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Objective: Dissociative symptoms are considered risk factors for suicide and non-suicidal self-injury (NSSI). In this study, the relationship between suicidal behaviors and NSSI with dissociative symptoms in adolescents with a history of Child Sexual Abuse (CSA) was investigated. Methods: A total of 100 adolescents with a history of CSA were evaluated with a detailed forensic psychiatric interview. Dissociative symptoms were measured with the self-report Adolescent Dissociative Experiences Scale (A-DES) and the parent-reported Child Dissociative Checklist (CDC). Results: While dissociative symptoms did not differ between adolescents with and without suicide attempts (CDC; p = .068 and A-DES; p = .060), they were significantly higher in adolescents with non-suicidal self-harming behavior (CDC; p < .001 and A-DES; p = .001). Suicide attempts and NSSI were more common in those who reported genital touching as a type of sexual abuse (respectively, p = .003; p = .048). In regression analysis; history of psychiatric treatment (OR = 9.09 [95% CI = 1.52, 54.29]) and NSSI (OR = 8.18 [95% CI = 2.01, 33.23]) were independently associated with suicide attempts. In addition, parent-reported dissociative symptoms (CDC scores) (OR = 1.27 [95% CI = 1.06, 1.53] and suicide attempt (OR = 8.09 [95%CI = 1.96,33.42] showed independent association with NSSI. Conclusions: Dissociative symptoms may be predictive factors for NSSI and should be considered in risk assessment of adolescents with a history of CSA.

Social anxiety disorder can be quite a challenge for adolescents, often leading to intense fear of social situations and sometimes even dissociation. In this case study, we explored the experiences of a 15-year-old girl who was dealing with social anxiety disorder, dissociation, and self-harm. Despite initially showing symptoms of anxiety, avoiding social situations, and experiencing dissociation, the patient made significant progress through Cognitive Behavioral Therapy (CBT). One notable aspect of this case was the patient's experience of dissociation, which manifested as interactions with imaginary friends. This highlights the need for further research and consideration of dissociative symptoms in the context of social anxiety disorder. It also emphasizes the importance of addressing the root causes of these symptoms. While our main focus in therapy was on reducing social anxiety, it's worth noting that the patient's dissociative symptoms and self-harming behaviors significantly improved with CBT. This underscores the effectiveness of CBT as a powerful treatment option for managing social anxiety disorder, dissociation, and self-harm.