Adolescent and psychotherapist views of psychosocial factors in Dissociative Neurological Symptom Disorder: A mixed-method study

Abstract

Background

The existing etiological understanding of Dissociative Neurological Symptom Disorder in adolescents often overlooks socio-cultural variations, highlighting the need for culturally sensitive frameworks.

Objective

Our study explores key psychosocial factors associated with Dissociative Neurological Symptom Disorder in adolescents, comparing these factors with perspectives from psychotherapists working within an Indian psychiatric context.

Methods

We used a Cross-sectional research design with a Convergent parallel mixed-method approach. Twenty (n = 20) adolescents aged between 14 and 18 years and thirteen (n = 13) psychotherapists were recruited to complete the study procedures. This resulted in two distinct datasets. For the quantitative aspect, adolescent participants underwent assessment through a semi-structured interview schedule and objective psychological measures. The qualitative facet involved in-depth interviews with psychotherapists, guided by a comprehensive interview guide. We first analysed findings separately and later integrated them in accordance with Creswell, 2015.

Main Findings

The quantitative analysis of 20 adolescents (mean age = 16.50) revealed that most were girls (90 %) from lower or lower-middle-class families, with 90 % reporting significant life stressors. Common issues included sexual harassment or abuse (45 %), parental conflicts (45 %) and deficits in family communication (75 %). Nearly half of adolescents (45 %) faced school changes last year, with 40 % reporting past academic struggles, underscoring adaptation challenges. The qualitative analysis of the psychosocial characteristics unveiled a notable influence of multifaceted stressors on the adolescent population. The analysis of psychotherapist participants underscores the intricate interplay between five psychosocial factors namely, 1) coping mechanisms, 2) traumatic experiences, 3) interpersonal/familial conflicts, 4) academic stress, and 5) cultural aspects in shaping adolescents' illness.

Conclusions

: Our findings suggest the multifarious nature of stressors, highlighting the significance of employing a biopsychosocial approach when dealing with adolescents affected by DNSD. Furthermore, these results have implications for cultivating an aetiological understanding that is both developmentally and culturally tailored, thus influencing the focus of interventions.