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There is a gap in research exploring the experiences and explanatory models of people labelled in local communities as possessed. While previous accounts often focused on the links between possession and dissociative disorders or psychosis, the current study elaborates on problems attributed to possession in women with features of personality disorders. Participants were eight Polish Roman Catholic women who had frequented deliverance ministries or individual exorcisms because they were perceived as suffering from malignant possession. Following clinical assessment, video-recorded in-depth interviews about possession experiences were transcribed and subjected to interpretative phenomenological analysis. Participants talked about: 1) Difficulties with expressing emotions and needs; 2) Aversion to the church and its people; 3) Casting spirits out; and 4) Negotiating explanatory models and seeking help. Data shows that the notion of possession can justify unaccepted conflicts and impulses associated with anger, sexuality, and attachment needs in women with personality disorders. Endorsement of, and identification with this belief can prevent people from taking ownership of emotions and using professional treatment. Alongside spiritual counselling, priests involved should have a basic understanding of mental disorders and encourage the use of clinical consultations.
Content may be subject to copyright.
Research
Paper
Beyond
dissociative
disorders:
A
qualitative
study
of
Polish
catholic
women
reporting
demonic
possession
Igor
J.
Pietkiewicz
a,
*,
Urszula
Kłosin
´ska
a
,
Radosław
Tomalski
a
,
Onno
van
der
Hart
b
a
Research
Centre
for
Trauma
&
Dissociation,
Faculty
of
Psychology,
SWPS
University
of
Social
Sciences
&
Humanities,
Katowice,
Poland
b
Department
of
Clinical
and
Health
Psychology,
Utrecht
University,
Utrecht,
The
Netherlands
Spirit
possession
is
a
popular
folk
category
in
many
cultures
worldwide,
especially
Asia
and
Africa
(Hitchcock
&
John,
1976;
Kianpoor
&
Rhoades
Jr,
2006;
Somer,
2004;
Suryani
&
Jensen,
1994;
Van
Duijl,
Kleijn,
&
De
Jong,
2014).
It
is
based
on
a
belief
that
spiritual
entities
(ghosts
of
ancestors,
deities
or
evil
spirits)
can
influence
human
behaviour
by
taking
control
of
the
body,
speech,
or
mind
of
the
person.
Religious
methods
are
often
applied
in
an
attempt
to
appease
these
spirits,
control
or
exorcise
them
from
the
host
(Boddy,
1994).
This
malignant
or
pathological
form
of
possession,
associated
with
suffering
and
distress,
should
be
distinguished
from
pleasant
or
desired
experiences
associated
with
channelling
or
mediumship
(Carden
˜a,
Van
Duijl,
Weiner,
&
Terhune,
2009;
Lewis,
2003;
Pietkiewicz,
Lecoq-Bamboche,
&
Van
der
Hart,
2019;
Schaffler,
Carden
˜a,
Reijman,
&
Haluza,
2015).
Delmonte,
Lucchetti,
Moreira-Almeida,
and
Farias
(2016),
for
instance,
presented
a
Brazilian
woman
reporting
episodes
of
possession-trance,
who
became
involved
in
the
Umbanda
trance
religion
and
subsequently
became
a
medium.
There
are
similarities
between
her
history
and
the
Mauritian
faith
healer
described
by
Pietkiewicz,
Pietkiewicz,
Lecoq-Bamboche,
and
Van
der
Hart
(2019).
The
non-malignant
religious
possession
described
by
Delmonte
et
al.
(2016)
apparently
refers
to
the
kind
of
positive
experiences
(sometimes
ritually
induced)
associated
with
medi-
umship,
where
people
feel
they
are
controlled
by
spirits,
and
receive
their
support
and
guidance
(Boddy,
1994).
Despite
reporting
problems
with
relationships
and
distress,
participants
in
both
the
Brazilian
and
Mauritian
case
studies
adopted
the
highly
valued
role
of
faith
healer,
and
enjoyed
certain
associated
advantages.
This
demonstrates
the
thin
line
between
so
called
malignant
and
non-malignant
possessions.
Apart
from
the
theological
meaning
of
possession,
this
term
is
also
used
in
medical
discourse.
By
including
Trance
and
Possession
Disorders
(F44.3)
in
the
chapter
on
dissociative
disorders
in
ICD-10,
the
World
Health
Organization
(1993)
indicates
that
there
is
a
link
between
possession-form
presentations
and
dissociative
disorders.
