Are symptoms of spirit possessed patients covered by the DSM-IV or DSM-5 criteria for possession trance disorder? A mixed-method explorative study in Uganda
- 914 Downloads
Introduction and aims
As in many cultures, spirit possession is a common idiom of distress in Uganda. The DSM-IV contains experimental research criteria for dissociative and possession trance disorder (DTD and PTD), which are under review for the DSM-5. In the current proposed categories of the DSM-5, PTD is subsumed under dissociative identity disorder (DID) and DTD under dissociative disorders not elsewhere classified. Evaluation of these criteria is currently urgently required. This study explores the match between local symptoms of spirit possession in Uganda and experimental research criteria for PTD in the DSM-IV and proposed criteria for DID in the DSM-5.
A mixed-method approach was used combining qualitative and quantitative research methods. Local symptoms were explored of 119 spirit possessed patients, using illness narratives and a cultural dissociative symptoms’ checklist. Possible meaningful clusters of symptoms were inventoried through multiple correspondence analysis. Finally, local symptoms were compared with experimental criteria for PTD in the DSM-IV and proposed criteria for DID in the DSM-5.
Results and conclusion
Illness narratives revealed different phases of spirit possession, with passive-influence experiences preceding the actual possession states. Multiple correspondence analysis of symptoms revealed two dimensions: ‘passive’ and ‘active’ symptoms. Local symptoms, such as changes in consciousness, shaking movements, and talking in a voice attributed to spirits, match with DSM-IV-PTD and DSM-5-DID criteria. Passive-influence experiences, such as feeling influenced or held by powers from outside, strange dreams, and hearing voices, deserve to be more explicitly described in the proposed criteria for DID in the DSM-5. The suggested incorporation of PTD in DID in the DSM-5 and the envisioned separation of DTD and PTD in two distinctive categories have disputable aspects.
KeywordsSpirit possession Dissociative trance disorders Dissociative disorders Dissociative identity disorder DSM-IV DSM-5
We like to thank all the healers who gave us their trust and collaborated in this research by referring their patients. We especially want to thank all the participants in this study. We are also very grateful to our research assistants Andrew Ainomugisha and Blanka Conze for their valuable assistance in the fieldwork and to Ellert Nijenhuis and Jeroen Knipscheer for their very valuable comments in earlier stages of this study.
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Odenwald M, Van Duijl M, Schmitt T (2007) Psychology and culture: disorders of possession and dissociation in intercultural practice. In: Bhui Kamaldeep, Bhugra Dinesh (eds) Culture and mental health, a comprehensive textbook. Hodder Arnold, London, pp 87–97Google Scholar
- 6.Cardeña E, Van Duijl M, Weiner L, Terhune DB (2009) Possession/trance phenomena. In: Dell PF, O’Neil JA (eds) Dissociation and dissociative disorders: DSM V and beyond, 1st edn. Routledge, New YorkGoogle Scholar
- 10.Behrend H (1999) Power to heal, power to kill: spirit possession and war in northern Uganda (1986–1994). In: Behrend H, Luig U (eds) Spirit possession: modernity and power in Africa. James Currey, Oxford, pp 20–33Google Scholar
- 13.American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, DSM-IV-TR. American Psychiatric Association, WashingtonGoogle Scholar
- 14.World Health Organization (2010) International statistical classification of diseases and related health problems 10th revision. http://apps.who.int/classifications/icd10/browse/2010/en#/F40-F48
- 17.American Psychiatric Association (2012) Task force DSM-5 development. http://www.dsm5.org. Consulted September 2012: proposed text for DSM-5, available untill 30 Nov 2012
- 19.Kleinman A (1980) Patients and healers in the context of culture. University of California Press, BerkeleyGoogle Scholar
- 20.Corbin J, Strauss A (2008) Basics of qualitative research, 3rd edn. Sage, Los AngelesGoogle Scholar
- 21.De Jong JT, Reis R, Poortinga Y (2010) Onderzoeks methodologie (research methodology). In: de Jong JT, Colijn (eds) Handboek Culturele Psychiatrie en psychotherapie. De Tijdstroom, UtrechtGoogle Scholar
- 24.World Health Organization (2005) Mental health atlas (Online 2012)Google Scholar
- 26.Van Duijl M (2003) Culturally sensitive counselling in Uganda. Memisa Medisch 69:18–27Google Scholar
- 28.Dell PF (2009) The phenomena of pathological dissociation. Dissociation and dissociative disorders: DSM V and beyond. Routledge, New YorkGoogle Scholar
- 29.Steele K, van der Hart O, Nijenhuis E (2009) The theory of trauma-related structural dissociation of the personality. In: Dell PF, O’Neil JA (eds) Dissociation and the dissociative disorders: DSM-V and beyond. Routledge, New York, pp 239–258Google Scholar