Table 2.
Review of studies exploring possession trance.
| No. | Study | Country | Study type | No. of participants | Aim | Diagnostic procedure | Diagnosis | Diagnostic criteria |
|---|---|---|---|---|---|---|---|---|
| 1 | Bakhshani et al. (28)b | Iran | Cross-sectional study | 21 out of 4,129 | To describe Djinnati and examine its prevalence and demographic attributes in the rural population of Baluchistan in southeast Iran. | Psychiatric examination Self-report instrument: Dissociative Experiences Scale (DES) |
DTD and Culture-bound syndrome (Dijnnati) | DSM-IV |
| 2 | Bayer et al. (29)b | Jordan | Descriptive study | 179 | Describing the clinical features of patients who believed they were possessed or influenced by Jinn. | Psychiatric examination | “Possessive disorder” (Jinn) | No data provided |
| 3 | Butt et al. (30) | Pakistan | Cross-sectional study | 350 | To determine the frequency of anxiety and depression among patients with dissociative trance (possession) disorder. | Psychiatric examination Self-report instrument: Hospital Anxiety and Depression (HAD) - Urdu version |
PTD | ICD-10 |
| 4 | Castillo et al. (31)a, b | South Asia | Case study | 2 | Reexamining previously published cases of spirit possession from the dissociation theory perspective. | No data provided | “Spirit possession” | No data provided |
| 5 | Chand et al. (32)a, b | Oman | Retrospective chart review | 19 out of 111 | Retrospective analysis of clinical manifestations and psychosocial aspects of dissociative disorders. | Psychiatric examination: “Information extracted from case records included demographic variables, illness variables, and psychosocial variables [...] Patients with dissociative trance disorder presented with altered state of consciousness, screaming and irrelevant talk.” | DTD | ICD-10 |
| 6 | Chaturvedi et al. (33)b | India | Retrospective chart review | 84 out of 893 | To examine patterns of dissociative disorders among subjects attending psychiatric services over a period of 10 years. | Psychiatric examination | PTD | ICD-10 |
| 7 | Das et al. (34)a | India | Retrospective chart review | 2–4 out of 42 | Comparing the suitability of DSM-III-R and ICD-10 criteria for dissociative states | Psychiatric examination | DDNOS (n=2) or PTD (n=4) | DSM-III-R and ICD-10 |
| 8 | Dein (35) | UK | Case study | 1 | To illustrate the relationship between spirit possession and psychiatric treatment in a 42 year-old Catholic women. | Psychiatric examination | “Dissociative trance and possession disorder” | No data provided |
| 9 | Delmonte et al. (20) | Brazil | Case study | 1 | A comprehensive account of possession experiences, associated sensations and social interactions | Clinical interview: Structured Clinical Interview for DSM-5 (SCID) | Ruled out DID (“non-pathological possession”) | DSM-5 |
| 10 | Etsuko (36)a | Japan | Case study | 1 | Comparing folk and psychiatric interpretations of fox possession. | No diagnostic assessment | “Fox possession” | No data provided |
| 11 | Ferracuti and Sacco (37)a | Italy | Case series | 10 | Clinical assessment of people with possession-trance states | Clinical interview: Dissociative Disorders Interview Schedule (DDIS), Psychological tests: Rorschach, Standard Progressive Matrices (SPM) |
DTD | DSM-IV |
| 12 | Ferracuti and DeMarco (38)a | USA | Case study | 1 | Describing a case of a man with DTD who was sentenced for the homicide of a 6-month-old baby girl during satanic ritual. | Psychiatric examination Neuroimaging: CT, EEG Psychological tests: MMPI, WAIS-R, Rorschach, TAT |
DTD and Histrionic-dependent personality disorder | DSM-IV |
| 13 | Freed and Freed (39)a | India | Ethnographic study | 38 | Describing traditional ghost beliefs and cases of ghost possession among villagers | No diagnostic assessment | “Ghost possession” | No data provided |
| 14 | Gaw et al. (40)a, b | China | Case series | 20 | Describing clinical characteristics of patients who believed they were possessed | No data provided | “Possession states” (kwei-fu, dzao-mo, zhong-xea) | Chinese diagnostic criteria |
