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Dissociative disorder in children. A case study.

R Donfrancesco1, A Dell'Uomo, D Mugnaini

  • 1Unit of Mental Health Protection and Rehabilitation of Development Age, La Scarpetta Hospital, Rome, Italy. lascarpetta@libero.it

Minerva Pediatrica
|October 1, 2004
PubMed
Summary
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Childhood dissociative disorder is often overlooked and misdiagnosed as attention deficit hyperactivity disorder (ADHD) or borderline personality disorder. Early identification of dissociative symptoms is crucial for accurate diagnosis and treatment in children.

Area of Science:

  • Child and Adolescent Psychiatry
  • Developmental Psychology
  • Clinical Psychology

Background:

  • Dissociative disorders frequently emerge in childhood but are often underdiagnosed or misattributed to other conditions like borderline personality disorder.
  • Childhood dissociation can be characterized dimensionally by symptoms exceeding 2 standard deviations or categorically by primary symptoms.
  • Accurate diagnosis is essential as childhood onset is common, yet often missed.

Observation:

  • A comprehensive psychiatric assessment was conducted on an 11-year-old child reporting auditory hallucinations ('voices in his head').
  • The assessment utilized multiple validated instruments including the Children Dissociative Checklist (CDC), Adolescent Dissociative Experience Scale (A-DES), and the K-SADS PL 1.0 semistructured interview.
  • Standardized questionnaires (SDQ, CDI, CBCL) indicated pathological scores across all assessed areas.

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Findings:

  • The K-SADS PL 1.0 ruled out schizophrenia and identified attention deficit, disthymic disorder, generalized anxiety disorder, oppositive-defiant disorder, and conduct disorder with rage episodes, mimicking borderline disorder.
  • The child's IQ was 76, with high scores on parent-reported scales (SDAG, Conners) suggesting Attention Deficit with Hyperactivity Disorder (ADHD).
  • Elevated scores on the CDC (23) and A-DES (85), alongside dissociative amnesia, strongly indicated a dissociative disorder.

Implications:

  • This case highlights that dissociative disorders manifest in childhood and require careful differentiation from ADHD and borderline personality disorder.
  • Recognizing primary dissociative symptoms is key to distinguishing these conditions in pediatric populations.
  • Early and accurate diagnosis of childhood dissociative disorders is vital for appropriate therapeutic interventions.