DSM-5
mentions
that
distinct
personality
states
present
in
the
Dissocia-
tive
Identity
Disorder
may
be
described
in
some
cultures
as
an
European
Journal
of
Trauma
&
Dissociation
5
(2021)
100204
A
R
T
I
C
L
E
I
N
F
O
Article
history:
Received
27
July
2020
Received
in
revised
form
7
January
2021
Accepted
15
January
2021
Available
online
Keywords:
Possession
Folk
categories
Personality
disorders
Religious
coping
Exorcism
Dissociation
A
B
S
T
R
A
C
T
There
is
a
gap
in
research
exploring
the
experiences
and
explanatory
models
of
people
labelled
in
local
communities
as
possessed.
While
previous
accounts
often
focused
on
the
links
between
possession
and
dissociative
disorders
or
psychosis,
the
current
study
elaborates
on
problems
attributed
to
possession
in
women
with
features
of
personality
disorders.
Participants
were
eight
Polish
Roman
Catholic
women
who
had
frequented
deliverance
ministries
or
individual
exorcisms
because
they
were
perceived
as
suffering
from
malignant
possession.
Following
clinical
assessment,
video-recorded
in-depth
interviews
about
possession
experiences
were
transcribed
and
subjected
to
interpretative
phenomenological
analysis.
Participants
talked
about:
(1)
Difficulties
with
expressing
emotions
and
needs;
(2)
Aversion
to
the
church
and
its
people;
(3)
Casting
spirits
out;
and
(4)
Negotiating
explanatory
models
and
seeking
help.
Data
shows
that
the
notion
of
possession
can
justify
unaccepted
conflicts
and
impulses
associated
with
anger,
sexuality,
and
attachment
needs
in
women
with
personality
disorders.
Endorsement
of,
and
identification
with
this
belief
can
prevent
people
from
taking
ownership
of
emotions
and
using
professional
treatment.
Alongside
spiritual
counselling,
priests
involved
should
have
a
basic
understanding
of
mental
disorders
and
encourage
the
use
of
clinical
consultations.
C
2021
SWPS
University
of
Social
Sciences
&
Humanities,
Research
Centre
for
Trauma
&
Dissociation.
Published
by
Elsevier
Masson
SAS.
This
is
an
open
access
article
under
the
CC
BY
license
(http://
creativecommons.org/licenses/by/4.0/).
*Corresponding
author
at:
Research
Centre
for
Trauma
&
Dissociation,
SWPS
University
of
Social
Sciences
&
Humanities,
Techniko
´w
9,
Katowice,
Poland.
E-mail
address:
ipietkiewicz@swps.edu.pl
(I.J.
Pietkiewicz).
Available
online
at
ScienceDirect
www.sciencedirect.com
https://doi.org/10.1016/j.ejtd.2021.100204
2468-7499/
C
2021
SWPS
University
of
Social
Sciences
&
Humanities,
Research
Centre
for
Trauma
&
Dissociation.
Published
by
Elsevier
Masson
SAS.
This
is
an
open
access
article
under
the
CC
BY
license
(http://creativecommons.org/licenses/by/4.0/).
experience
of
possession
(APA,
2013).
Thus,
authors
of
DSM-5
stress
the
fact
that
sudden
changes
in
behaviour
and
identity
attributed
to
possession,
may
entail
switches
between
dissociative
personality
states
in
individuals
suffering
from
Dissociative
Identity
Disorder
or
Other
Specified
Dissociative
Disorder.
However,
a
distinct
possession
category
does
not
exist
in
this
manual
(APA,
2013).
So,
possession-form
presentations
were
often
associated
with
dissociative
disorders
and
traumatic
experiences
(Pietkiewicz
&
Lecoq-Bamboche,
2017;
Ross,
2011;
Somer,
2004;
Suryani
&
Jensen,
1994;
Van
der
Hart,
Lierens,
&
Goodwin,
1996;
Van
Duijl,
Nijenhuis,
Komproe,
Gernaat,
&
De
Jong,
2010).
On
the
other
hand,
delusions
of
possessions
were
rather
linked
with
schizophrenia
(Goff,
Brotman,
Kindlon,
Waites,
&
Amico,
1991),
but
there
is
insufficient
research
exploring
possession
in
the
context
of
psychosis.
Kua,
Sim,
and
Chee
(1986)
observe
that
some
people
were
wrongly
diagnosed
with
schizophrenia
only
because
they
held
beliefs
about
being
controlled
by
alien
forces,
so
fulfilling
the
criterion
of
Schneiderian
first-rank
symptoms.
However,
having
strong
beliefs
in
spirit
possession
does
not
have
to
indicate
delusions.
