Dissociative trance and possessive states

Introduction Dissociative trance and possession: The paralyzed state is characterized by a narrow range of consciousness, the subject is in a state of self-enclosement, and its attention and consciousness activities are limited to one or two aspects of the current environment, only in the environment. Individual stimuli react, and the typical sputum state is seen in hypnosis, witchcraft or superstition activities, when the surgeon interacts with "ghosts" and "god", and certain qigongs, such as Hexiang piles, induce fascination. . A person in a state of paralysis, if his identity is replaced by a deity or a dead person, claiming that he is a god or someone who has died is talking. Separate sputum state and appendage state are involuntary, undesired pathological processes; patients' movements, postures and speech are mostly monotonous and repetitive. The person who can control the appearance or disappearance of such a state by others or self-introduction is a kind of behavior related to a specific culture or superstition; although it is a separation of consciousness, it should not be diagnosed as a separation disorder.

Cause

(1) Causes of the disease

Mental and psychological factors

The causes of separation (conversion) disorders are closely related to mental factors, various unpleasant moods, anger, grievances, panic, shame, embarrassment, sadness and other traumas, often the cause of the first onset. In particular, stress and fear are important factors in triggering this disease. This acute snoring reaction in combat is particularly evident; traumatic experiences in childhood, such as mental abuse, physical or sexual devastation, are one of the important causes of conversion and dissociation disorders in adulthood. A small number of patients may have no obvious incentives after multiple episodes, and later may be re-emerged because of association or re-experience of the first episode, and more often due to suggestion or self-suggestion. For example, in the former Soviet Union's Great Patriotic War, a woman was insulted by the German fascist army. Later, when passing through a movie theater that was showing a war movie, she heard the sound of guns and convulsions. The attack is conducive to the patient getting out of trouble, venting emotions, gaining the sympathy of others or getting support and compensation.

2. Susceptibility

The relationship between the onset of somatization disorders and mental factors is not obvious. Whether mental factors cause snoring or what type of snoring is related to the patient's physical and psychological quality. Those with a susceptible quality may be more susceptible to this disease. The patient with snoring character characteristics accounted for 49.8%, and the main characteristics of his personality are:

1 Performing personality characteristics: About 20% of the patients have typical performance personality, as follows: distinct emotional emotions, excessive emotions, exaggerated expressions, naive and dramatic speech acts, poor emotional control, emotions shallow.

2 The level of culture is low and the concept of superstition is heavy.

3 Self-centeredness: Constantly pursuing excitement to seek the attention of the people around you.

4 Highly suggestive: It is easy to be hinted by people and the environment around, and it is easy to suggest yourself.

5 rich fantasy: imagination is rich, even with fantasy instead of reality. Always intentionally or unintentionally playing the role of fantasy, there may be fantasy lies.

6 Women in adolescence or menopause are more prone to snoring than the average person. However, this personality trait is not a necessary condition for snoring. When a person with a susceptible quality is prone to snoring after being frustrated, having a psychological conflict or accepting a suggestion. Some people who do not belong to this type of personality can also suffer from snoring reactions under the influence of strong mental factors.

3. Organic factors

Previous studies have found that about two-thirds of patients with this disease have brain disease or have organic brain disease. 32% of patients have had a history of neurological diseases, especially epilepsy.

4. Genetic factors

The genetic research results of this disease are quite inconsistent. Some studies have found that some patients have genetic quality. Ljunberg's (1957) family survey found that the father, brother, and son of the sputum proband had 1.7%, 2.7%, and 4.6% of the snoring; mother, sister, and daughter. The prevalence rates were 7.3%, 6.0%, and 6.9%, respectively. In general, the prevalence of male first-degree relatives is 2.4%, and the prevalence of female first-degree relatives is 6.4%. Foreign data also indicate that the incidence of this disease among close relatives of snoring patients is 1.7% to 7.3%. The incidence rate of first-degree relatives can reach 20%. In Fujian, China, 24% of patients reported positive family history. Both are higher than the normal population. It suggests that genetic factors may play a role in the pathogenesis of the disease. However, Slater (1961) studied 24 pairs of twins, single-female twins and twin-oval twins, 12 of which were diagnosed as snoring with at least 1 in each pair, and 1 in the other pair was diagnosed as snoring personality. Regardless of whether the single or double-oval twins did not have a pair of snoring, the results of Ljunberg were in sharp contrast. Arkonac and Guze (1963) found that the family of 25 female snoring patients had 5 first-degree relatives. The snoring patients, all women, accounted for 9% of all first-degree relatives, accounting for 15% of female first-degree relatives, and the authors estimate that the prevalence of snoring in women of the general population is only 1% to 2%.

