Table 3.

The participant's clinical presentation based on TADS-I profiles.

Treatment history	She reports three hospitalizations in the past: first, at age 17, after overdosing drugs and alcohol but being wanted due to having run away from home, she also ran away from the unit; second hospitalization at age 23 and the third one abroad at age 25—both after suicide attempts; no medical records available. She has never used counseling or psychotherapy.
Substance use	Alcohol—at age 15 she started to drink beer, wine and vodka; but is unable to define quantity and frequency. Currently drinks recreationally and seldom. Drugs—used marihuana every day for a few years from age 17, sometimes used heroin and LSD (especially when living in squats). During her stay abroad, used cocaine several times a month for six months. Currently no drugs. Medication—as a teenager, she stole diazepam and other tranquilizers from her mother. At age 17, frequently obtained them on prescription, and mixed them with drugs and alcohol.
Problems with eating	Doesn't report.
Problems with sleep	Doesn't report.
Mood and affect regulation	Her mood fluctuates depending on daily problems (son's school problems and court cases). She has felt depressed and abandoned since ending an intimate relationship with a priest, and been left without support. She has had frequent fantasies of committing suicide by hanging herself on a stole, or stealing the host and putting it into her vagina during intercourse to profane sacred objects. She tends to lose control over sexual or aggressive impulses a few times a month. She maintains this is triggered by prayer and leads to alterations in consciousness. After regaining control she feels ashamed and guilty for what she has done (e.g., sending offensive text messages to her spiritual director).
Fear and panic	She doesn't report clinically significant symptoms. No intrusive memories, avoidance or panic attacks.
Autodestructive behavior	She doesn't report any self-mutilation. Suicide attempts, substance abuse and prostitution in the past. During the episodes of losing control, she sometimes hits the wall.
Self image and identity	She reports many conflicts associated with her sexuality, need for attention, and expressions of anger. She feels guilty for things she has done in the past, contradicting her values and religious beliefs. She also describes herself as strong, stubborn, and reluctant to follow rules. She thinks she is different from other people, spiritually sensitive. She also expresses remorse that she is not as good a mother as she thinks she should be.
Problems in relationships	She reports a great sense of isolation, abandonment and loneliness. She also reveals a great need for attention and being acknowledged. She justifies her tendency for social withdrawal with shame about the work she did abroad. She maintains superficial relationships with people and mainly relies on support offered by clergy. At the same time, she expresses distrust and disappointment in authority figures (teachers, priests). She also feels rejected by the Church after being forbidden to receive the sacrament of penance unless she starts psychiatric treatment. She seeks revenge by using phone or Internet to initiate contacts with men declaring to be priests, exchanging pornographic content, and encouraging them to have sexual conversations. All this proves to her they are dishonest and sinful. She declares having no lay friends and being fully committed to her children.
Problems with sexuality	She denies problems in intimate relationships, although she has been avoiding sexual relations for the last 10 years. During her stay abroad, she offered sex for money, often felt numb and detached from emotions. She also reports having been raped. She feels guilty and ashamed of her past but reports no intrusive memories associated with these incidents. She is afraid of overindulging herself in sex or entering sexual relationships with “the wrong men,” thereby putting her children in danger. Sex-chats with alleged priests evoke in her strong excitement and remorse.
Alterations in consciousness	Depersonalization—she frequently felt emotionally detached and numb for short periods of time and without clinical significance. Derealization—a sense of being “on a carousel” in stressful moments or during religious activities, leading to aggression.
Somatoform symptoms	She reports “seizures” at home, during which she is unable to move, and trembles, but remains aware of her daughter calling the exorcist for help. She also has convulsions during exorcisms accompanied with rage (biting, kicking, swearing, destroying objects), corresponding to the stereotype of the possession episode—twice a month.
Psychoform symptoms	She does not report amnesia for daily events. She declares some memory gaps for trance episodes at church or events happening when she abused alcohol and drugs. Schneiderian symptoms—she has an impression of hearing male voices which encourage her to commit suicide, flirt with priests, or criticize her. Rather than hearing them acoustically, they seem like voiced, intrusive thoughts, which she experiences as ego-dystonic and attributes to “the voice of evil.” She does not report any thought broadcasting or Messianic delusions.
Symptoms indicating a division of self	There is no evidence for the existence of autonomous dissociative parts.
PTSD symptoms	She does not report any.
Summary and diagnosis	She maintains proper orientation, good verbal contact, affect in normal range, denies hallucinations and does not express delusional content, nor provide evidence of it during the interview. She reports episodes of derealization and depersonalization accompanied by partial amnesia limited to changes in behavior and speech, and convulsions. Basic mood and drive within normal limits, proper sleep. She reports problems with self-image and interpersonal relationships which can be interpreted as symptoms of a personality disorder. There is history of suicide attempts but currently does not report suicidal ideations. There were also episodes of using psychoactive substances but she now abstains from them. Changes in behavior and speech with associated alterations of consciousness occur in an isolated manner during religious practices but also at home. This meets the premises for the diagnosis of trance and possession disorders. There are no obvious symptoms of complex dissociative disorders. Her symptoms can be understood in relation to difficult experiences and conflicts about experiencing needs for attention, dependence or unacceptable emotions, such as desire or anger. Her conflicts are additionally reinforced by cultural and religious norms internalized during socialization. F44.3 Trance and possession disorders; Features of personality disorders.