Fantasy, Dissociation, or Hallucination? Clinical Challenges in the Assessment of Childhood Psychopathology: A Case Report
DOI:
https://doi.org/10.61978/psychosocia.v3i2.758Keywords:
Childhood Trauma, Dissociation, Auditory Hallucinations, Maladaptive Fantasy, PsychopathologyAbstract
Childhood trauma is increasingly recognized as a major contributor to psychopathological outcomes such as hallucinations, dissociative symptoms, and maladaptive fantasy use. This case report explores a 20-year-old female patient with a history of recurrent trauma since early childhood, who developed auditory hallucinations commanding self-harm, dissociative episodes, and persistent escapist fantasy as coping mechanisms. Using a case study approach supported by literature review, we examined the clinical trajectory, psychological symptoms, and coping strategies used by the patient. Findings suggest that early and prolonged trauma may distort reality monitoring and identity integration, with dissociation and fantasy serving as maladaptive emotional regulation tools. This case adds to the understanding of how childhood trauma can produce overlapping features of dissociative and psychotic-like symptoms. The report emphasizes the importance of early screening for dissociation and fantasy-based coping in trauma-exposed adolescents, particularly when hallucinations are present. Early interventions, including trauma-informed psychotherapy and family support, may prevent progression to chronic psychiatric disorders.
References
A.P.A. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425787 DOI: https://doi.org/10.1176/appi.books.9780890425787
A.P.A. (2025). DSM-5-TR update: September 2025 supplement. American Psychiatric Association. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm/updates-to-dsm-5-tr-criteria-text
Ben-David, S. (2025). Sensory modulation difficulties and complex PTSD among children: A longitudinal analysis. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2025
Davis, M. (2024). Neuroimaging of posttraumatic stress disorder in adults and youth. Molecular Psychiatry, 29, 1860–1879. https://doi.org/10.1038/s41380-024-02558-w DOI: https://doi.org/10.1038/s41380-024-02558-w
First, M. B. (2022). DSM-5-TR: Overview of what’s new and what’s changed. World Psychiatry, 21(2), 218–219. https://doi.org/10.1002/wps.20905 DOI: https://doi.org/10.1002/wps.20989
Giordano, F. (2025). Perception of loneliness in adolescence: PTSD, DSO, and maladaptive personality. Brain Sciences, 15(1), 86. https://doi.org/10.3390/brainsci15010086 DOI: https://doi.org/10.3390/brainsci15010086
Hjelseng, I. V. (2022). Childhood trauma and social functioning in severe mental disorders. Schizophrenia Research, 243, 241–246. https://doi.org/10.1016/j.schres.2021.12.012 DOI: https://doi.org/10.1016/j.schres.2020.03.015
Inyang, B., Gondal, F. J., Abah, G. A., Dhandapani, M. M., Manne, M., Khanna, M., Challa, S., & Kabeil, A. S. (2022). The role of childhood trauma in psychosis and schizophrenia: A systematic review. Cureus, 14(1), 21234. https://doi.org/10.7759/cureus.21234 DOI: https://doi.org/10.7759/cureus.21466
Jensen, T. K. (2023). Complex posttraumatic stress disorder in adolescence: A two-year follow-up study. Journal of Traumatic Stress, 36(4), 780–792. https://doi.org/10.1002/jts.23000 DOI: https://doi.org/10.1002/jts.23000
Karatzias, T. (2025). Efficacy of psychological interventions for ICD-11 CPTSD: Systematic review and meta-analysis. Clinical Psychology Review, 109, 102533. https://doi.org/10.1016/j.cpr.2025.102533
Kaya, S., & Somer, E. (2024). Maladaptive daydreaming in clinical samples: A meta-analytic review. Journal of Behavioral Addictions, 13(1), 15–29. https://doi.org/10.1556/2006.2024.00003 DOI: https://doi.org/10.1556/2006.2024.00003
