vol. 1, num. 1, 2003

Dissociative Phenomena. Questions and Answers.

Editors: Mario Di Fiorino and Maria Luisa Figueira

Conversion and Dissociative Disorders in Children and Adolescents

Summary. Conversion symptoms most typically are related to voluntary motor or sensory functioning and, thus, are referred to as ”pseudoneurologic”. The incidence of conversion ranges in children from 0.5% to 10%, which is three times higher in adolescence than in preadolescence. Onset is generally from late childhood to early adulthood and rarely occurs before age 5 . In adolescence female-to-male ratio (1.7/1) is less than adults whereas the ratio is 1/1 in children. Lower socioeconomic status and lower levels of psychological sophistication are associated with higher prevalence. Contrary to adults conversion disorder usually occurs suddenly and temporarily in children and adolescents. Most common symptoms are pseudoseizures and unexplained falls/faints (50 to 70% of all symptoms). Conversion symptom is thought to be the direct symbolic and somatic expression of an underlying psychologic/unconscious conflict, but in children and adolescents unconscious conflict may involve dependency needs or performance anxiety. Dissociation is a complex psychopathological coping process that exists along a continuum ranging from minor normative dissociative experiences (e.g., daydreaming or lapses in attention) to severe psychiatric diagnoses (e.g., dissociative identity disorder, amnesia, and fug). The frequency of dissociative experiences is at its highest during childhood. The single best predictor of dissociative disorder is frequent ”trance-like behavior”. Children with dissociative disorders exhibit a plethora of fluctuating abilities, shifting preferences, and inconsistent knowledge. The link between dissociative disorders and trauma is well accepted. Children and adolescents may present dissociative symptoms prior to meeting full criteria for PTSD, panic disorder, personality disorders, or dissociative disorders.
Treatment starts from psychiatric evaluation and goes with a psychiatric formulation. Psychodynamic techniques help a child gain insight into unconscious conflicts and understand how psychological factors help to maintain symptoms. Educational and pharmacological interventions, and individual psychotherapy can also be used. Longitudinal studies of children with conversion and dissociative symptoms are needed.

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