Masked presentations of dissociative disorder among Sri Lankan adolescents

Abstract

Dissociation could occur in adolescence in response to traumatic life experiences disrupting essential areas of psychological functioning. We report three complex presentations of dissociation in adolescents in Sri Lanka. A 16-year-old girl presented with poor sleep, overtalkativeness and euphoric mood after her father had left home a day before. During the war, a 14-year-old boy was brought to hospital as he was speaking in Tamil and mentioning the names of terrorist leaders. Later it was found that he is from a Sinhalese family and had experienced violence at home. A 16-year-old boy presented with irritability, disinhibition and regressed behaviour. A detailed assessment revealed an underlying depressive state in the context of family conflicts. All the above patients presented with features suggestive of mania, misleading clinicians and leading to unsuccessful treatment strategies. Therefore, in-depth psychosocial assessment is needed to diagnose dissociation in adolescents and to plan evidence-based treatment.