Fifteen Years of Dissociation in Maltreated Children: Where do We Go from Here?

Abstract

Controversies have centered on the prevalence of dissociative symptoms and disorders in children and adolescents, recommended treatment approaches, and the potential effects of suggestive interpersonal influences. Convergence among diverse practitioners describing dissociative children and adolescents with similar symptoms and maltreatment histories supports the occurrence of these symptom patterns. Although prevalence information has not been well studied, dissociative symptoms may be found in children from a variety of settings across a continuum of severity. There is not yet agreement on exact treatment protocols, but successful treatment outcomes have been reported. A challenge for future research is to develop assessment protocols that are derived from multiple sources of data, and to incorporate the latest developmental research findings into theory development that addresses psychobiological, family, and cultural factors. The study of dissociation in children and adolescents has the potential to clarify some puzzling child and adolescent presentations and to identify a process by which some children respond and adapt to traumatic environments.

Posttraumatic Stress Disorder in Maltreated Youth: A Review of Contemporary Research and Thought

“…Dissociation is sometimes difficult to determine in children, however, because the phenomenon may be misperceived as symptomatic of attention deficit hyperactivity, oppositional defiant, psychotic, developmental, cognitive, or mood disorders. In addition, dissociative ''freezing'' may occur in very young children who move and speak little following an intense stressor Silberg 2000).…”

Trauma-related dissociative (conversion) disorders in children and adolescents – an overview of assessment tools and treatment principles

“…The reported cases involve loss of consciousness, amnesia and identity confusion, and mostly involve conflicts in the family, frequently regarding sexuality and expression of anger. The rarity of these case reports, the similarities across diagnosis and the links between these conditions and severe traumata suggest that separation into these discrete psychoform ICD-10 categories may not be particularly useful in children and adolescents (1). Most of the publications on the three conversion dissociative disorders (F44.4 Á/ F44.6) ( Table 1) in children and adolescents are case reports on psychogenic pseudo-/non-epileptic seizures in addition to unexplained motor symptoms as psychogenic paralysis, gait disturbance, incoordination, tremor, dysfunctional postures of the hand, pseudodystrophy, psychogenic cough, hysterical aphonia, globus pharyngis and visual conversion reactions, e.g.…”

“…Different guidelines for treatment of dissociative symptoms in children and adolescents have been published (1,44,50,88,91,92). The growth in the USA of ''recovered memory therapy'' for past sexual abuse has caused great professional concern, controversy and polarization in the psychiatric milieu; much of the guidance addresses recovered memory and therapy.…”

“…According to the existing diagnostic criteria, there must be no evidence of a physical disorder that can explain the symptoms, but evidence for psychological causation should be present, in the form of clear association in time with stressful or traumatic events, insoluble or intolerable problems or needs, or disturbed relationships even if denied by the individual. It is important to recognize that the current distinctions between the diagnostic criteria are not necessarily applicable for children and adolescents (1,31). The dissociative (conversion) disorders (ICD-10) are presented in Table 1.…”

“…W hereas the field of adult dissociative (conversion) disorders has developed steadily with a voluminous clinical and research literature on theory, diagnostics and treatment, the study of dissociative (conversion) disorders in children and adolescents has until recently lagged behind (1). This may seem surprising, as dissociative disorders are founded on a conception of dissociation as a mental phenomenon based on a reaction to severe, intense and complex traumatic experiences in early childhood.…”