For Specialists

Dissociation in children and adolescents

Traumatic childhood experiences, such as emotional, physical and sexual abuse, are associated with the development of complex symptomatology, including dissociation, which may range from the mild to severe forms of the disorder. Dissociation can be understood as a response to traumatic experiences in which the victim’s psyche splits and functions fragmented, keeping the traumatized part of the psyche out of consciousness so that the person can maintain partially healthy functioning.

Dissociation is a survival mechanism. A child who is physically abused by a parent can’t fight back or run away but can escape mentally by disconnecting from reality through dissociation. Thus, he manages to “run away” when what he is experiencing and feeling too much and overwhelms his ability to cope.

Sexual abuse, by its nature, is an invasion of a child’s private space. This violation threatens the child’s sense of security and trust that child in his or her own body and undermines the child’s ability to defend himself or herself physically and psychologically. Being trapped in a body which has been betrayed and forced to continue to rely on it for survival, the self has several options, including splitting the body from the mind through dissociation. From o therapeutical perspective, the splitting between mind and body takes place because the victim can’t perceive anymore the body as a safe place.

Case study

T, 11 years, went to therapy because of inappropriate sexual behavior towards peers. Her father was an abusive man, who her mother broke up with after 6 months. When she was 2 and a half years old, following visits to her father, T. stated that her father touched her with his hand and mouth in her intimate area. Despite the Child Protection Service’s efforts, visits to her father continued for several years. At the age of 6, the little girl recounted that she was sexually abused by several men at parties at her father’s house. Due to the details that T. provided to the authorities, visitation stopped. The father relinquished his parental rights in exchange for dropping all charges against him.

At 11, the problems started to escalate. T. had increasingly frequent concentration difficulties and memory loss which affected her school work. The teachers told the mother that the little girl stares blankly for long periods of time during class and, when her attention is drawn to it, doesn’t know what is being discussed in class. At home it took her a lot to do her homework and she often didn’t finished it. She began to be afraid to go to school and in the mornings she would woke up very hardly, going into a trance-like state that lasted almost 2 hours, during which time her mother was unable to connect with her. She confessed her mother that she hears voices telling her to make sexual advances on other children. At school, her classmates nicknamed her “Shady” for the times she acted “like a different person”, flirting and acting out her sexualized behavior. At the same time, T. frequently said that she felt strange, as if she was floating and someone else was moving her body. At other times, she claimed that she saw people around her “in a blur” or that she could hear them in a muffled voice.

According to Diagnostic and Statistical Manual of Mental Disorders, the dissociative disorders “frequently occur in the immediate aftermath of trauma and many of the symptoms, including embarrassment and confusion about symptoms, as well as the tendency to hide them, are influenced by the proximity in time of the trauma”.

Specific manifestations of dissociative disorders:

  • Identity fragmentation, characterized by two or more distinctive states of personality which implies marked discontinuity of self-awareness and action, accompanied by associated disturbances in affect, behavior, consciousness, memory, perception, cognition and/or sensory-motor functioning;

The girl in the case was nicknamed „Shady” because of the times in which she did not seem to be herself, exhibiting sexual behavior inappropriate for her age. The nickname she received indicates the fragmentation of her identity, which caused her to behave inappropriately at times.

  • Recurrent gaps in recall of everyday events, of important personal information and/or of traumatic events that do not fit into normal forgetfulness;

T. was having more and more problems at school, because of the times when she was losing her concentration, staring blankly and failing to remember the topic of class discussion.

  • Dissociative amnesia, which is the inability, usually of a traumatic or stressful nature, to recall important autobiographical information that is unrelated to natural forgetting; this may be information related to a specific event or may include one’s own identity and life history;

From the information presented in our example, it is not clear whether or not T. remembered the abuse or other important autobiographical information.

  • Episodes of depersonalization: feeling of unreality, detachment or be the extern observatory of their own thoughts, feelings, sensations, body or actions (e.g. alterations in perception, sense of time distortion, sense of unreality or absence of self, emotional and/or physical indifference);

The mother failed to connect with T. when she went into trances that sometimes lasted up to 2 hours. The little girl remained indifferent to her mother’s attempts to bring her out of this state. At times, she recounted feeling strange, as if she was floating and someone else had control over her body.

  • Episodes of derealization: the feeling of unreality or detachment from the environment (e.g. people or objects are perceived as unreal, dream-like, blurred, lifeless or distorted).

T. perceived the people he interacted with in a distorted manner, claiming to see them “in a blur” or to hear them in a muffled voice.

Symptoms specific to dissociative disorders, such as episodes of depersonalization or derealization, can be found in people with post-traumatic stress disorder or with symptoms specific to post-traumatic stress disorder (about post-traumatic stress disorder you can read here).

A psychiatric diagnosis can only be established by a psychiatrist. This article is only intended as information for parents/adults or professionals who meet minors who are suspected of having been exposed to abusive situations and who are observed to show signs that may indicate symptoms of dissociative disorders.

 

Bibliography:

American Psychiatric Association, DSM-5, Manual de Diagnostic și Clasificare Statistică a Tulburărilor Mintale, Text revizuit, Editura Callisto, 2024;

Silberg, J. L. (2004). The treatment of dissociation in sexually abused children from a family/attachment perspective. Psychotherapy: Theory, Research, Practice, Training41(4), 487–495;

Goldner, L., Lev-Wiesel, R., & Bussakorn, B. (2023). “I’m in a Bloody Battle without Being Able to Stop It”: The Dissociative Experiences of Child Sexual Abuse Survivors. Journal of interpersonal violence, 38(13-14), 7941-7963

 

Article realized by Diana Munteanu, clinical psychologist & psychotherapist, Barnahus Center