Dissociative Disorders

- Introduction

Dissociative disorders (DD) in children and adolescents are a complex group of psychiatric conditions marked by disruptions in consciousness, memory, identity, perception, and behaviour. These symptoms often develop as involuntary coping mechanisms in response to trauma or overwhelming stress, and they frequently impair a child’s social, academic, and emotional functioning (1, 2). Although primarily psychological, dissociative symptoms may resemble or coexist with neurological or developmental conditions, making careful assessment and exclusion of physiological causes essential (2).

DDs may present early in life, sometimes from the age of three, and their manifestations can vary widely across developmental stages. In young children, symptoms may take the form of regression, trance-like episodes, or imaginary companions that appear unusually vivid or controlling. In school-aged children, dissociation may emerge through unexplained amnesia, abrupt changes in behaviour or identity, or somatic complaints without a medical basis. During adolescence, presentations often become more structured, with clearer episodes of amnesia, identity disturbance, depersonalization, derealization, or trance states (2, 3). Because presentation may overlap with normal developmental behaviour, careful attention to features that are inconsistent with developmental expectations—such as loss of control, memory gaps, or functional impairment—is essential for timely recognition. The ICD-11 framework identifies Dissociative Identity Disorder, Dissociative Amnesia, Depersonalization-Derealization Disorder, and trance or possession states as part of this spectrum (1).

These Egyptian Guidelines aim to provide practical recommendations for doctors working with children and adolescents. They recommend evidence-based and culturally appropriate interventions, with particular focus on early recognition, accurate differentiation, and trauma-informed care. In Egypt, where family bonds and community traditions strongly shape children’s development, clinicians should consider cultural meanings of distress and use family-engaged, school-linked pathways to ensure care that is both effective and respectful.