Netherlands Institute for Forensic Psychiatry, The Hague, The Netherlands.
Soc Psychiatry Psychiatr Epidemiol. 2013 Sep;48(9):1417-30. doi: 10.1007/s00127-012-0635-1. Epub 2012 Dec 27.
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.
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.
与许多文化一样，在乌干达，神灵附体是一种常见的苦恼表现形式。DSM-IV 包含了分离性和附身恍惚障碍（DTD 和 PTD）的实验研究标准，这些标准正在为 DSM-5 进行审查。在 DSM-5 的当前提议类别中，PTD 被归入分离性身份障碍（DID），而 DTD 则归入未在其他地方分类的分离性障碍。目前迫切需要对这些标准进行评估。本研究探讨了乌干达当地神灵附体的症状与 DSM-IV 中 PTD 的实验研究标准以及 DSM-5 中 DID 的提议标准之间的吻合程度。
采用定性和定量研究方法相结合的混合方法。通过疾病叙事和文化性分离症状检查表，对 119 名被神灵附体的患者进行了局部症状的探索。通过多元对应分析，列出了可能有意义的症状集群。最后，将当地症状与 DSM-IV 中 PTD 的实验标准和 DSM-5 中 DID 的提议标准进行了比较。
疾病叙事揭示了神灵附体的不同阶段，其中被动影响体验先于实际的附体状态。症状的多元对应分析揭示了两个维度：“被动”和“主动”症状。意识改变、抖动运动以及用归因于神灵的声音说话等当地症状与 DSM-IV-PTD 和 DSM-5-DID 标准相符。被动影响体验，如感觉受到外部力量的影响或控制、奇怪的梦境和听到声音，值得在 DSM-5 中为 DID 提议的标准中更明确地描述。将 PTD 纳入 DSM-5 中的 DID 以及将 DTD 和 PTD 分开归入两个独特类别的建议存在争议。
