Hypnosis to Treat Dissociative Disorders in Children

SUMMARY: At present, diagnostic criteria specific to pathological dissociation in children is not included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013). Despite formal diagnostic criteria, there have been many documented cases of children presenting with dissociative disorders. In many reported cases of Dissociative Identity Disorder (DID) in adults, presence of an alter was reported to occur before the age of 12 and even before the age of 6. Research to-date, suggests that treatment of dissociative disorders in children can be completed in a shorter time span than with adults.

METHODS:

• Resources which specified ‘dissociative disorders’ and ‘children’ were reviewed

• Resources which were specific to ‘dissociative disorders’ and ‘children and adolescents’ were reviewed

• Resources which were specific to ‘dissociative disorders’ and ‘adolescents’ were not included 

• ‘Guidelines for the Evaluation and Treatment of Dissociative Disorders in Children and Adolescents’ were reviewed

• The breadth of literature specific to dissociative disorders in children was winnowed to sources that included the keyword(s) ‘hypnosis’ ‘clinical hypnosis’ and/or ‘hypnotherapy’. 

• Resources which included ‘dissociative disorders’ and ‘hypnosis’ but did not include ‘children’ were excluded

RESULTS:

Hypnosis with Children Who Have Dissociative Disorders

Hypnotherapy can be used with children to access different self-states, support containment of traumatic material and intense affect, promote ego-strengthening, and inner-resourcing (Bowman, Blix, & Coons, 1985; Cagiada et al., 1997; Dell & Eisenhower, 1990; ISSD, 2004; Kluft, 1985, 2000; Shirar, 1996; Williams & Velazquez, 1996).

Hypnosis can be used to help the child in rewriting traumatic flashbacks or to desensitize them to flashbacks (Cagiada et al., 1997; Friedrich, 1991; ISSD, 2004; Williams & Velazquez, 1996). 

Play therapy integrated with hypnotic techniques can help children integrate dissociated feelings, experiences, and give voice to internal conflicts or self-states (Cagiada et al., 1997; Gil, 1991; ISSD, 2004; Kluft, 1985; McMahon & Fagan, 1993; Shirar, 1996; Waters & Silberg 1998b). 

Dissociative Disorders & Children

Despite formal diagnostic criteria, there have been many documented cases and studies of children presenting with severe dissociation that could be categorized as a dissociative disorder

(Baita, 2011; Ellenberger, 1970; Fagan & McMahon, 1984; Fine, 1988; Grimminck, 2011; Hornstein & Tyson, 1991; Kluft, 1984; LaPorta., 1992;  Marks, 2011; Putnam, 1997; Putnam et al., 1996; Reycraft, 2013; Rhue et al., 1995; Riley & Mead, 1988; Silberg et al., 1997; Snow, et al., 1995; Waters, 2011; Zoroglu, et al., 1996). 

The literature specifically discussing dissociative disorders in children is scarce (Reycraft, 2013; Silberg, 2000).

In many reported cases of Dissociative Identity Disorder (DID) in adults, presence of an alter was reported to occur before the age of 12 and even before the age of 6 (Bliss, 1980; Putnam et al., 1986; Putnam, 1997; Reycraft, 2013).

Research to-date, suggests that treatment of dissociative disorders in children can be completed in a shorter timespan than with adults (Fagan & McMahon, 1984; Kluft, 1985, 1985a; Reycraft, 2013).

“[T]he lack of consensus on diagnostic criteria is the greatest barrier to identifying dissociative pathology in children and adolescents” (Silberg and Dallam, 2009, p. 70).

Dissociative disorders can present with similar symptoms in children as they do in adults but also have age-related differences in presentation (Kluft, 1984; Reycraft, 2013; Putnam et al., 1996). 

However, children have the potential to develop out of them as they mature or are removed from a problematic environment. Furthermore, the prevalence of adult dissociative disorders should not presuppose the existence or ubiquity of children with dissociative disorders (Reycraft, 2013; Silberg, 2000). 

Children with dissociative disorders have been documented (Ellenberger, 1970; Fagan & McMahon, 1984; Fine, 1988; Hornstein & Tyson, 1991; Kluft, 1984; Putnam, 1997; Putnam et al., 1996; Reycraft, 2013;  Rhue et al., 1995; Riley & Mead, 1988; Silberg et al., 1997).

Cases wherein the child did not have a history of trauma,  but was diagnosed with a dissociative disorder have also been documented (Coons, 1996; Malenbaum & Russell, 1987; Reycraft, 2013).

Childhood trauma and neglect can lead to dissociative disorders in children  (Coons, 1994; Hornstein & Putnam, 1992; Klein, Mann, & Goodwin, 1994; Reycraft, 2013; Silberg & Waters, 1996; Yeager and Lewis, 1996). 

• Physical and sexual abuse (Coons, 1996; Dell & Eisenhower, 1990; Hornstein & Putnam, 1992; Macfie, Cicchetti, & Toth, 2001; Reycraft, 2013; Trickett, Noll, Reiffman, & Putnam, 2001)

• Neglectful parenting (Brunner, Parzer, Schuld, & Resch, 2000; Ogawa, Sroufe, Weinfield, Carlson, & Egeland, 1997; Reycraft, 2013; Sanders & Giolas, 1991)

• Inconsistent and rejecting parenting (Mann & Sanders, 1994; Reycraft, 2013) 

• Natural disasters (Laor et al., 2002; Reycraft, 2013) 

• War trauma (Cagiada, Camaido, & Pennan, 1997; Reycraft, 2013)

• When a child witnesses domestic violence, experiences emotional abuse, peer rejection, inconsistency from a parent or guardian, an unstable living environment, or painful medical procedures (ISSD, 2004; Reycraft, 2013; Wieland, 2011)

Dissociative disorders can run in families. Identifying whether or not a parent/guardian has been diagnosed with a dissociative disorder can help with the differential diagnosis process in their children (Braun, 1985; Coons, 1985; Kluft, 1984; Malenbaum and Russell, 1987; Reycraft, 2013; Yeager & Lewis, 1996).

ISSTD Standards for diagnosing dissociative disorders in children (ISSTD, 2004): 

Symptoms

The ISSD Guidelines (2004) classifies the symptoms of dissociative disorder in children as: “trance states, amnesia and transient forgetting, imaginary playmates, identity alteration and state changes, changes in affect and behavior, somatic symptoms, posttraumatic symptoms, sexually reactive or offending behaviors in children, depersonalization, derealization, and self-injurious behavior (Reycraft, 2013, p. 30).”

Diagnosis 

Clinical interviews (ISSD, 2004; Reycraft, 2013)

Comorbid conditions (Graham, 1998; Hornstein, 1998; Hornstein & Tyson, 1991; ISSD, 2004; Peterson, 1998; Peterson & Putnam, 1994; Reycraft, 2013; Silberg, 1998; Wieland, 2011)

Medical evaluation  (Graham, 1998; ISSD, 2004; Reycraft, 2013)

Screening tests (ISSD, 2004; Reycraft, 2013)

Structured clinical interviews (Reycraft, 2013;Silberg, 1998b)

Psychological testing (Silberg, 1998a; Reycraft, 2013)

Pharmacological and hypnotic interventions  (Benjamin & Benjamin, 1993; ISSD, 2004; Reycraft, 2013; Williams & Velazquez, 1996)

Ongoing assessment (Hornstein 1998; ISSD, 2004; Nemzer, 1998; Reycraft, 2013)

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This handout and poster were created by Madeline Stein © for a Poster Presentation at the Society for Clinical & Experimental Hypnosis’ Annual meeting 2019.