In addition, the number of cases of anti-social personality disorder and alcoholism among male first-degree relatives of snoring probands has increased. The genetic results of the study are more consistent with Briquet syndrome. Cloninger et al. (1986) reported that the prevalence of Briquet syndrome in first-degree relatives of such probands was 7.7%, compared with 2.5% in the normal control group. Torgersen (1986) reported a twin study of somatoform disorders with a 29% incidence of monozygotic twins and a 10% twin twins. At the same time, the prevalence of generalized anxiety disorder in patients' siblings was also increased. Cloninger et al. (1975) considered this to be a multifactorial genetic model with Briquet syndrome in women and antisocial personality disorder in men.

5. Social and cultural qualities

Such as customs, religious beliefs, living habits, etc., also have an impact on the occurrence and form of the disease and the symptoms.

(two) pathogenesis

There are two neurophysiological explanations for the pathogenesis of this disease: one is based on Janet's theory of consciousness separation. It is believed that changes in state of consciousness are the neurophysiological basis for the onset of snoring. With the separation of patient consciousness, there are damages to cognitive functions such as attention, alertness, near memory and information integration. As the inhibition of afferent stimuli in the cerebral cortex is enhanced, the patient's self-awareness is diminished and there is a suggestive increase. At this time, when the individual is threatened by biological, psychological or social factors, there are various instinctive reactions like the animal encountering dangers, such as severe exercise response, false death reflexes and return to the naive period.

Another explanation is based on Pavlov's theory of advanced neurological activity. The mechanism of the onset of snoring is that harmful factors act on people with weak neurological types, causing separation or disharmony between the first and second signaling systems of high-grade neurological activity, and between the cerebral cortex and the lower cortex. The patient's first signaling system and the function of the lower cortex are relatively dominant. Under the influence of external stimuli, the cerebral cortex, which is already weakened, rapidly enters over-limit inhibition, resulting in positive induction, which enhances the activity of the lower cortex, clinically manifested as emotional outbursts, seizures, and instinctual activities and autonomic nerves. symptom. On the other hand, strong and persistent emotional stress can also produce excitatory foci in the cerebral cortex, causing negative induction. This induced inhibition is combined with the above-mentioned over-limit inhibition, and spreads to other parts of the cortex and the lower part of the cortex, causing the cerebral cortex to assume a phase state. Symptoms and signs such as loss of feeling, limb paralysis, and paralysis are clinically present.

Pavlov believes that the physiological mechanism of suggestive and self-suggested increase in snoring patients is that harmful stimuli can be applied to weak neurological types, which can lead to weakening of cerebral cortex and enhanced subcortical activity, which is called positive induction. Clinical manifestations include emotional outbursts, seizures, instinctual activity, and autonomic symptoms. In addition, strong emotional stress can excite the cortex and cause negative induction. The clinical manifestations are symptoms and signs such as sensory loss, limb paralysis, and spasticity. In the case of weakening of the cerebral cortex, external real-world stimuli produce weak negative induction, and other parts of the cerebral cortex are in a state of inhibition. At this point, the linguistic influence of the suggestive is completely isolated from the activities of other parts of the cortex; thus it has an absolute, irresistible force.

The pathogenesis of this disease has a variety of pathological psychological explanations, different clinical types, and different pathological psychological mechanisms.

Somatization: The concept proposed by Steckel (1943), originally referred to as a deep-seated neurosis of physical disorders, identical to Freud's concept of "transformation". Since then, the meaning of this term has evolved to refer to the pathological psychological process of expressing psychological pain through physical symptoms. The occurrence of somatization is usually not recognized by the patient, but the physical symptoms are not symbolic expressions of inner conflicts in the unconscious area, but are closely related to unpleasant emotional experiences, especially anxiety and depression; For "conversion." Somatization is a fairly common phenomenon in the clinic and in the community and is not limited to snoring. The so-called somatization disorder is only a type of somatization. Somatization is more prominent in the pathogenesis of somatization disorders than in other types of snoring.

Conversion: The concept proposed by Freud early (1894). He believes that the sexual psychology of snoring patients is fixed in the early stage, that is, the stage of the love complex; its sexual impulses are suppressed. Then the mental energy is transformed into physical symptoms; this not only protects the patient from making him unaware of the existence of sexual impulses, but these physical symptoms are often a symbolic expression of inner conflict, thus saving the patient from anxiety (primary acquisition) beneficial).

This type of snoring patient often shows an indifferent attitude towards his physical dysfunction; the 19th-century French doctor called it "belle indifference." This attitude gives the impression that patients do not pay attention to the recovery of their physical functions, but want to retain symptoms to obtain certain social benefits (secondary benefits). Although patients themselves are often unaware of the intrinsic link between symptoms and benefits, pathologists believe that such patients have unintentional motivations, and that switching symptoms are caused by impaired motivations.