Various
authors
stress
that
all
experiences
and
beliefs
must
be
understood
within
the
context
in
which
they
appear
because
cultural
factors,
including
folk
beliefs
and
practices,
will
affect
both
clinical
presentations
and
people’s
explanatory
models
(e.g.,
Kua
et
al.,
1986;
Tseng,
2001).
People
labelled
or
identifying
themselves
as
possessed
and
using
religious
coping
strategies
may
represent
a
heterogeneous
group
of
diagnostic
categories,
including:
schizophrenia,
dissocia-
tive
disorders,
and
also
personality
disorders.
However,
possession
experiences
have
been
insufficiently
explored
in
the
last
category
(Pietkiewicz
&
Lecoq-Bamboche,
2017;
Pietkiewicz,
Lecoq-Bambo-
che
et
al.,
2019;
Van
der
Hart
et
al.,
1996).
There
also
may
be
individuals
without
a
psychiatric
diagnosis
who
simply
express
their
conflicts
and
needs
in
a
culturally
legitimate
way
(Pietkie-
wicz,
2008).
Experiences
attributed
to
spirit
possession,
ways
of
reporting
them,
and
accompanying
symptoms
have
never
been
clinically
analysed
in
detail,
although
existing
research
has
compared
possession
narratives
with
local
categories
and
phenomena
described
in
psychiatric
manuals
(Somer,
2004;
Van
der
Hart
et
al.,
1996;
Van
Duijl,
Kleijn,
&
De
Jong,
2013).
Pietkiewicz,
Pietkiewicz,
Lecoq-Bamboche,
and
Van
der
Hart
(2019)
stress
the
need
for
more
qualitative
studies
in
which
individuals
labelled
as
possessed,
while
using
religious
methods
would
be
subjected
to
thorough
clinical
assessment.
People
have
a
natural
tendency
to
search
for
meaning,
especially
when
they
face
illness
or
distress
(Pargament,
1997).
Cultural
psychiatrists
use
the
term
‘explanatory
models’
(EMs)
to
describe
the
concepts
about
an
episode
of
sickness
developed
by
individuals,
its
aetiology,
severity,
symptoms,
potential
risks,
and
recommended
treatment
(Kleinman,
1980;
Pietkiewicz,
2008).
These
personal
EMs
are
held
by
everyone
involved
in
and
interpreting
a
given
problem,
e.g.,
the
patient,
family
members,
healthcare
providers,
or
their
spiritual
community,
and
can
be
influenced
by
more
general
‘folk
categories’,
i.e.,
ways
in
which
different
communities
recognise
and
label
mental
problems
(Tseng,
2001).
From
a
clinical
perspective,
it
is
important
to
explore
patients’
EMs,
because
they
are
likely
to
determine
coping
strategies,
motivation
to
use
treatment,
and
compliance.
For
example,
people
who
ascribe
their
symptoms
to
demonic
influence
may
be
more
inclined
to
use
religious
coping
instead
of
clinical
assessment
and
treatment
(Pietkiewicz,
2008).
Individuals
may
also
feel
confused
and
distressed
when
they
hold
different
and
conflicting
EMs
simultaneously,
or
when
their
EMs
are
not
supported
by
the
environment
for
example,
when
they
attribute
current
problems
to
possession
but
their
priest
refutes
this
theory
and
refers
them
to
a
psychiatrist,
or
when
family
and
friends
try
to
persuade
someone
that
he
or
she
is
possessed
(Pietkiewicz
&
Lecoq-Bamboche,
2017;
Pietkiewicz,
Lecoq-Bamboche
et
al.,
2019).
Exploration
of
spiritual/religious
coping
is
one
of
the
leading
trends
in
the
psychology
of
religion
(Westerink,
2013).
Research
shows
that
this
type
of
coping
can
be
both
beneficial
and
maladaptive
(Dillon
&
Wink,
2007).
On
the
one
hand,
religion
can
provide
people
with
a
sense
of
meaning
and
control,
when
they
can
justify
life
events
through
a
spiritual
lens.
It
can
also
be
a
means
of
emotional
comfort,
reassurance,
and
closeness
with
the
congregation,
clergy,
or
God.
This
is
often
associated
with
benevolent
religious
reappraisal,
conviction
that
God
is
a
source
of
love
and
support,
and
that
there
exists
a
greater
meaning
in
life
(Pargament,
1997;
Pargament,
Koenig,
&
Perez,
2000).
On
the
other
hand,
people
who
strive
with
a
punishing
and
rejecting
image
of
God
are
likely
to
experience
spiritual
discontent,
conflicts
with
the
community
and
religious
authorities.