| 15 | Guenedi et al. (41)b | Oman | Case study | 1 | Presenting a case of a man in an altered state of consciousness and comparing its phenomenological features with functional abnormality in specific regions of the brain in order to “link possession to brain abnormality.” | Psychiatric examination Neuroimaging: CT, EEG, SPECT Psychological test: MMSE |
An organic pathology: functional changes in the temporal lobe and structural abnormality in the left basal ganglia | No data provided |
| 16 | Hale and Pinninti (26)a, b | UK | Case study | 1 | Presenting pharmacological treatment. | Psychiatric examination | Dissociative state or paranoid schizophrenia “Exorcism-resistant ghost possession, successfully treated with a depot neuroleptic.” |
No data provided |
| 17 | Hanwella et al. (6) | Sri-Lanka | Case study | 3 | Presenting three patients from Sri Lanka whose possession states were strongly influenced by different religious beliefs and backgrounds | No data provided | “Possession state” (n = 1); “Trance and Possession State” (n = 1); Acute Stress Reaction (n = 1) | No data provided |
| 18 | Igreja et al. (5)b | Mozambique | Cross-sectional study | 175 out of 941 | To evaluate the prevalence of self-reported spirit possession in Mozambique. | Self-report instruments: Harvard Trauma Questionnaire (HTQ) Questionnaire about spirit possession experience and health-seeking behavior |
“Spirit possession” (two subtypes: possession trance and ku tekemuka) | No data provided |
| 19 | Khalifa and Hardie (3)a | UK | Case study | 2 | Describing cultural, religious and psychiatric aspects of jinn possession. | No diagnostic assessment | “Jinn possession” | No data provided |
| 20 | Khan and Sahni (27)b | Nepal | Case study | 1 | To present a case of possession syndrome in a 20 year-old Hindu girl from Nepal. | Psychiatric examination Assessment by an exorcist |
“Possession syndrome” | No data provided |
| 21 | Khattri et al. (42) | Nepal | Cross-sectional study | 4 out of 66 | To find out the prevalence of dissociative convulsions type in psychiatric patients suffering from dissociative disorder. | Psychiatric examination | PTD | ICD-10 |
| 22 | Khoe and Gudi (43) | China | Case study | 1 | To demonstrate an atypical presentation of panic disorder which imitated episodes of possession trance. | Psychiatric examination Neuroimaging: EEG, MRI |
Panic disorder with culture specific symptoms | DSM-5 |
| 23 | Khoury et al. (44)b | Haiti | Ethnographic study | 4 | To investigate whether explanatory models of mental illness invoking supernatural causation result in care-seeking from folk practitioners and resistance to biomedical treatment. | No diagnostic assessment | “Moderate to severe mental illness” | No data provided |
| 24 | Kianpoor and Rhoades (8)b | Iran | Case series | 10 | Presenting psychopathology of Djinnati and discussing it in the light of socio-cultural, communication, and dissociation/psychoanalytic theories. | Psychiatric examination | Culture-bound syndrome (Djinnati) and PTD or DTD | ICD-10 and DSM-IV |
| 25 | Martinez (23) | Puerto Rico | Case study | 1 | Presenting a case of a man with possession and glossolalia experiences, the diagnostic and therapeutic process. | Psychiatric examination | DDNOS | DSM-IV |
| 26 | Mattoo et al. (45)a | India | Case study | 10 | Describing a case of family hysteria and issues related to its medical and social management. | Psychiatric examination Neuroimaging: EEG |
PTD and BPD (n = 1) “Mass hysteria manifest with possession attacks and dissociative symptoms” (n = 9) |
ICD-10 |
| 27 | Mercer (9)a | USA | Review study | 1 out of 2 | Describing the impact of the Protestant belief system on the psychopathology and clinical interventions among children and adolescents raised in that religious context. | No diagnostic assessment | “Trance state” | No data provided |