Kim, Y. S. (2021). Cross-cultural measurement invariance of the International Trauma Questionnaire – Child/Adolescent. European Journal of Psychotraumatology, 12(1), 1998264. https://doi.org/10.1080/20008198.2021.1998264
Lee, H. (2024). Childhood trauma, oxytocin, and schizophrenia psychopathology: Mediation analysis. Schizophrenia. https://doi.org/10.1038/s41537-024-00433-9 DOI: https://doi.org/10.1038/s41537-024-00433-9
Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y. R., Khoury, B., Hitchcock, C., & Bohus, M. (2022). Complex post-traumatic stress disorder. The Lancet, 400(10345), 60–72. https://doi.org/10.1016/S0140-6736(22)00821-2 DOI: https://doi.org/10.1016/S0140-6736(22)00821-2
Medina, R. (2021). Source monitoring in trauma-exposed youth: A systematic review. Development and Psychopathology, 33(5), 1783–1796. https://doi.org/10.1017/S0954579421000123
Önder, A. (2024). Hallucinations across sensory modalities in PTSD: Mechanisms and clinical implications. Nature Reviews Psychology, 3, 512–528. https://doi.org/10.1038/s44159-024-00055-1
Onyeama, C. (2025). Maladaptive daydreaming among patients with dissociative identity disorder. Frontiers in Psychiatry, 16, 1511749. https://doi.org/10.3389/fpsyt.2025.1511749
Özbabalık, Y. (2025). Trauma exposure, prevalence and associated factors of complex PTSD in China. European Journal of Psychotraumatology. https://doi.org/10.1080/20008198.2025.2502208
Park, S. (2025). Longitudinal cross-lagged relationships of CPTSD, depression, and anxiety in adolescents. Journal of Traumatic Stress. Advance Online Publication. https://doi.org/10.1002/jts.XXXX
Perez, A. (2023). Dissociation measures in clinical research: A systematic mapping review. Trauma, Violence, & Abuse, 24(5), 1861–1879. https://doi.org/10.1177/15248380231156789
Raine, A., & Chen, F. (2024). Sleep loss, dissociation, and hallucination-proneness in adolescents. Sleep Medicine Reviews, 70, 101766. https://doi.org/10.1016/j.smrv.2023.101766 DOI: https://doi.org/10.1016/j.smrv.2023.101766
Ribeiro, J. (2022). Bullying and CPTSD symptoms in adolescents: A multi-site cohort. European Child & Adolescent Psychiatry, 31, 1565–1578. https://doi.org/10.1007/s00787-021-01912-3
Shin, Y. (2021). Trauma-focused CBT for youth with dissociative symptoms: A randomized pilot. Journal of Child Psychology and Psychiatry, 62(9), 1098–1109. https://doi.org/10.1111/jcpp.13450 DOI: https://doi.org/10.1111/jcpp.13450
Sing, R. (2024). EMDR for adolescents with CPTSD: Systematic review. European Journal of Psychotraumatology, 15(1), 2298471. https://doi.org/10.1080/20008198.2024.2298471
Somer, E. (2025). Maladaptive daydreaming: A scoping review and meta-analytic update. Current Psychiatry Reports, 27, 233–251. https://doi.org/10.1007/s11920-025-01345-2 DOI: https://doi.org/10.1155/crps/9700504
Stanley, B. (2024). Maladaptive daydreaming and problematic online behaviors in youth: Systematic review. Child and Adolescent Mental Health, 29(2), 123–136. https://doi.org/10.1111/camh.12592 DOI: https://doi.org/10.1111/camh.12592
Tariq, M. (2020). Childhood adversity and psychotic-like experiences in adolescents: Meta-analytic evidence. Schizophrenia Research, 220, 14–23. https://doi.org/10.1016/j.schres.2020.03.012 DOI: https://doi.org/10.1016/j.schres.2020.03.012
Thompson, J. (2024). Digital media overuse and maladaptive daydreaming in teens. Journal of Adolescent Health, 74(6), 987–995. https://doi.org/10.1016/j.jadohealth.2023.09.015 DOI: https://doi.org/10.1016/j.jadohealth.2023.09.015
Valenstein-Mahn, E. (2025). Global prevalence and determinants of PTSD in children and adolescents: Umbrella review. Child and Adolescent Psychiatry and Mental Health, 19, 45. https://doi.org/10.1186/s13034-025-00345-8
Yap, M. B. H. (2023). School-based trauma-informed care: Evidence update. Annual Review of Clinical Psychology, 19, 421–449. https://doi.org/10.1146/annurev-clinpsy-123021-022622