This
type
of
God
representa-
tion
was
reported
more
often
by
people
with
personality
disorders
and
affective
disorders
than
in
non-clinical
groups
(Schaap-Jonker,
Van
der
Velde,
Eurelings-Bontekoe,
&
Corveleyn,
2017).
Greenway,
Milne,
and
Clarke
(2003)
observe
that
women
with
a
negative
image
of
God
were
more
depressed,
had
more
self-doubt,
and
suffered
from
lower
self-competence
and
self-esteem.
They
could
perceive
the
world
around
them
as
more
hostile.
Rizzuto
(1979,
2009)
attributes
that
to
traumatic
childhood
experiences
and
insecure
attachment.
Ineffective
religious
coping
also
includes
faulty
appraisals
based
on
religious
beliefs
and
practices,
and
neglecting
other
potentially
appropriate
explanations
(Pargament
et
al.,
2003).
In
people
suffering
from
mental
or
physical
illness,
this
may
lead
to
refusing
clinical
assessment
or
treatment,
and
leaving
one’s
health
exclusively
in
the
hands
of
God
or
demonisa-
tion
(Paloutzian
&
Park,
2014).
According
to
Rhoades
(2006),
understanding
a
patient’s
clinical
presentation
requires
exploring
their
traditional
upbringing
and
engagement
in
cultural
practices.
Kru
¨ger
(2020)
claims
that
qualitative
research
is
best
suited
for
this
purpose.
It
allows
in-depth
exploration
of
people’s
individual
experiences,
symptoms
and
meaning-making,
and
is
not
limited
to
predefined
concepts
and
hypotheses.
The
aim
of
this
idiographic
research
was
interpretative
phenomenological
analysis
of
experiences
attributed
in
the
local
community
to
possession
for
which
participants
were
subjected
to
deliverance
ministries
or
individual
exorcisms,
combined
with
their
thorough
clinical
assessment.
This
paper
focuses
on
participants
with
features
of
personality
disorder
and
reporting
possession,
in
whom
psychosis
or
severe
dissociative
disorder
have
been
ruled
out.
It
thus
contributes
to
understanding
the
complexity
of
the
folk
category
of
possession.
Method
This
study
was
carried
out
in
Poland
in
2018
and
2019.
Qualita-
tive
data
were
gathered
using
in-depth
clinical
interviews
and
psychiatric
mental
health
assessment,
and
were
subjected
to
Interpretative
Phenomenological
Analysis
(IPA;
Smith
&
Osborn,
2008).
This
popular
methodological
framework
in
psychology
is
most
suitable
for
exploring
people’s
lived
experiences
and
interpretations
of
phenomena
under
investigation.
IPA
was
chosen
to
explore
how
people
use
folk
categories
associated
with
possession
to
make
meaning
of
their
own
experiences
or
life
adversities.
IPA
relates
to
phenomenological,
hermeneutic,
and
idiographic
principles,
employing
‘double
hermeneutics’,
in
which
participants
share
their
experiences
and
interpretations,
followed
by
resear-
chers
trying
to
make
sense
and
comment
on
these
interpretations.
IPA
studies
in
particular
use
small,
homogenous,
purposefully
selected
samples,
and
qualitative
material
is
carefully
analysed
case-by-case
(Pietkiewicz
&
Smith,
2014;
Smith
&
Osborn,
2008).
I.J.
Pietkiewicz,
U.
Kłosin
´ska,
R.
Tomalski
et
al.
European
Journal
of
Trauma
&
Dissociation
5
(2021)
100204
2
Procedure
This
study
is
part
of
a
larger
project
examining
phenomena
and
symptoms
reported
by
people
seeking
religious
rituals
to
liberate
themselves
from
demonic
influence.
This
project
was
held
at
the
Research
Centre
for
Trauma
and
Dissociation,
financed
by
the
National
Science
Centre,
and
approved
by
the
Ethical
Review
Board
at
the
SWPS
University
of
Social
Sciences
and
Humanities
in
Poland.
Potential
candidates
enrolled
themselves
via
an
applica-
tion
integrated
with
a
dedicated
website,
or
were
registered
by
healthcare
providers
and
pastoral
counsellors.
They
filled
in
demographic
information
and
completed
online
tests,
including:
Somatoform
Dissociation
Questionnaire
(Pietkiewicz,
Hełka,
&
Tomalski,
2018),
Dissociative
Experiences
Scale
-
Revised
(Piet-
kiewicz,
Hełka,
&
Tomalski,
2019),
and
Traumatic
Experiences
Checklist
(Nijenhuis,
Van
der
Hart,
&
Kruger,
2002).
