This view is strengthened by studies comparing dissociative symptoms with the emic accounts of possession trance (Castillo, 1994 Duijl et al., 2014) and cases suggestive of a dissociative disorder but lacking through diagnostic assessment (Pietkiewicz & Lecoq-Bamboche, 2017 Van der Hart et al., 1996). DSM-5 indicates a link between possession-form presentations and dissociative identity disorder: “Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession” (American Psychiatric Association, 2013). People reporting possession and subjected to exorcisms can be a diagnostically heterogeneous group (During et al., 2011 Pfeifer, 1999 Somer, 1997). They may also be encouraged by family or friends to use exorcisms, which are practiced in many communities as a culturally legitimate way to appease or exort evil spirits (Boddy, 1994 Hanwella et al., 2012). If people perceive symptoms as the expression of demonic influence, they are likely to employ religious coping strategies and ignore other potentially valid explanations for illness (Pietkiewicz, Kłosińska et al., 2021 Somer, 1997 Tajima-Pozo et al., 2011). Beliefs in possession can also affect people’s help-seeking behavior and pathways. Possession is often linked with alterations in behavior and consciousness (possession-form presentations) marked by: talking in a different voice, sensation of paralysis, shaking, glossolalia or making animal sounds, fugues, or “night dances” (Van Duijl et al., 2013). Beliefs in possession have been widely studied by anthropologists for decades and are found common not only in developing countries but also in modern societies (Bourguignon, 1979 Hecker et al., 2015 Kianpoor & Rhoades, 2006 Kua et al., 1986 Ross, 2011 Somer, 2004). Studies show that in many cultures people share folk beliefs about spiritual influence to explain a wide range of phenomena. If these symptoms occur in religious environments they may be interpreted as demonic possession (Hecker et al., 2015 Schaffler et al., 2016 Van der Hart et al., 1996). These parts can represent different aspects of mental reality for example, a helpless child or an internalized perpetrator. In some cases, dissociative parts become fairly autonomous, obtain the first person perspective and take executive control. This can be associated with non-realization, meaning that trauma survivors find it difficult to recognize these experiences as their own (Howell, 2011). However, parts of them (i.e., dissociative parts) remain stuck in traumatic memories and, when triggered by inner or outer cues, reexperience them in the here and now. Being phobic of inner experiences, survivors often strive to cope with everyday life and avoid thinking about or discussing their trauma and symptoms. They would rather perceive symptoms as strange, unexplainable, and feel reluctant to use clinical assessment, for the shame and fear of being labeled as insane and sent to a psychiatric hospital (ISSTD, 2011). It is common for trauma survivors not to see links between their flashbacks, nightmares, or somatoform symptoms, and horrific past events. Psychotraumatology literature elaborates on how adverse childhood experiences, especially repeated child sexual abuse (CSA), can lead to personality fragmentation and post-traumatic symptoms (Nijenhuis, 2015 Sar et al., 2014 Steele et al., 2016 Van der Hart et al., 2006). This justifies the need for educating religious leaders in recognizing and understanding basic psychopathological symptoms.
Accepting the demonic reappraisal of trauma-related symptoms and interventions offered by clergy contributed to receiving social support but discouraged them from seeking diagnostic consultations and trauma-focused therapy, leading to their continued symptoms. Following a thorough clinical assessment, interpretative phenomenological analysis was used to explore their meaning-making and help-seeking behavior.
This study reports the symptoms of two women with a history of sexual abuse, labeled in their religious communities as possessed, and subjected to exorcisms. High incidence of traumatic experiences are also found among “possession” victims but there are few studies exploring in detail their clinical presentations. In many cultures, people use the concept of spirit possession to explain abrupt changes in behavior and identity or problems with affect regulation.