative disorder or the dissociative subtype of PTSD. Among subscales, self-confusion showed the strongest association followed by depersonalization/derealization, flashbacks, severe memory problems, persecutory intrusions, and trance experiences ( r s = 0.39–0.56). These findings highlight the high prevalence and patterns of dissociative symptoms in depression and raise important conceptual questions about their role, whether as intrinsic features of depression, as indicators of a dissociative subtype, or as markers of comorbidity. These possibilities are not mutually exclusive. The results support the clinical utility of routine screening for dissociation in individuals presenting with depression, particularly when symptoms are treatment-resistant, complex, or trauma-related. Greater recognition of dissociative phenomena may lead to more accurate diagnosis and more targeted, effective interventions.