They
then
participated
in
a
semi-structured
interview
exploring
their
biography,
family
situation,
religious
socialisation
and
spiritual
involvement,
and
motives
for
enrolling
in
the
study.
Example
of
the
open-ended
questions
were:
How
did
you
decide
to
enrol
this
study
and
why?
Can
you
tell
me
something
about
your
family
and
growing
up?
What
is
the
role
of
religion
or
spirituality
at
your
home?
The
reviewer
negotiated
meaning,
requested
specific
examples
and
asked
additional
question
to
explore
issues
reported
by
the
participants.
This
was
followed
by
an
in-depth
clinical
assessment
using
the
Trauma
&
Dissociation
Symptoms
Interview
(TADS-I;
Boon
&
Matthess,
2017).
TADS-I
completion
ranges
from
two
to
four
hours
and
was
often
held
in
separate,
shorter
sessions.
It
collects
information
about
problems
related
to:
use
of
substances,
eating,
sleep,
mood
and
affect
regulation,
auto-
destructive
behaviour,
self-image
and
identity,
interpersonal
relationships,
sexuality.
It
also
explores
dissociative
symptoms
and
post-traumatic
symptoms,
which
enables
the
diagnosis
of
dissociative
disorder
or
ruling
it
out.
It
also
provides
sufficient
clinical
information
to
diagnose
a
personality
disorder
as
a
general
category,
without
distinguishing
a
specific
sub-type.
Participants
were
asked
to
explain
all
symptoms
and
provide
specific
examples
from
daily
life.
In
Poland,
there
is
no
gold
standard
for
diagnosing
or
ruling
out
dissociative
disorders,
and
this
instrument
was
found
most
suitable.
This
interview
was
followed
by
an
additional
mental
state
assessment
performed
by
the
third
author
who
is
a
psychiatrist.
He
collected
medical
data,
double-checked
the
most
important
symptoms,
confirmed
and
communicated
the
diagnosis
and
discussed
available
coping
strategies.
All
interviews
were
video-recorded
and
assessed
by
three
healthcare
professionals
experienced
in
the
dissociation
field,
who
discussed
each
case
and
consensually
came
up
with
an
ICD-10
based
diagnosis.
Eight
participants
out
of
17
were
chosen
for
this
IPA
study.
Selection
was
based
on
the
following
inclusion
criteria,
ensuring
a
homogenous
sample
expected
of
IPA
studies
(a)
female,
(b)
labelled
in
local
communities
as
possession
victims,
(c)
earlier
participation
in
individual
exorcism
or
deliverance
ministry,
(d)
psychosis
or
complex
dissociative
disorder
ruled
out.
Interviews
with
every
participant
in
this
study
ranged
from
4
to
5.5
h.
Participants
Participants
in
this
study
were
eight
Roman
Catholic
women
aged
between
19
and
37
years,
labelled
by
members
of
local
religious
communities
as
victims
of
demonic
influence
due
to
their
uncontrollable
behaviour,
physical
complaints
or
life
difficulties.
Three
of
them
had
higher
education,
five
of
them
secondary.
Five
enrolled
themselves
in
the
study,
hoping
to
discuss
their
symptoms
with
a
healthcare
provider;
two
were
referred
by
a
priest,
and
one
by
her
psychiatrist.
Three
had
been
subjected
to
individual
exorcisms
and
four
participated
in
Roman
Catholic
church
group
rituals
for
pacifying
demonic
influence.
All
but
one
(Emily)
regularly
participated
in
religious
rituals,
confession
or
used
pastoral
counselling.
All
had
familiarised
themselves
with
the
concept
of
possession
by
reading
books,
religious
magazines,
or
watching
YouTube
videos
presenting
exorcisms.
Two
had
previ-
ously
used
psychiatric
treatment
and
one
had
used
psychotherapy
for
problems
with
affect
regulation
and
relationships.
All
presented
features
of
personality
disorders,
including:
problems
with
affect
regulation,
difficulty
in
establishing
and
maintaining
satisfactory
relationships,
and
poor
self-image.
None
met
the
criteria
for
a
psychotic
or
complex
dissociative
disorder:
none
reported
auditory
hallucinations,
PTSD
symptoms
(e.g.,
intrusions
of
traumatic
memories
and
avoidance),
amnesia
for
daily
events,
autoscopic
phenomena
(e.g.,
out-of-body
experiences),
or
other
symptoms
indicating
the
existence
of
autonomous
dissociative
parts.
