Pathological Possession Trance (PPT) was formerly known as dissociative trance disorder in the DSM psychiatric manual, and became included within the dissociative identity disorder criteria in the DSM-5. PPT has been researched in many countries, including Puerto Rico, China, India, Iran, Turkey, Uganda and the USA.
PPT covers involuntary possession experiences only. The most complex study to date (Van Duijl et al.) which addressed the causes of PPT found that there is a significant association between PPT and earlier life trauma; other studies have found stressful but not traumatic life experience were associated with PPT.
Diagnostic criteria in the DSM-5
Pathological Possession Trance (PPT) is the new name for dissociative trance disorder, which was in the appendix of the DSM-IV manual. Spiegel et al. (2011) states that it tends to be described in case series as more transient and episodic than ‘traditional’ Dissociative Identity Disorder, which is typically chronic.
Dissociative symptoms experienced as a result of PPT have included talking in a different voice, ‘made’ feelings, the inability to speak or move, loss of control of actions, loss of awareness of surroundings, insensitivity to pain and loss of personal identity.
PPT has now been included within the [dissociative identity disorder] diagnosis, which has been slightly reworded to include the phrase “experience of possession”. To meet this criteria there must be amnesia, it must cause clinically significant distress and/or impaired functioning and it must not be part of normal cultural or religious practice.
Other Specified Dissociative Disorder (formerly DDNOS) may be appropriate for similar symptoms which do not meet the full criteria. In the DSM-5 one example presentation is described as “dissociative trance”.
Differences between alters in DID and PPT
Spiegel (2011) states:
DID is hypothesized to evolve during a traumatic, neglectful, and/or abusive early childhood. These alter identities, as already noted, are shaped by posttraumatic, developmental, intrafamilial, psychosocial, interpersonal, and cultural substrates.”
Alternate identities in PPT tend to represent supernatural agents, typically the spirit of a dead person, or a culturally accepted spirit, demon, god, animal, or mythical figure. Unlike DID alters, possessing entities display a collective existence. For example, the same spirit may possess different family members down the generations (or different villagers in the same generation).”
Both DID alternate identities and/or PPT possessing entities share stereotypical features (‘‘child alters,’’ ‘‘protectors,’’ ‘‘introjects,’’ ‘‘vengeful ghosts,’’ ‘‘angry gods’’) that pattern their behaviors, affects, and cognitions into stable alternate roles with whom the sufferer’s social network can interact… It is of interest that in the more sociocentric Eastern cultures, dissociative identities take the form of a member of the community, while in the more individually focused Western cultures, the dissociation involves a variety of internal individual identities.”