Dissociative disorder often persists to adulthood

NEW YORK (Reuters Health) - Dissociative disorder that begins in childhood or adolescence frequently persists into adulthood and is often followed by other psychiatric disorders, according to a report published online in the journal Child and Adolescent Psychiatry and Mental Health.

Dr. Thomas Jan from the University of Wuerzburg, Germany and colleagues analyzed the long-term clinical outcomes of 27 former patients with juvenile dissociative disorder (two of whom had committed suicide). The average age at onset of dissociative disorder was 12 years old.

According to the researchers, 89 percent of these patients had "recovered or had markedly reduced symptoms" after treatment during childhood. However, at follow-up an average of 12.4 years after the initial diagnosis, 83 percent of the patients "met the criteria for some form of psychiatric disorder."

Dissociative disorder is characterized by psychiatric symptoms such as the disruption of consciousness, identity, memory, behavior or awareness of the environment, according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.

Dissociative disorder may take the form of altered consciousness as a reaction to overwhelming psychological trauma. Psychiatrists suggest these memories are encoded in the mind, but have been repressed.

Review of the follow-up data revealed that more than one quarter of patients (26 percent) still suffered from a dissociative disorder, the report indicates, and 48 percent had a personality disorder.

Compared with a control group, the patients previously diagnosed with dissociative disorder were less likely to have financial and emotional independence from their parents, more likely to still be living with their parents, and less likely to have social leisure activities outside the home, the researchers note.

Only 8 percent of patients, however, had serious impairment of social, occupational, and psychological functioning, and only 4 percent were unable to function in all these areas, the investigators say.

"Treatment strategies have to consider that in a significant portion of young patients, initial recovery may not be stable over time," the authors conclude.

Even after patients are stabilized, they recommend that these patients see a mental health provider periodically to detect recurrence of dissociative or other psychopathological symptoms.

SOURCE: Child and Adolescent Psychiatry and Mental Health, July 23, 2008.