This is clearly not the first time it has happened and helps explain Nathan's desire to escape from his family.
The blow is clearly fatal and Nathan "dies" yet is still inside his body and aware of his surroundings.
The book ends with Nathan leaving the abandoned house and finding Roy.
Dream Boy has been adapted for a film, written and directed by James Bolton.
This article about a novel of the 1990s with a lesbian, gay, bisexual, transgender, or queer theme is a stub.