Dissociative Symptoms and Reported Trauma Among Patients with Spirit Possession and Matched Healthy Controls in Uganda

Duijl, Marjolein van; Nijenhuis, Ellert R. S.; Komproe, Ivan H.; Gernaat, Hajo B.P.E.; Jong, Joop T. V. M. de

doi:10.1007/s11013-010-9171-1

Cited by 94 publications

(68 citation statements)

References 59 publications

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“…Consistent with prior research (Ertl et al, 2010;Neuner et al, 2012;van Duijl et al, 2010), results revealed positive correlations of spirit possession symptom severity over lifetime with symptom severity of numerous trauma-related disorders such as PTSD symptom severity, TRAUMA-RELATED DISORDERS &SPIRIT POSSESSION 16 depression symptom severity, and shame and guilt feelings. Additionally, a positive correlation with psychotic symptom severity was found.…”

Section: Discussionsupporting

confidence: 89%

Pathological spirit possession as a cultural interpretation of trauma-related symptoms.

Hecker¹,

Barnewitz²,

Stenmark³

et al. 2016

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: Spirit possession is a phenomenon frequently occurring in war-torn countries. It has been shown to be an idiom of distress entailing dissociative symptoms. However, its association with trauma exposure and trauma-related disorders remains unclear. This study aimed to explore subjective disease models and the relationship between pathological spirit possession and trauma-related disorders in the Eastern DR Congo. Methods: Seventy-three (formerly) possessed persons (74% female, mean age: 34 years), referred by traditional and spiritual healers, were interviewed about their experiences of pathological spirit possession, trauma exposure, posttraumatic stress disorder (PTSD) symptoms, depression symptoms, shame and guilt, psychotic symptoms, somatic complaints and the impairment of psycho-social functioning. Results:The most common disease model for pathological spirit possession was another person having sent the spirit, mostly a family member or a neighbor, out of jealousy or conflict over resources. Significant correlations were found between spirit possession over lifetime and PTSD symptom severity, feelings of shame and guilt, depressive symptoms, somatic complaints and psychotic symptoms. Spirit possession during the preceding four weeks was associated with PTSD symptom severity, impairment of psycho-social functioning and psychotic symptom severity. Conclusions: The results of this study indicate pathological spirit possession to be a broad explanatory framework for various subjectively unexplainable mental and physical health problems, including but not limited to trauma-related disorders. Understanding pathological spirit possession as a subjective disease model for various mental and physical health problems may help researchers and clinicians to develop culturally sensitive treatment approaches for affected individuals.

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Section: Discussionsupporting

confidence: 89%

Pathological spirit possession as a cultural interpretation of trauma-related symptoms.

Hecker¹,

Barnewitz²,

Stenmark³

et al. 2016

Psychological Trauma: Theory, Research, Practice, and Policy

View full text Add to dashboard Cite

show abstract

“…Several explicitly trauma-related disorders emphasized the experience of anger and intense rage (e.g., West Papuan saki hati ; Rees & Silove, 2011). Spirit possession was reported in several African and Latin American studies (Betancourt, et al, 2009; Englund, 1998; van Duijl, Nijenhius, Komproe, Gernaat, & de Jong, 2010; Ventevogel, Jordans, Reis, & de Jong, 2013; Zur, 1996), with spirits of the dead revisiting trauma survivors and characterized symptomologically by intrusion, hyperarousal, and dissociation. Two CCDs drew upon hybrid explanatory models comprised of local conceptualizations and those brought by psychosocial humanitarian workers.…”

Section: Resultsmentioning

confidence: 99%

Posttraumatic stress in emergency settings outside North America and Europe: A review of the emic literature

Rasmussen

Keatley

Joscelyne

2014

Social Science & Medicine

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Mental health professionals from North America and Europe have become common participants in postconflict and disaster relief efforts outside of North America and Europe. Consistent with their training, these practitioners focus primarily on posttraumatic stress disorder (PTSD) as their primary diagnostic concern. Most research that has accompanied humanitarian aid efforts has likewise originated in North America and Europe, has focused on PTSD, and in turn has reinforced practitioners’ assumptions about the universality of the diagnosis. In contrast, studies that have attempted to identify how local populations conceptualize posttrauma reactions portray a wide range of psychological states. We review this emic literature in order to examine differences and commonalities across local posttraumatic cultural concepts of distress (CCDs). We focus on symptoms to describe these constructs – i.e., using the dominant neo-Kraepelinian approach used in North American and European psychiatry – as opposed to focusing on explanatory models in order to examine whether positive comparisons of PTSD to CCDs meet criteria for face validity. Hierarchical clustering (Ward’s method) of symptoms within CCDs provides a portrait of the emic literature characterized by traumatic multifinality with several common themes. Global variety within the literature suggests that few disaster-affected populations have mental health nosologies that include PTSD-like syndromes. One reason for this seems to be the almost complete absence of avoidance as pathology. Many nosologies contain depression-like disorders. Relief efforts would benefit from mental health practitioners getting specific training in culture-bound posttrauma constructs when entering settings beyond the boundaries of the culture of their training and practice.

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“…Indeed, sensorimotor dissociative symptoms were moderately to strongly correlated with reported adverse events, and in particular threat to the body and life itself, in every study with the Somatoform Dissociation Questionnaire (SDQ-20; Nijenhuis et al 1996;Nijenhuis 2009). The correlation was not mediated by absorption (Näring and Nijenhuis 2005), and existed in a variety of populations and cultures (e.g., Van Duijl et al 2010). Diseth (2006) documented that chronic invasive medical traumatization in very early childhood was the only predictor of sensorimotor dissociation in adolescence.…”

Section: Relationship To Adverse Eventsmentioning

confidence: 93%

Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder

Nijenhuis¹

2017

European Journal of Trauma & Dissociation

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Key words: PTSD, dissociative disorders, dissociation of the personality, cognitive-emotional dissociative symptoms, sensorimotor dissociative symptoms, psychophysiology, neurobiology DSM-5 includes a subtype of PTSD 'with dissociative symptoms'. However, as presented and discussed in this article, there are solid conceptual, theoretical, empirical, and clinical reasons to comprehend and classify any form of PTSD as a dissociative disorder. The conceptual grounds pertain to philosophical principles seldom discussed or realized in the field of psychotraumatology. The theoretical grounds particularly involve the understanding of dissociation as a division of the personality as a whole biopsychosocial system in two or more conscious subsystems. Empirical reasons include the presence of cognitive-emotional and sensorimotor dissociative symptoms-i.e., manifestations of a dissociation of the personality--in PTSD. There are also major structural and functional neural commonalities between PTSD and complex dissociative disorders. Clinically, there is close correspondence at the level of assessment and treatment. PTSD and dissociative identity disorder can be parsimoniously conceived as minor and major forms of personality dissociation, as Pierre Janet would have avowed.

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Dissociative Symptoms and Reported Trauma Among Patients with Spirit Possession and Matched Healthy Controls in Uganda

Cited by 94 publications

References 59 publications

Pathological spirit possession as a cultural interpretation of trauma-related symptoms.

Pathological spirit possession as a cultural interpretation of trauma-related symptoms.

Posttraumatic stress in emergency settings outside North America and Europe: A review of the emic literature

Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder

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