'Vampirism' in a Case of Dissociative Identity Disorder and Post-Traumatic Stress Disorder

Article (PDF Available)inPsychotherapy and Psychosomatics 81(5):322-3 · August 2012with495 Reads
DOI: 10.1159/000335930 · Source: PubMed
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who the victim was anymore, and remained amnesic to this part
of his act. From time to time, he saw his own face in the mirror
changed into that of a strange violent person. He was disturbed by
intrusive images of the events he had witnessed and also of his acts
because they were ‘shown to him’ by the imaginary companion
vividly. These ‘demonstrations’ triggered ‘crises’, i.e. violent be-
havior, self-mutilation, and suicide attempts. He attempted suicide
several times including hanging himself and tak ing overdoses. He
had recently realized that this imaginary companion resembled
his own childhood. He felt himself to be a ‘slave’ to him. To his as-
tonishment, he became an optimistic person out of the blue from
time to time, which lasted very briefly (i.e. minutes).
He grew up in a disadvantaged neighborhood of a small town
with high crime rates. Having 8 years of education, he was em-
ployed occasionally in minor jobs. He was struck in quarrels sev-
eral times. He denied using drugs except frequent use of alcohol
to ‘relax’. His trunk was covered with tattoos, some of them hid-
ing hypertrophic self-inf liction scars. He was drafted into obliga-
tor y milita ry ser vice 3 mont hs earl ier, however, severe ad aptation
problems associated with his ‘condition’ led to sick leave.
His mother had ‘freak out’ episodes during his entire adoles-
cence and possibly childhood, which seem to be transient disso-
ciative psychosis attacks
[3] . During these episodes, she was out of
control and damaged household appliances. Otherwise, she took
care of her family. He denied having had any childhood psycho-
logical trauma except being attacked by his mother during her
aggressive outbursts. On Childhood Trauma Questionnaire
[4] ,
he only had an elevated score on emotional abuse. Nevertheless,
he was amnesic to his childhood between 5 and 11 years of age.
He had no affective blunting, formal thought disorder, disor-
ganiz ed behavior or delusions. EEG, MRI, a nd IQ (105; Cattel l 2A)
were normal. On the Dissociative Experiences Scale
[5] he got el-
evated scores: 86/100 initially and 54/100 at follow-up. The Struc-
tured Clinical Interview for DSM-IV Dissociative Disorders
[6] confirmed the diagnosis of DID.
Supportive interviews, olanzapine (10 mg/day), paroxetine
(20–40 mg/day), and naltrexone (50 mg/day) were helpful for sta-
bilization during the first 2-week hospitalization; the latter aimed
at alleviation of acute dissociative symptoms. He separated from
his wife and became assaultive in an argument with her family
during the 6-week period after discharge. Sodium valproate
(1,000 mg/day) was added during the second hospitalization for
3 weeks. ‘Blood drinking’ behavior was in remission at follow-up
6 weeks after discharge, however, dissociative symptoms persist-
ed. He insisted that ‘drugs were merely sleeping pills, they would
not cure him’. Being naive about the nature of his frightening dis-
sociative experiences and unable to put them in any meaningful
context, he stated hopelessly: ‘This mess can end by my death
only’, ‘God wanna rescue me’.
‘Vampirism myt h’ has existe d for centur ies. Papers on the sub-
ject appeared in psychiatric journals in the 1960s and 1980s
[1, 2] .
A survey among psychiatrists suggested that ‘vampirism’ has al-
ways been assoc iated with a ‘mental illness’ such as ‘schiz ophreni-
form disorders, hysteria, severe psychopathic disorder, and men-
tal retardation’ or severe sexual offending
[2] . A link to disso-
ciative identity disorder (DID), post-traumatic stress disorder
(PTSD), or possible traumatic antecedents has never been made.
