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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

Abstract

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.

Methods

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.

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Acknowledgments

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.

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Correspondence to Marjolein van Duijl.

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van Duijl, M., Kleijn, W. & de Jong, J. 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. Soc Psychiatry Psychiatr Epidemiol 48, 1417–1430 (2013). https://doi.org/10.1007/s00127-012-0635-1

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Keywords

  • Spirit possession
  • Dissociative trance disorders
  • Dissociative disorders
  • Dissociative identity disorder
  • DSM-IV
  • DSM-5