Clinical and socio-demographic characteristics of adolescents with dissociative disorders

Objective: The aim of this study was to define the characteristics of the adolescents with dissociative disorders (DD) and their families, including the presenting symptoms, exposure to trauma, experience of suicide and self-harm and socio-demographic features.

Methods: Forty-three patients (38 girls and 5 boys, aged between the ages of 12 and 18 years) participated in the study. All of them were being followed up at the outpatient clinic for at least 6 months and diagnosed with DD according to the DSM-IV criteria. Their parents filled in a questionnaire, generated by the authors, about the socio-demographic characteristics, trauma experiences, attempted suicide and self-mutilation. Adolescent Dissociative Experiences Scale (ADES) and Posttraumatic Stress Reaction Index (PSRI) were also performed and the relationship between these data was investigated.

Results: The mean age at the first assessment was 13.9±2.4 years and the mean age at the time of diagnosis of DD was 15.9±1.8 years. The presented symptoms in the first assessment were as follows in order of frequency: attention problems (n=8), conversion symptoms (n=7), dissociative symptoms such as depersonalization, derealization, amnesia and fugue (n=7), anxiety symptoms (n=6), suicide attempts (n=4), hearing voices (n=4), depressive symptoms (n=2), behavior problems (n=2), homicidal and suicidal thoughts (n=1) and tics (n=1). One of the patients was referred for the legal consultation (n=1). About half of the parents (48.8%) described their marriage as quarrelsome and 11.6% of them were divorced. Psychiatric history was higher in the mothers than fathers were (32.6% vs. 20.9%, p=0.04). The mean ADES score was 163.9±61.7 (between 61 and 296). No statistically significant relationship was found between ADES scores and age of patients, level of parental education, socio-economic status and the type of trauma. All of the patients reported a history of abuse and the mean score of the PSRI was 53.4±14.7 (between 24 and 80). The types of trauma, in order of frequency were emotional abuse (n=30, 69.8% ), physical abuse (n=27, 62.8%), neglect (n=25, 58.1% ), sexual abuse (n=25, 46.5% ). Thirty-one (72.1%) patients described multiple trauma and 7 (16.3%) reported incest. The ADES score showed significant correlation with the PSRI (p=0.002, r=0.46). Suicide attempts (n=27, 62.8%) and self-mutilation (n=38, 88.4%) were very frequent in these patients.

Conclusion: Dissociative disorders are usually under-diagnosed and the symptoms are overshadowed by other psychiatric disorders. Our patients could be diagnosed with DD after a mean delay time of two years. All of the patients described exposure to trauma, and emotional trauma was the most frequent one consistent with the literature. Physical and sexual traumas were also very common. Thus, questioning the trauma, including sexual and physical trauma, should be an essential part of the psychiatric assessment in order to prevent late diagnosis and the consequences of it.