C a s e R e p o r t
A 23-year-old married male (3rd of 6 siblings) presented with
a 2-year history of ‘addiction’ to dri nking blood. He used to cut his
arms, chest, and abdomen with razor blades to collect the blood in
a cup and to drink it. The initia l interest in drink ing his own blood
ha d s ub se qu en tl y t u rn ed to th at of ot he rs ’. T he se ‘cr i se s’ we re c ha r-
acterized by a strong urge to drink blood immediately, ‘as urgent
as breathing’. He enjoyed the smell and taste of blood despite find-
ing this ‘foolish’. He also enjoyed biting wounds of others to taste
flesh. He was arrested several times after attack ing people by stab-
bing and biting t hem with t he intention of collecting and drinking
their blood . He forced his father to obta in blood from blood bank s.
His ‘thirst’ for blood started after the illness and death of his
4-month-old daughter 3 years earlier. He also associated this con-
dition with the murder of his uncle 4 years earlier which he wit-
nessed and st ill recal led lucidly. He remembered hugging the dead
body and feeling blood smeared on his face. He witnessed anoth-
er violent murder 3 years earlier when one of his friends cut off
the victim’s head and penis.
He reported amnesic gaps in daily life. He found himself in a
new place several times without having an idea how he got there.
Occasiona lly, he did not recognize people familiar to him. He was
also called by others using different names. He stated, ‘there are
two me’s in myself ’. He reported seeing a tall man with a black coat
younger than him and a 6- to 7-year-old ‘imaginary companion’.
The latter forced hi m to conduct violent acts and suicide, d ictating:
‘jump on him’, ‘choke him’, ‘kill yourself’. Seemingly related to
these internal dialogues, others observed him talking to himself
occasionally. Possibly due to ‘switching’ to another personality
state, he was losing track during the ‘bloody’ events, did not care
Recei ved: October 11, 2011
Accepted a fter revision: Decembe r 15, 2011
Publish ed online: August 1, 2012
© 2012 S. Ka rger AG, Basel
Accessible online at:
Psychother Psychosom 2012;81:322–323
DOI: 10.1159/000335930
Vampirism’ in a Case of Dissociative Identity
Disorder and Post-Traumatic Stress Disorder
Direnc Sakarya a , Cengiz Gunes
a , Erdinc Ozturk
b , Vedat Sar
a Denizli Military Hospital, Denizli , and
b Department of
Psychiatry, Faculty of Medicine, Istanbul University, Istanbul ,
Tur key
Direnc Sakar ya
Deni zli Asker Hast anesi
TR–20100 Denizli (Turkey)
Tel. +90 312 231 1264
E-Mail direnc  @  gmail .com
Vampirism in a Case of DID Psychother Psychosom
D i s c u s s i o n
Dissociation is defined as a disruption in usually integrated
functions of consciousness, memory, identity or perception of the
[7] . Being the most pervasive type of dissociative
disorders, DID is considered as a chronic post-traumatic condi-
tion closely related to childhood abuse and/or neglect. In PTSD,
trauma-related mental intrusions may lead to dissociative flash-
backs. Ba sed on more chronic and earlier t rauma, these intr usions
become elaborated to distinct mental states in DID. Decontextu-
alized from their traumatic background, some of them obtain
sense of self and agency
[3] .
To our knowled ge, this is the f irst report of a patient wit h ‘vam-
pirism’ and DID. He also met t he criteria for PTSD, major depres-
sive disorder (chronic), and alcohol abuse. Despite his criminal
behaviors, he did not meet the diagnostic criteria of antisocial or
borderline personality disorder, or those of schizophrenic disor-
[7] . Several st udies have shown that SCID-D di fferentiates dis-
sociative disorders from other psychiatric disorders including
schizophrenia reliably
[8] . Malingering was ruled out due to the
consistency of the observations in clinical and standardized ex-
aminations which were too complex to simulate. Factitious disor-
der with psychotic features was also ru led out, because the patient
did not have a history of frequent psychiatric admissions in the
past. Moreover, several symptoms of the patient fit associated fea-
tures of DID such as self-mutilat ion and suicidal behav ior
[3] . Im-
pulsive and aggressive acts leading to crime and conviction in-
cluding serial killing have also been reported previously in DID
[9] . Ma ny studies of DID report an 80–100% prevalence of present
or lifetime PTSD and depression
[3] . Both untreated DID and
PTSD may be complicated with drug or alcohol addiction
[10] .
