The presentation of dissociative symptoms in childhood and early adolescence: A systematic review and thematic synthesis of 30 case studies

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. 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. 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. 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. 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.