They
had
elevated
scores
in
SDQ-20
and
DESR,
but
they
had
a
tendency
to
aggravate
and
no
pathological
dissociative
symptoms
were
confirmed
during
diagnostic
assessment.
They
all
felt
emotionally
neglected
by
caregivers
in
childhood
and,
except
Maria,
reported
emotional
abuse
by
significant
others
(see
Table
1).
Their
names
have
been
changed
to
maintain
confidentiality.
Data
analysis
All
video
recordings
were
transcribed
verbatim
and
analysed
together
with
researchers’
notes
using
qualitative
data-analysis
software
NVivo10.
Consecutive
steps
recommended
for
IPA
were
employed
in
the
study
(Pietkiewicz
&
Smith,
2014).
For
each
interview,
researchers
watched
the
recording
and
carefully
read
the
transcript
several
times.
They
individually
made
notes
about
body
language,
facial
expressions,
the
content
and
language
use,
and
wrote
down
their
interpretative
comments
using
the
annotation
feature
in
NVivo10.
Next,
they
categorised
their
notes
into
emergent
themes
by
allocating
descriptive
labels
(nodes).
The
team
then
compared
and
discussed
their
coding
and
interpreta-
tions.
Connections
between
themes
in
each
interview
and
between
cases
were
analysed,
and
grouped
according
to
conceptual
similarities
into
main
themes
and
sub-themes.
Credibility
checks
During
each
interview,
participants
were
encouraged
to
give
specific
examples
illustrating
reported
symptoms
or
experiences.
Clarification
questions
were
asked
to
negotiate
the
meaning
participants
wanted
to
convey.
At
the
end
of
the
interview,
they
were
also
asked
questions
to
check
that
their
responses
were
thorough.
The
researchers
discussed
each
case
thoroughly
and
also
compared
their
interpretative
notes
to
review
their
understanding
of
the
content
and
its
meaning
(the
second
hermeneutics).
Results
Participants
described
relationships
and
personal
experiences
which
led
to
their
participation
in
exorcisms
or
deliverance
ministries.
Salient
themes
appeared
in
interviews
and
were
organised
into
four
main
themes
and
four
sub-themes,
as
listed
in
Table
2.
Each
theme
is
discussed
and
illustrated
with
verbatim
excerpts
from
the
interviews,
in
accordance
with
IPA
principles.
Theme
1:
difficulties
with
expressing
emotions
and
needs
All
participants
were
brought
up
in
Catholic
environments
with
strict
rules
about
how
to
express
emotions
and
needs
in
a
normative
way.
Some
of
these
norms
fuelled
internal
conflicts
associated
with
aggression,
sexuality,
seeking
pleasure
and
attention.
I.J.
Pietkiewicz,
U.
Kłosin
´ska,
R.
Tomalski
et
al.
European
Journal
of
Trauma
&
Dissociation
5
(2021)
100204
3
Poor
regulation
of
anger
All
participants
talked
about
problems
confronting
anger
and
expressing
their
own,
which
they
attributed
to
negative
childhood
experiences.
They
described
their
environment
as
unpredictable
and
unsupportive:
mothers
as
controlling
but
powerless
against
abusive
husbands,
and
fathers
as
verbally
and
physically
abusive,
sometimes
absent,
indifferent
and
withdrawn.
All
had
experienced
physical
punishment
and
emotional
abuse.
My
home
wasn’t
normal.
My
father
drank
and
sometimes
disappeared
for
a
couple
of
weeks.
My
mother
tried
to
take
care
of
everything
and
shared
all
her
troubles
with
me,
so
I
tried
not
to
burden
her
with
my
own
stuff.
(Karina)
My
father
was
impulsive
and
sometimes
hit
me
with
his
belt.
It
wasn’t
always
my
fault,
though
sometimes
I
may
have
deserved
it.
But
my
mother
made
me
feel
guilty:
‘‘I
spend
so
much
time
raising
you,
and
this
is
how
you
repay
me!’’
(Alina)
My
father
invited
me
once
for
holidays,
and
he
beat
me
up
when
I
spilt
coffee
on
his
laptop.
He
was
furious
and
I
ended
up
with
a
broken
lip,
twisted
hand,
and
a
bruise
on
my
head.
When
I
told
my
aunt
and
grandmother
they
didn’t
believe
me.
They
took
his
side
and
warned
me
not
to
go
to
the
police,
because
it
would
destroy
our
family.
(Pat)
In
adult
life
they
often
experienced
increased
irritability
and
had
difficulties
with
self-soothing.