Tragically, the PTSD of this patient was reinforced by his own
criminal experiences.
A c k n o w l e d g m e n t
The authors declare no conflict of interest and thank Banu
Ibaoglu Vaughn, MA for her help in editing this article.
1 Vandenbergh RL , Kelly JF: Vampirism : a review wit h new observat ions.
Arch Gen Psychiatry 1964;
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2 P rins H: Vampirism: a le gendary or cli nical phenomenon? Med Sci L aw
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3 Spiegel D, Lewis-Fernandez R, Loewenstein R, Sar V, Simeon, D, Ver-
metten E, Cardeña E, Dell PF: Dissociative disorders in DSM-5. De-
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4 Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K,
Sapareto E, Ruggiero J: Initial reliability and validity of a new retro-
spective measure of child abus e and neglect. Am J Ps ychiatry 1994;
5 Bernstein EM, Putnam PW: Development, reliability and validity of a
dissociation scale. J Ner v Ment Dis 1986;
174: 727–735.
6 Steinberg M: Structured Clinical Interview for DSM-IV Dissociative
Disorders-Revised (SCID-D-R). Washing ton, American Psychiatric
Press, 1994.
7 American Psychiatric Association: Diagnostic and Statistical Manual
of Mental Disorders, ed ition 4. Washington, A merican Psychiatric As-
sociation, 1994.
8 Steinberg M, Cicchetti D, Buchana n J, Rak feldt J, Rounsaville B: Dis-
tinguishing between multiple personality disorder (dissociative iden-
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view for DSM-IV Dissociative Disorders. J Ner v Ment Dis 1994;
9 Lewis DO, Yeager CA, Swica Y, Pincus JH, Lewis M: Objective docu-
mentation of child abuse and dissociation in 12 murderers with disso-
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154: 1703–1710.
10 Karadag F, Sar V, Tamar-Gurol D, Evren C, Karagöz M, Erkiran M:
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  • [Show abstract] [Hide abstract] ABSTRACT: A total of 34 consecutive patients with dissociative identity disorder or dissociative disorder not otherwise specified were evaluated using the Turkish version of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). They were compared with a matched control group composed of 34 patients who had a nondissociative psychiatric disorder. Interrater reliability was evaluated by 3 clinicians who assessed videotaped interviews conducted with 5 dissociative and 5 nondissociative patients. All subjects who were previously diagnosed by clinicians as having a dissociative disorder were identified as positive, and all subjects who were previously diagnosed as not having a dissociative disorder were identified as negative. The scores of the main symptom clusters and the total score of the SCID-D differentiated dissociative patients from the nondissociative group. There were strong correlations between the SCID-D and the Dissociative Experiences Scale total and subscale scores. These results are promising for the validity and reliability of the Turkish version of the SCID-D. However, as the present study was conducted on a predominantly female sample with very severe dissociation, these findings should not be generalized to male patients, to dissociative disorders other than dissociative identity disorder, or to broader clinical or nonclinical populations.
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  • [Show abstract] [Hide abstract] ABSTRACT: Vampiristic behaviors are rarely seen clinically and less than 100 cases have been reported in the world literature to date. A distinction is usually made as to whether the patient drinks their own blood or the blood of others. We describe a 38-year-old patient who had vampiristic thoughts and fantasies that began in adolescence, but did not act on these thoughts until after she suffered a traumatic brain injury with a three-week loss of consciousness while serving in the military. Brain imaging showed focal damage to her bilateral frontal lobes. Psychological testing demonstrated impairment of executive function. We review the proposed diagnostic criteria for vampirism and discuss how behavioral disinhibition may have affected the emergence into behavior of her previously inhibited vampiristic thoughts.
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