Patients with such symptoms have a sick role and can enjoy the patient's rights; the symptoms themselves are sufficient to indicate that their work tasks are not completed, not his own fault, or to achieve the purpose of claiming compensation or controlling others. Therefore, some people regard the symptoms of conversion as a non-verbal communication between the patient and the outside world. But behavioralists believe that switching symptoms is a way for patients to adapt to life experiences that are frustrated, and that post-illness benefits are enhanced by operational conditioning. The symptoms of snoring are seen as a learned response. Once the patient finds such symptoms, it can alleviate the anxiety that the difficult situation brings to him, and the satisfaction of his dependence needs, the symptoms will be strengthened, persist, or reappear in the future.

Separation: The concept proposed by Janet (1889). He pointed out that in many mental disorders, some concepts and cognitive processes can be separated from the mainstream of consciousness and transformed into neurological symptoms such as paralysis, forgetting, state of consciousness changes and autonomic symptoms. But through hypnosis, these concepts and processes can be reintegrated and returned to normal. He believes that these separate components are subconscious. Separation of consciousness is mainly an obstacle to the integration of different conscious components, and is the basis for hypnosis and various snoring. But Freud thinks that separation is a variant of repression, a positive defense process, and its role is to remove painful emotions and thoughts from consciousness. Some modern scholars believe that separation is both a transformational disorder and a basic pathological psychological mechanism of separation disorders. Its occurrence is associated with acute mental stress or self-hypnosis. These patients often have a suggestive increase. The integration of psychological functions such as perception, memory, and identity is suppressed, and it manifests itself as various separation symptoms.

an examination

Related inspection

EEG check EEG sharp wave

There is no specific laboratory test for this disease. When complications such as infections occur, laboratory tests show positive results of complications.

Differential diagnosis

Differential diagnosis of the isolated sputum state and the attached state:

(1) Dissociative amnesia (dissociative amnesia): belongs to psychogenic forgetting. The patient has no organic damage such as head and brain trauma, but suddenly loses memory for major events he has experienced. Forgotten events are often associated with trauma or It is related to stressful events and cannot be remembered for accidental reasons. If it is only limited to events that occur within a certain period of time, it is called a local form or selective forgetting. For those who have lost all memories in the past, they are called generalized form forgetting.

(2) Dissociative fugue: a special form of dissociative disorder. Patients often develop under the influence of acute mental stimulation. Suddenly wandering from one place to another, often it is never If you are away from home, you can leave home or work place and travel to other places. The place of travel may be a familiar and emotional place. At this time, although the patient is in an awakening state, but the scope of consciousness is narrowed, roaming lacks planning and purpose, but the daily basic life (such as eating and drinking) ability and simple social contact (such as ticket purchase, ride, asking for directions, etc.) Keeping, some patients forget their past experiences, and appear in a new identity, others can not see their words and deeds and appearances are obviously abnormal, lasting for tens of minutes to a few days or longer, during which the behavior is quite complete, Afterwards, it will be completely forgotten or only a piece of memory. A typical tour is extremely rare.

(3) Dissociative stupor: triggered by trauma or traumatic experience, with deep disturbance of consciousness, maintaining a fixed posture for a long time, lying on his back or sitting, without words and random movements, No response to light, sound and painful stimuli. At this time, the patient's muscle tension, posture and breathing may be no abnormality. By opening the upper eyelid with your hand, you can see that the eyeball is turning downwards or closing its eyes, indicating that the patient is neither sleeping nor in a coma. It usually takes a few dozen minutes to wake up on its own.

(4) Dissociative trance and possession: The paralyzed state is characterized by a conspicuous narrowing of consciousness, and the parties are in a self-enclosed state, and their attention and consciousness activities are limited to one or two aspects of the current environment. Responding to individual stimuli in the environment, the typical sputum state is seen in hypnosis, witchcraft or superstition activities when the surgeon interacts with "ghost" and "god", and some qigong, such as Hexiang pile, induces The fascination state. A person in a state of paralysis, if his identity is replaced by a deity or a dead person, claiming that he is a god or someone who has died is talking. Separate sputum state and appendage state are involuntary, unintended pathological processes, and the patient's movements, postures, and speech are mostly monotonous and repetitive. The person who can control the occurrence or disappearance of such a state by others or self-introduction is a kind of behavior related to a specific culture or superstition. Although it is separated by consciousness, it should not be diagnosed as a separation disorder.

(5) Dissociative identity disorder: also known as snoring double or multiple personality. The patient suddenly loses all memories of his past events, does not recognize his original identity, and performs daily social activities in another identity, such as devils or undead, to replace the patient's identity. Insufficient awareness of the surrounding environment, its attention and perception are limited to certain aspects of the surrounding people and things, and are linked to the changed identity of the patient. The disease is a transient mental disorder, and there are no psychiatric symptoms such as delusions and hallucinations. It is more common to alternate between two types of personality, called double personality or alternating personality, one of which is often dominant.

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