The Presentation of Dissociative Symptoms in Childhood and Early Adolescence: A Systematic Review and Thematic Synthesis of 30 Case Studies - 01/04/26

Doi : 10.1016/j.ejtd.2026.100676

Maryam Boutrus ^1,^2,⁴ , Michael English ^1,³ , Bronwyn Milkins ^1,^2,^4,^⁎ , Helen Milroy ^1,^2,⁴ , Jeneva L. Ohan ^1,³

¹ The Kids Research Institute Australia, 15 Hospital Ave, Nedlands, Western Australia, Australia, 6009

² Child and Adolescent Health Services, 2 Mill Street, Perth, Western Australia, Australia, 6000

³ The University of Western Australia, School of Psychological Sciences, 35 Stirling Hwy, Crawley, Western Australia, Australia, 6009

⁴ The University of Western Australia, Centre for Child Health Research, 35 Stirling Hwy, Crawley, Western Australia, Australia, 6009

^⁎ Corresponding Author: Dr Bronwyn Milkins, The University of Western Australia, 35 Stirling Hwy, Crawley, Australia, 6009;. The University of Western Australia 35 Stirling Hwy Crawley 6009 Australia

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Abstract

Background

Dissociative disorders in children and young adolescents are under-recognised and under-treated. Current diagnostic criteria rely on downward extensions of adult models and do not adequately consider developmental differences in younger populations. This reliance risks overlooking symptom patterns that may be unique in childhood, thereby perpetuating diagnostic gaps and delayed treatment.

Aim

This study aimed to enhance understanding of the presentation of dissociation in children (0-9 years) and younger adolescents (10-12 years) diagnosed with a dissociative disorder or disorder with prominent dissociative symptoms; for example, the dissociative subtype of post-traumatic stress disorder.

Methods

A search of eligible case studies and qualitative accounts on the Embase, Medline, PsycInfo, and PTSDpubs databases identified 11,629 articles. A systematic screening process led to the identification of 21 studies containing 30 cases for analysis. Data were synthesised using reflexive thematic analysis.

Results

Six themes were developed: (1) Lost Time and Memory describing pronounced amnesia and temporal disorientation, (2) Disconnection from Body and Emotions describing detachment from body and affect, (3) Reality Reshaping and Retreating describing a tendency to reshape or withdraw from reality, (4) Invading Voices and Visions describing vivid hallucinatory experiences, (5) Somatic Symptoms describing medically unexplained somatic complaints, and (6) Fractured Self (subthemes: inconsistent self and disavowal) describing identity disruption and behaviours suggestive of alternate or emerging dissociative identity.

Conclusion

Findings align with previously proposed symptom domains of childhood dissociation and highlight the relevance of certain features, such as somatic symptoms, in younger populations. They also broadly correspond with adult diagnostic frameworks, although derealisation did not emerge as a core symptom, and vivid imaginary worlds appeared more prominent than suggested in adult criteria. Clarifying these points of convergence and divergence will support the development of age-appropriate diagnostic frameworks for earlier recognition and intervention.

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Keywords : Dissociation, Dissociative Disorders, Child, Adolescent, Trauma, Qualitative Research