Dissociative disorders psychotherapy outcome research: in favor of single case studies

Can the DSM-5 differentiate between nonpathological possession and dissociative identity disorder? A case study from an Afro-Brazilian religion

The aim of this article is to examine whether the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are able to differentiate between nonpathological religious possession and dissociative identity disorder (DID). We use the case study of an individual who leads an Afro-Brazilian religious group (Umbanda), focusing on her personal development and possession experiences from early childhood to the present, spanning a period of more than 40 years, and examine these data following DSM-5 criteria for DID (300.14). Her experiences of possession can be broken into 2 distinct stages. In the 1st stage (childhood and early adulthood), she displayed intrusive thoughts and a lack of control over possession states, which were associated with a heightened state of anxiety, loneliness, amnesia, and family conflict (meeting all 5 criteria for DID). In the 2nd stage (late 20s up to the present), she regularly experienced possession states but felt in control of their onset and found them religiously meaningful. In this 2nd stage, she only fulfilled 3 criteria for DID. We question the accuracy of diagnosing this individual with DID in her earlier life and suggest that the DSM-5 criteria fail to address the ambiguity of affect surrounding possession experiences (positive at the individual level, negative at the interpersonal level) and lack a clearer acknowledgment of the prevalence of possession and other unusual experiences in general populations.

The therapeutic release of anger: Helen Watkins's silent abreaction and subsequent elaborations of the anger rock

This paper summarizes Helen Watkins's (1980) silent abreaction technique for releasing anger and the subsequent elaborations it has inspired. Discussion of Watkins's seminal article incorporates her verbatim account of the technique, 2 clinical applications, and her encouragement of further adaptations. Other scholars' subsequent contributions include an adaptation for dissociative identity disorder, brief treatment of constant pain syndrome, and inpatient treatment of a suicidally depressed, dissociative survivor of sexual abuse. Commonalities and distinctions among Watkins's work and these modifications are discussed. New case material from the author's practice illustrate further elaborations, with emphasis on the role of releasing anger in the resolution of dissociative defenses and internal fragmentation in dissociative clients. To enhance the clinical utility of this paper, verbatim passages are included for all case illustrations in H. H. Watkins (1980), the 3 published elaborations, and the new case material.