Management of dissociation in high-functioning autism adolescents

Background: Dissociation is an umbrella term for trans, depersonalization, derealization, and dissociative amnesia. Dissociation is usually seen in association with trauma, but it can arise in individuals with autism spectrum disorder(ASD) even in the absence of trauma. The interactions between sensory sensitivities, emotional dysregulation, and heightened stress responses in ASD may predispose patients to dissociative experiences, which significantly impair functioning and complicate psychiatric care. Case presentation: We report the case of an 18-year-old female with high-functioning ASD, attention deficit hyperactivity disorder (ADHD), and generalized anxiety disorder who presented with recurrent dissociative episodes. These were characterized by emotional withdrawal, a subjective sense of detachment, and difficulties maintaining present awareness, particularly during stress and overstimulation. Her clinical history was notable for sensory sensitivities, learning difficulties, and a prior depressive episode. At presentation, she endorsed persistent sleep disturbance, fatigue, poor appetite, low self-worth, impaired concentration, and depressed mood. Current medications included duloxetine, lisdexamfetamine, brexpiprazole, and L-methylfolate. Conclusion: Dissociation in ASD presents unique diagnostic and therapeutic challenges, particularly in non-trauma contexts. A combined psychosocial and pharmacological approach, tailored to individual symptom profiles, may optimize outcomes. This case underscores the importance of recognizing dissociation as a clinically significant phenomenon in ASD and calls for further study into targeted management strategies.