All
reported
rapid
mood
changes
which
sometimes
led
to
explosions
of
anger:
they
screamed,
called
people
names
and
were
destructive.
They
didn’t
usually
know
why
they
were
so
angry.
Emily
admitted
being
very
stressed
about
her
family
situation
and
her
own
health
problems.
When
she
sensed
a
critical
moment
was
coming,
she
relied
on
tranquillisers.
I
was
playing
chess
with
a
friend
and
I
had
no
idea
why
I
got
so
upset.
I
was
about
to
explode
and
pick
a
fight,
so
I
ran
home
to
take
a
pill.
I
was
still
furious,
but
I
also
felt
safe
as
it
would
not
get
out
of
control
and
I
would
not
hurt
anyone.
(Emily)
Five
participants
admitted
a
tendency
to
violence
and
auto-
aggression.
Maria
said
she
often
lost
her
temper
if
she
felt
ignored
and
humiliated.
Table
1
Study
participants.
Karina
Age
19,
single,
secondary
education.
Lives
with
her
mother
and
two
younger
brothers;
parents
divorced
due
to
father’s
alcohol
problems
and
physical
abuse.
Has
had
no
intimate
relationships,
involved
with
youth
religious
groups
since
childhood,
currently
reports
difficulties
in
trust,
establishing
and
maintaining
friendships,
affect
regulation,
low
self-esteem,
feelings
of
rejection.
Previously
diagnosed
and
treated
for
conversion
symptoms.
At
age
14,
consulted
exorcists
because
of
non-epileptic
seizures,
difficulty
swallowing
holy
communion,
upsetting
religious
dreams,
and
anger
towards
priests.
Convinced
she
had
mediumic
powers.
Subjected
to
individual
exorcisms
multiple
times.
Mira
Age
20,
single,
secondary
education.
Lives
with
her
parents
and
elder
sister.
No
reports
of
traumatic
experiences.
Has
had
no
intimate
relationships,
involved
with
youth
religious
groups
since
childhood,
limited
social
contacts
(maintains
online
friendship
with
two
girls
and
an
older
friend);
convinced
she
made
a
pact
with
devil
at
age
16
in
exchange
for
saving
a
friend
from
excessive
masturbation;
cuts
herself
to
sign
contracts,
experiences
pain
during
religious
rituals
or
confession,
referred
by
a
priest
to
an
exorcist,
ambivalent
about
the
support
of
community
members
who
show
interest
and
pray
for
her.
Reports
no
memory
of
texting
offensive
messages
to
friends;
depressive
mood,
emptiness,
outbursts
of
anger,
suicidal
ideations.
Has
never
had
psychiatric
treatment
or
psychotherapy.
Emily
Age
22,
single,
secondary
education.
Works
in
a
grocery,
lives
with
parents,
has
had
a
boyfriend
for
four
years.
Rarely
engages
in
religious
practices
usually
under
parents’
pressure.
At
age
14
diagnosed
with
multiple
sclerosis
and
later
treated
with
steroids
or
interferon.
Reports
problems
controlling
anger
towards
mother,
conflicts
with
negligent
father,
difficulties
with
self-soothing,
no
friends,
two
suicide
attempts,
appears
cheerful
to
mask
depressive
mood,
concerned
about
her
future
and
limitations
associated
with
disease.
Has
participated
in
deliverance
ministries
under
the
pressure
of
her
mother.
Pat
Age
22,
single,
secondary
education.
Unemployed
and
never
worked,
lives
with
her
mother
and
grandparents
who
are
very
religious;
parents
divorced
due
to
father’s
alcohol
problems
and
physical
abuse.
Has
never
had
a
partner
or
intimate
contacts,
no
close
friends,
encouraged
by
mother
to
participate
in
individual
exorcisms
and
deliverance
ministries
because
of
irritability,
outbursts
of
anger,
screaming,
breaking
things,
and
not
reacting
to
attempts
to
calm
her
down;
difficulties
with
sleep.
Alina
Age
26,
single,
higher
education.
Works
as
a
teacher,
lives
with
parents
who
support
her
financially,
reports
conflicts
with
father
who
used
to
be
physically
abusive.
Has
never
been
in
a
relationship
nor
had
intimate
contacts.
Involved
with
religious
activities,
participated
in
church
youth
groups
since
childhood,
has
limited
social
group,
and
maintains
contact
with
two
friends
from
religious
communities.
Had
individual
exorcisms
for
three
years
because
unable
to
say
anything
during
confession
or
prayers;
intense
anger
towards
religious
community
members,
sent
offensive
texts
to
her
confessor,
or
spat
out
holy
communion
(some
behaviours
covered
by
amnesia).