| 28 | Neuner et al. (46)b | Uganda | Cross-sectional study | 91 out of 1,113 | To estimate the frequency of harmful spirit possession phenomena and to evaluate the validity of harmful spirit possession as psychological disorder in the case of Northern Uganda. | Self-report instruments: Cen Spirit Possession Scale, The Violence, War and Abduction Exposure Scale, Posttraumatic Stress Diagnostic Scale, Hopkins Symptom Checklist (Depression section), Luo Functioning Scale, Mini International Neuropsychiatric Interview (module C for suicide risk), Perceived Stigmatization Questionnaire, Aggression Questionnaire. Survey about the presence of 12 common complaints or symptoms (e.g., malaria, diarrhea, etc.) in the 4 weeks prior to the screening. |
“Spirit possession” (Cen) | DSM-IV |
| 29 | Ng (47)b | Singapore | Case series | 55 | Describing the characteristic features of trance states in three different ethnic communities (Chinese, Malays and Indians). | Psychiatric examination | DTD | DSM-IV |
| 30 | Ng and Chan (48)a, b | Singapore | Case-control study | 58 out of 116 | To study the psychosocial stressors that precipitate DTD and to identify predictors of DTD. | Psychiatric examination: “Consecutive cases seen at the psychiatric hospital diagnosed with DTD were included in the study. The psychiatric diagnosis, assigned on the basis of information obtained in a semi structured psychiatric interview and hospital chart review, were made according to DSM-IV criteria” | DTD | DSM-IV |
| 31 | Peltzer (49)a | Malawi | Descriptive study | 116 | Describing the nosology and etiology of Vimbuza experience. | No data provided | “Spirit disorder” (Vimbuza) | DSM-III |
| 32 | Pereira et al. (50)a, b | India | Case study | 2 | Describing cases of possession by a goddess and an evil spirit. | No data provided | “Spirit possession” | No data provided |
| 33 | Piñeros et al. (51)a | Colombia | Ethnographic study | 9 | To describe a collective episode of psychogenic illness in an indigenous group (Embera). | No diagnostic assessment | “Embera” (Mass hysteria) | DSM-IV |
| 34 | Prakash et al. (52)a | India | Case study | 1 | Describing a woman a with precipitation of possession disorder by treatment with nortriptyline. | Psychiatric examination Neuroimaging: EEG |
Dissociative epileptic disorder | ICD-10 |
| 35 | Ross et al. (53) | USA | Cross-sectional study | 1 out of 100 | To determine the prevalence of classical culture-bound syndromes among psychiatric inpatients with dissociative disorders. | Clinical interviews: Dissociative Disorders Interview Schedule (DDIS), Dissociative Trance Disorder Interview Schedule (DTDIS) Self-report instrument: Dissociative Experiences Scale (DES) |
DTD (n = 1) Culture-bound syndromes: latah (n =1 1), amok (n = 11), bebainan (n =2 6), pibloktoq (n = 3) |
DSM-IV |
| 36 | Sar et al. (54)b | Turkey | Cross-sectional study | 13 out of 628 | To determine the prevalence of possession experiences and paranormal phenomena among and their relationships with traumatic stress and dissociation in Turkish women. | Self-report instruments: Childhood Abuse and Neglect Questionnaire Clinical interviews: SCID (PTSD and BPD sections), SCID-PTSD (17-items part), Dissociative Disorders Interview Schedule (DDIS) |
“Possession experiences” and DID (n = 2) or DDNOS (n = 7) or Depersonalization disorder (n = 2) or Dissociative fugue (n = 1) or Not diagnosed (n = 1) |
DSM-IV |
| 37 | Satoh et al. (55)a | Japan | Case study | 1 | To illustrate diagnostic difficulties in patient whose possessive state and suicidal thoughts were precipitated by door-to-door sales. | No data provided | (DSM) Brief Reactive Psychosis and DDNOS and Somatization disorder (ICD) Somatization disorder and Acute and Transient Psychotic Disorder and Dissociative Disorder | DSM-IVand ICD-10 |
| 38 | Saxena and Prasad (56)a | India | Retrospective chart review | 6 out of 62 | Presenting clinical characteristics and subclassification of dissociative disorders in psychiatric outpatients in India. | Psychiatric examination | Possession disorder (subcategory of Atypical Dissociative Disorder) | DSM-III |
