“I don’t really exist here”: A reflexive thematic analysis of dissociative symptoms described by adolescents and their parents and clinicians

Abstract

Background

Dissociative symptoms are associated with a range of negative outcomes, yet little is understood about how adolescents experience dissociation in their daily lives.

Objective

This study aimed to describe adolescents’ dissociative symptoms from the perspective of adolescents, their parents, and their treating clinicians.

Methods

Semi-structured interviews were conducted with 13 participants about adolescents’ experiences of dissociation. Participants were 6 female adolescent patients (aged 14–17 years, M = 15.67) from a psychiatric outpatient service, 3 parents, and 4 clinicians. Reflexive thematic analysis was used to analyse interview data.

Results

Dissociative experiences varied in frequency, duration, and type (theme 1, Dissociation is Diverse: “It can vary a lot”). However, commonalities were also observed: intense emotions experienced during dissociation were described as qualitatively different from typical emotional dysregulation (theme 2, Emotion Takes Over: “It’s like it just consumes me”). During dissociation, adolescents reported a pronounced detachment from the present moment (theme 3, Disconnecting from the Present: “I don’t really exist here” with subthemes of Affective Disconnection and Bodily Disconnection). The dissociative state, not reality, felt real (theme 4, Reality Feels Unreal: “I didn’t feel real”). Finally, a marked decline in memory and attention was described (theme 5, Problems with Memory and Attention: “My brain stops working”).

Conclusions

This study is the first to examine adolescent dissociative experiences from the perspective of adolescents, their parents, and their clinicians. Adolescents’ dissociative symptoms mostly aligned with symptoms for dissociative disorders in the DSM-5-TR/ICD-11. However, identity disruption appeared absent, while the presence of fantasy elements was potentially unique and warrants replication and clarification through formal assessment. Findings can inform the refinement of symptom criteria in diagnostic guides and the development of adolescent-focused assessment tools. This may support earlier and more accurate identification of dissociation and enable tailored interventions to improve clinical outcomes for this population.