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Abstract
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This case study focuses on the psychological management of a 16-year-old female presenting with dissociative symptoms, including aphonia, inability to walk, and complete dependence on family for daily activities. These symptoms developed over three years, accompanied by tremulous limbs and neck weakness. The intervention followed a five-step approach: (1) identifying secondary gains and reducing reliance on her sister for activities of daily living (ADLs), while engaging her in independent, enjoyable activities like drawing; (2) exploring stressors, such as potential abuse, bullying, academic challenges, and familial dynamics, including maternal anxiety and frustration, paternal helplessness, and the patient’s close bond with her sister, which intensified post-onset; (3) integrating physiotherapy to promote self-reliance and using relatable examples to foster psychological insight into her symptoms without evoking feelings of shame; (4) systematically reducing familial attention and encouraging the patient to practice exercises independently, leading to progressive improvement in mobility and self-care; and (5) continued ABC analysis to explore the underlying triggers, behaviors, and outcomes of her dissociative episodes. Psychological assessments, including the Dissociative Experiences Scale, TAT, and Experiences in Close Relationships, revealed themes of deprivation, affiliation needs, and unresolved familial conflicts, particularly feelings of rejection by her mother. Over time, the patient showed marked improvement in physical independence and emotional resilience. By discharge, she regained her ability to speak and identified her long-standing sadness stemming from perceived maternal neglect. This case underscores the value of an integrative therapeutic approach, combining psychological, physiotherapeutic, and family-centered strategies for the effective management of dissociative disorders.
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