| 39 | Schaffler et al. (57) | Dominican Republic | Cross-sectional study | 47 out of 85 | To evaluate demographic variables, somatoform dissociative symptoms, and potentially traumatizing events in the Dominican Republic with a group of Vodou practitioners with or without the experience of spirit possession. | Self-report instruments: Somatoform Dissociation Questionnaire (SDQ-5), Traumatic Experience Checklist – Dominican Republic (TEC), Spirit Possession Questionnaire – Dominican Republic (SPQ); Interview-based survey (limited data provided). Participants were classified as ‘possessed' upon their positive answer to a screening question whether or not they had experienced full possession by spirits at least once in their lifetime. |
“Spirit possession” | No data provided |
| 40 | Schieffelin (58)a, b | Papua New Guinea | Ethnographic study | 4 | Analyzing the Evil Spirit Sickness among the Bosavi people of Papua New Guinea during a period of intense Christian evangelization and religious excitement. | No diagnostic assessment | “Evil Spirit Sickness” | No data provided |
| 41 | Sethi and Bhargava (59)a | India | Case study | 7 | A description of possession simultaneously affecting seven family members. | No data provided | “Mass possession state” | No data provided |
| 42 | Somasundaram et al. (60)a, b | Sri Lanka | Cross-sectional study | 90 | Describing phenomenology of possession states among psychiatric patients, somatic patients and local mediumship adepts of Tamil society in Northern Sri Lanka. | Psychiatric examination (n = 30) No data provided (n = 60) |
“Possession states” (n = 90) Psychiatric sample included patients with: Schizophrenia (n = 16), Acute psychotic illnesses (n = 6), Bipolar disorder (n = 1), Dissociative disorder (n = 3), Somatoform disorder (n = 4) |
ICD-10 |
| 43 | Somer (61)a | Israel | Case series | 4 | To describe how patients used cultural idioms of spirit possession to describe their suffering. | No data provided | DDNOS / DTD (n = 1), PTSD (n=1), Schizophrenia (n = 1), Histrionic personality disorder and conversion disorder with seizures (n = 1). | DSM-IV |
| 44 | Szabo et al. (7)a, b | South Africa | Case study | 1 | Describing a female adolescent with features of DTD as part of recovery from major depression following the death of her father | Psychiatric examination Neuroimaging: EEG |
DTD and Major depressive disorder | No data provided |
| 45 | Trangkasombat et al. (62)a | Thailand | Descriptive study | 32 | To describe epidemiological and clinical aspects of the spirit possession epidemic in Thai girls. | Psychiatric examination corroborated with a family interview. Self-report instruments: Children's Depression Inventory (CDI) Examination of medical records. |
“Mass hysteria” (n = 32) DSM diagnoses: Adjustment disorder (n = 9), Dysthymia (n = 1), Major depressive disorder (n = 2), Anxiety disorder (n = 1), Dissociative disorder (n = 1), Dissociative tendency (n = 1), Histrionic personality trait (n=6). |
DSM-IIII-R |
| 46 | Van Duijl et al. (24)b | Uganda | Case-control studies | 119 out of 190 | To explore the relationships between spirit possession, dissociative symptoms and reported potentially traumatizing events in Uganda. | Self-report instruments: Spirit Possession Questionnaire -Uganda (SPQ), Checklist Dissociative Symptoms for Uganda (CDS), Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), Harvard Trauma Questionnaire (HTQ), Traumatic Experiences Checklist (TEC) | “Spirit possession” | No data provided |
| 47 | Witztum et al. (63)a | Israel | Case study | 1 | Describing the treatment of a 24 yr-old man with major depressive disorder who complained about being persecuted by an angel. | Psychiatric examination | Major depressive episode with psychotic features and “Hysterical psychosis” | DSM-III-R |
| 48 | Witztum et al. (64)a | Israel | Case study | 3 | To illustrate the Zar phenomenon and discuss its cultural and anthropological aspects. | Psychiatric examination Neuroimaging: EEG, CT |
Culture-bound syndrome (Zar) | ICD-10 and DSM-IV |