Research

Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence

Thomas Jans¹ , Stefanie Schneck-Seif¹ , Tobias Weigand¹ , Wolfgang Schneider² , Heiner Ellgring³ , Christoph Wewetzer⁴ and Andreas Warnke¹

¹University of Wuerzburg, University Hospital, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Fuechsleinstr.15, D-97080 Wuerzburg, Germany

²University of Wuerzburg, Department of Psychology – Educational Psychology, Roentgenring 10, D-97070 Wuerzburg, Germany

³University of Wuerzburg, Department of Psychology – Psychological Intervention, Behavior Analysis and Regulation of Behavior, Marcusstraße 9-11, D-97070 Wuerzburg, Germany

⁴Municipal Hospitals of Cologne, Clinic for Child and Adolescent Psychiatry and Psychotherapy, Florentine-Eichler-Str. 1, D-51067 Koeln, Germany

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Child and Adolescent Psychiatry and Mental Health 2008, 2:19doi:10.1186/1753-2000-2-19

Published:	23 July 2008

Abstract

Background

In the majority of cases short-term treatment outcome of juvenile dissociative disorder is rather favourable. In contrast, the long-term course seems to be less positive, but meaningful results are still fragmentary. The aim of this follow-up study is to bridge this gap to some extent describing the long-term outcome of juvenile dissociative disorder in a clinical sample. To our knowledge there is no comparable other long-term follow-up study which is based on a case definition according to actual classification systems using standardized interviews for individual assessment of the patients at the time of follow-up.

Methods

The total study group was made up of all patients treated for dissociative disorder at our department for child and adolescent psychiatry between 1983 and 1992 (N = 62). Two of these former patients committed suicide during the follow-up period (3%). We got information on the clinical course of 27 former patients (44%). 17 out of these 27 former patients were female (63%). The mean age of onset of dissociative disorder was11.7 years and the mean follow-up time was 12.4 years. Most of the patients were reassessed personally (n = 23) at a mean age of 24.8 years using structured interviews covering dissociative disorders, other Axis I disorders and personality disorders (Heidelberg Dissociation Inventory HDI; Expert System for Diagnosing Mental Disorders, DIA-X; Structured Clinical Interview for DSM-IV, SCID-II). Social adjustment was assessed by a semi-structured interview and by patient self report (Social Adjustment Scale – Self Report, SAS-SR). Psychosocial outcome variables were additionally assessed in 36 healthy controls (67% female, mean age = 22.9 years).

Results

At the time of follow-up investigation 82.6% of the patients met the criteria for some form of psychiatric disorder, while 26.1% were still suffering from dissociative disorder. A total of 56.5% presented with an Axis I disorder (especially anxiety, dissociative and somatoform disorders). Personality disorders were seen in 47.8% (especially borderline, obsessive-compulsive and negativistic personality disorders). More dissociative symptoms and inpatient treatment in childhood or adolescence were significantly related to a lower level of psychosocial adjustment in adulthood.

Conclusion

Treatment strategies have to consider that in a significant portion of young patients initial recovery may not be stable over time. Limitations of the study refer to the small sample size and the low rate of former patients taking part in the follow-up investigation.