eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Child Abuse & Neglect: Dissociative Identity Disorder: Treatment & Medication

Author: Muhammad Waseem, MD, Associate Professor of Emergency Medicine in Clinical Pediatrics, Weill Medical College of Cornell University; Consulting Staff, Department of Pediatrics, Bronx Lebanon Hospital; Consulting Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
Coauthor(s): Muhammad Aslam, MD, Clinical Fellow, Department of Newborn Medicine, Children's Hospital Boston; Richard M Switzer, Jr, MD, Consulting Staff, Department of Pediatrics, Brooklyn Hospital Center; Orlando Perales, MD, Associate Director of Pediatric Emergency Services, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
Contributor Information and Disclosures

Updated: Nov 28, 2007

Treatment

Medical Care

Patients who are survivors of extensive childhood abuse frequently present complicated clinical dilemmas. Dissociative episodes, flashbacks, and self-destructive and suicidal impulses are common difficulties encountered by such patients.

Once the diagnosis of abuse has been made, the initial task of therapy is to detoxify the patient's environment by stopping all forms of abuse. Treatment must be geared toward trust issues, toleration of affect with the patient's understanding of himself or herself, and enabling the patient to function as effectively as possible.

  • Encouraging healthy coping behaviors
    • The primary focus is to help patients learn to control and contain their symptoms. Patients must learn to deal with dissociation, flashbacks, and intense affects such as rage, terror, and despair.
    • Embarking on a treatment plan can be dangerous if the patient has not developed ways to tolerate the emotional turmoil that arises when uncovering traumatic memories. Until the patient can learn healthy alternatives to tolerate feelings and control behaviors, he or she cannot adequately or safely undertake the exploratory work involved in uncovering and processing memories of abuse.
    • Control is a major issue for survivors of abuse, and by learning new ways to control and contain their symptoms, patients no longer view themselves as victims of the past.
    • The emphasis is to have patients reconnect with their sense of power. Encouraging patients to design and choose which technique to use and when to use it contributes to their sense of being in charge of themselves; patients can begin to deal correctly with feelings of helplessness.
  • Logging and monitoring emotions
    • Many patients who experience loss of time through dissociation or flashbacks describe the events as being abruptly triggered. These symptoms sometimes become so severe that patients can no longer function in their usual way.
    • One way to help patients begin to work with their sense of unpredictability is to have them keep a log of their emotions. The patients must first identify emotions. Once they have developed the ability to identify feelings, they can monitor the intensity of each feeling.
    • Patients usually report a cluster of recurrent emotions such as anxiety, sadness, or rage. Quite frequently, these symptoms precede dissociation, flashbacks, self-destructive impulses, and suicidal impulses. Patients should be coached on how to intervene long before anxiety rises to a critical level.
  • Developing a crisis plan
    • Identifying the cause of the anxiety is also important. Teaching patients to develop a list that ranges from simple to complex activities is helpful. Once patients become engaged in the activities, the intensity of emotions usually decreases. In addition, patients feel more in control. This reconnects them to personal strengths and the choices that can be exercised.
    • Most patients require time to learn new and effective coping skills. Emphasize that patients must practice new skills and techniques until they develop a sense of mastery.
    • If the difficulties experienced by patients with histories of abuse are directly related to the abuse experiences, definitive treatment cannot seemingly be successful without acknowledgment of these experiences. Clinicians treating such patients may collude with them in their beliefs about themselves if unaware of the existence of the traumatic etiologies of the current disturbance.

Consultations

If the reason for the dissociative disorder is likely abuse, promptly initiate appropriate medical, surgical, and mental health consultation. The law requires that a child suspected of being abused or neglected be reported immediately to CPS.

  • Psychiatrist or behavioral/developmental pediatrician
  • Social services representative
  • Child abuse and sexual abuse (CASA) specialist

Medication

Pharmacologic management is essentially the same as for Posttraumatic Stress Disorder in Children. If the patient is currently being abused, treatment should be appropriate for acute stress disorder.

More on Child Abuse & Neglect: Dissociative Identity Disorder

Overview: Child Abuse & Neglect: Dissociative Identity Disorder
Differential Diagnoses & Workup: Child Abuse & Neglect: Dissociative Identity Disorder
Treatment & Medication: Child Abuse & Neglect: Dissociative Identity Disorder
Follow-up: Child Abuse & Neglect: Dissociative Identity Disorder
References
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References

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Further Reading

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Keywords

dissociative identity disorder, DID, borderline personality disorder, posttraumatic stress disorder, PTSD, dissociative disorder, dissociation, dissociative psychopathology, child abuse, neglect, multiple personality disorder, MPD, auditory hallucinations, severe depression, suicidality, phobic anxiety, somatization, substance abuse, borderline features, passive disengagement, psychodynamic dividedness, pathological dissociation, conversion disorder, hypnosis, fugue states, sleepwalking, automatic writing, auditory hallucinations, detachment, compartmentalization, temporal lobe epilepsy, schizophrenia

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Contributor Information and Disclosures

Author

Muhammad Waseem, MD, Associate Professor of Emergency Medicine in Clinical Pediatrics, Weill Medical College of Cornell University; Consulting Staff, Department of Pediatrics, Bronx Lebanon Hospital; Consulting Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
Muhammad Waseem, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Muhammad Aslam, MD, Clinical Fellow, Department of Newborn Medicine, Children's Hospital Boston
Muhammad Aslam, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Medical Association, Massachusetts Medical Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Richard M Switzer, Jr, MD, Consulting Staff, Department of Pediatrics, Brooklyn Hospital Center
Richard M Switzer, Jr, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Orlando Perales, MD, Associate Director of Pediatric Emergency Services, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
Orlando Perales, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Carol Diane Berkowitz, MD, Executive Vice Chair, Department of Pediatrics, Professor, Harbor-University of California at Los Angeles Medical Center
Carol Diane Berkowitz, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, American Pediatric Society, and North American Society for Pediatric and Adolescent Gynecology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation

Managing Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Division Chair of Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Division Chair of Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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