The children who have had frightening experiences or who have been neglected basic need (food, shelter, safety) can be traumatized and is likely to develop various coping mechanism to deal with painful experiences. A mechanism which often occurs to these children is dissociation. Through dissociation, the child who is going through an unbearable experience and has no other solutions, runs away mentally, i.e. disconnects from reality. The body remains in that situation, but the mind ‘escapes’, it is no longer aware of what is happening.

For example, a child beaten by his parents can neither defend himself, because of the obvious power imbalance, nor run away, because he or she is dependent on his/her parents to ensure his/her survival. The only way to adapt to the reality he/she is living is to disconnect from it in order to lessen the suffering. The pain that a child feels in such a situation is not only physical, but also emotional, because it comes to feel that he/she is not loved, that he/she is a bad child who deserve to be punished.

A child often continues to disassociate even when no longer in danger. His/her brain can’t stop this mechanism, which produces a separation between thoughts, emotions and behaviors, between body and mind. It is how the psyche places components of traumatic experiences and memories into different compartments. That means that a child may have a flashback (relive a memory, sensation, emotion, behavior or physical pain that they experienced in the past that makes them feel immediately in danger) without understanding what triggered the flashback or why. For example:

• A child may remember a traumatic event, without feeling any emotion about it;
• A child may have behavioral problems, without having any memory that might underlie those behaviors;
• A child may have frequent stomach pains without feeling the anxiety that may cause those pain.

These different parts of the lived experiences are connected, but the child learns to survive by becoming unaware of these connections.

Signs that may indicate the presence of dissociation in children and adolescents:

• Difficulties in following the instructions and completing tasks: e.g. they fail in do their homework or prepare for school; they may appear sluggish, physically stiff, unsure of themselves;
• They look lost: they may appear to be daydreaming, as if they are asleep, lose concentration or simply faint;
• Sudden mood swings without an obvious trigger: they may be calm, and the next second they may be angry, frightened or sad;
• Depersonalization: they may feel out of their own body and therefore convey that they did not do the things they did (e.g. “It wasn’t me, my hands moved by themselves!”) or engage in behaviours such as bed-wetting, due to the mind-body connection being impaired and the two not communicating;
• feel numb or dead inside: they may be physically present and even aware of what is going on around them, but feel completely emotionally disconnected or empty; the parents’ feeling is that they cannot connect with them;
• Extreme changes in behavior or physical appearance: there may be changes in voice, facial expressions, clothing, hairstyle, or handwriting;
• regressive behavior: may suddenly look like a child much younger than their age in voice, language and behavior;
• memory loss: they may forget what they have said or done; they may even lose some of the skills they have acquired, such as tying shoelaces;
• denial of misbehavior: children may deny that they said or did anything wrong because they honestly don’t remember, even if you saw the behavior yourself;
• physical symptoms with no medical explanation: there may be times when they experience physical aches and pains for which doctors fail to find a medical cause;
• Self-harm: this can be a form of emotional self-regulation in which they try to calm down or ‘wake up’, to feel something; examples of self-harm: cutting, scratching or burning their skin, pulling out their hair, hitting or biting their own body, poisoning or abusing medication;
• Confusion and disorientation: they may seem confused about what day it is, what time it is, where they are and who they are;
• using the pronouns “we” or “they” when referring to themselves: they may feel that there are more than one person inside them and express themselves as such: “We don’t like this!” or “No, we don’t want to go!”;
• talking to themselves: they may seem distracted by inner voices or speak in a voice that others do not hear.

All these behaviors are explained by the different types of dissociation that can occur: amnesia, derealization, depersonalization or identity confusion. You can read about these forms of dissociation here.

Principles on how to support a child or teenager who dissociates:

• Assure him that he is now safe.

Help him understand that survival strategies have served him in the past, but now he can put them aside because he is safe. Tell him that he is not alone and he will have the support of the adults around him to succeed. Do what you can to let him know that he is safe now.

• Help them realize the consequences of their actions.

You need to hold your child responsible for his own actions when he dissociates. But avoid using punishments or other strategies that can make him feel ashamed, as these only serve to ensure the child’s dissociation in order to protect him from suffering. Instead, give gentle feedback about what he did or said when he was dissociated, without shaming or blaming him. Use language that accepts and celebrates the dissociated parties and how they have coped with exceptional life situations.

• Inform the important adults in your child’s life about what they see in your child.

The changes that occur in children due to dissociation can be difficult for most people to understand. Help caregivers and other people who interact with the child (teachers, friends, extended family members, etc.) to better understand what is going on.

• Prevent or reduce the influence of triggers.

If you can identify certain triggers for your child’s dissociative reactions, do your best to prevent their occurrence or reduce their impact. For triggers that cannot be avoided, provide information so that the child understands what will follow and why. Dissociation can also be triggered by sensations or emotions that the child is feeling – for these internal triggers, it helps to be aware of their existence and help the child feel safe again.

Practical tips to help a child or teenager who is dissociating:

1. Make eye contact
2. Speak slowly, calmly, in a low voice
3. Call them by name, remind them where they are and repeat that they are safe
4. Use questions to bring him/her into the present: “Ana, can you tell me where you are?/ What is your name?/ How old are you?”
5. Lightly touch his hand or knee
6. Use strong odors
7. Play music
8. Offer something to eat, chew or drink
9. Make him move: take him for a walk or invite him to a dynamic game
10. Ask him questions about his surroundings: “Ana, what do you see/hear/ smell?”
11. Take him outside for a walk in the grass, preferably barefoot
12. If he has a pet, ask him to pet him

A psychiatric diagnosis can only be established by a psychiatrist. This article is intended only as information for parents/adults who come into contact with minors who are suspected of having been exposed to abusive situations and who are observed to show signs that may indicate dissociative symptoms.

Bibliography:

American Psychiatric Association, DSM-5, Manual de Diagnostic și Clasificare Statistică a Tulburărilor Mintale, Text revizuit, Editura Callisto, 2024;

https://beaconhouse.org.uk/wp-content/uploads/2020/02/Dissociation-in-Children-Teens-Resource_compressed.pdf

Article realized by Diana Munteanu, clinical psychologist & psychotherapist, Barnahus Center