DSM-IV

Research Criteria

A. Either (1) or (2):

  1. trance, i.e., temporary marked alternation in the state of consciousness or loss of customary sense of personal identity without replacement by an alternate identity, associated with at least one of the following:
    • a. narrowing of awareness of immediate surroundings, or unusually narrow and selective focusing on environmental stimuli
    • b. stereotyped behaviors or movements that are experienced as being beyond one's control
  2. possession trance, a single or episodic alternation in the state of consciousness characterized by the replacement of customary sense of personal identity by a new identity. This is attributed to the influence of a spirit, power, deity, or other person, as evidenced by one (or more) of the following:
    • a. stereotyped and culturally determined behaviors or movements that are experienced as being controlled by the possessing agent
    • b. full or partial amnesia for the event

B. The trance or possession trance state is not accepted as a normal part of a collective cultural or religious practice.

C. The trance or possession trance state causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The trance or possession trance state does not occur exclusively during the course of a Psychotic Disorder (including Mood Disorder With Psychotic Features and Brief Psychotic Disorder) or Dissociative Identity Disorder and is not due to the direct physiological effects of a substance or a general medical condition.

Differential Diagnosis

In DSM-IV, individuals whose presentation meets these research criteria would be diagnosed as having Dissociative Disorder Not Otherwise Specified.

Mental Disorder Not Otherwise Specified Due to a General Medical Condition and Substance-Related Disorder Not Otherwise Specified

This diagnosis should not be made if the trance state is judged to be due to the direct physiological effects of a general medical condition (in which case the diagnosis would be Mental Disorder Not Otherwise Specified Due to a General Medical Condition), or a substance (in which case the diagnosis would be Substance-Related Disorder Not Otherwise Specified).

Psychotic Disorders

The symptoms of the trance state (e.g., hearing or seeing spiritual beings and being controlled or influenced by others) may be confused with the hallucinations and delusions of Schizophrenia, Mood Disorder With Psychotic Features, or Brief Psychotic Disorder. The trance state may be distinguished by its cultural congruency, its briefer duration, and the absence of the characteristic symptoms of these other disorders.

Dissociative Identity Disorder

Individuals with Dissociative Identity Disorder can be distinguished from those with trance and possession symptoms by the fact that those with trance and possession symptoms typically describe external spirits or entities that have entered their bodies and taken over.

Voluntary trance or possession states

This proposed disorder should not be considered in individuals who enter trance or possession states voluntarily and without distress or impairment in the context of cultural and religious practices.

DSM-5

See Other Specified Dissociative Disorder

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