She
reports
intrusive
auto-aggressive
thoughts,
difficulties
falling
asleep,
bad
dreams,
irritability
and
distrust.
Has
previously
used
psychotherapy.
Maria
Age
27,
single,
higher
education.
Works
in
an
office,
lives
with
mother
and
her
partner,
reports
conflicts
with
father
who
abused
alcohol
and
was
violent.
Declared
lesbian
but
no
sexual
contacts,
finished
with
a
girlfriend
because
this
conflicted
with
her
religious
beliefs.
Highly
engaged
in
church
activities,
prayer
groups,
has
a
few
friends
from
these
communities.
Subjected
to
individual
exorcisms
because
of
irritability
and
trembling
during
group
prayers
or
deliverance
rituals,
in
which
she
participated
for
eight
months;
she
has
similar
reactions
when
she
thinks
people
try
to
put
her
down,
which
may
lead
to
screaming,
breaking
things,
and
auto-aggression
(slapping
her
face,
cutting
herself,
self-loathing).
Joan
Age
29,
single,
higher
education.
Works
in
a
company,
lives
alone,
engaged
in
religious
practices.
She
broke
with
her
partner
when
her
confessor
justified
her
problems
by
staying
in
an
extramarital
relationship.
Encouraged
by
her
father,
she
saw
an
exorcist
for
six
months,
convinced
she
was
cursed
by
neighbours
and
influenced
by
spirits
which
led
to
mother’s
neurological
disease
and
suicide
attempt,
parents’
car
accident
and
conflicts,
and
house
damage.
She
reports
problems
in
relationships,
depressive
mood
and
anxiety,
intrusive
auto-aggressive
thoughts.
She
has
been
diagnosed
with
autoimmune
disease,
and
previously
used
counselling
for
a
few
months.
Roma
Age
37,
married,
secondary
education.
Works
in
a
warehouse,
has
two
daughters
(16
and
18)
and
a
son
(19)
from
a
previous
marriage.
Her
ex-husband
was
violent
and
cheated
on
her,
now
pregnant
with
current
partner.
She
has
seen
a
psychiatrist
for
15
years
for
anxiety
and
depression,
made
three
suicide
attempts
(at
age
13,
16
and
34),
avoids
closer
relationships
(especially
with
women),
reports
conflicts
with
parents,
especially
father
who
abused
alcohol
and
was
violent,
has
difficulties
controlling
her
anger
(breaks
things
or
hurts
people
during
arguments).
She
participated
in
deliverance
ministries
for
three
years
during
which
she
had
seizures,
sobbed
heavily
and
was
unresponsive;
she
was
referred
to
an
exorcist
after
getting
auto-aggressive,
laughing
and
crying
out.
Table
2
Main
themes
and
sub-themes
identified
during
analysis.
Theme
1:
Difficulties
with
expressing
emotions
and
needs
Poor
regulation
of
anger
Declaring
amnesia
for
shameful
actions
Religious
norms
conflicting
with
sexual
behaviour
or
desires
Unsatisfactory
relationships
Theme
2:
Aversion
to
church
and
its
people
Theme
3:
Casting
spirits
out
Theme
4:
Negotiating
explanatory
models
and
seeking
help.
I.J.
Pietkiewicz,
U.
Kłosin
´ska,
R.
Tomalski
et
al.
European
Journal
of
Trauma
&
Dissociation
5
(2021)
100204
4
Sometimes
I
feel
that
people
are
trying
to
humiliate
me,
that
they
think
I
am
worthless,
nothing.
This
drives
me
crazy
and
I
am
obsessed
with
it
all
day.
I
may
plan
to
take
revenge
on
someone,
and
lash
out
suddenly
[.
.
.]
I
slap
myself,
hit
my
head
against
a
wall,
or
cut
myself
with
nail
clippers.
(Maria)
Joan
would
become
mean
and
nasty
to
her
work
colleagues
or
friends,
which
then
evoked
self-reproach.
I
would
lose
control
and
say
things
that
I
would
normally
never
do,
as
if
my
mind
lost
control
over
my
mouth.
I
would
become
snappy
and
say
something
unexpected.
(Joan)
Alina,
on
the
other
hand,
only
fantasised
about
retaliation.
Her
hostile
impulses
conflicted
with
internalised
strict
norms
and
affected
her
self-esteem.
I
know
I
am
such
a
bad
person.
When
I
am
angry
with
someone,
I
want
to
say
a
thousand
bad
things.
But
I
only
think
about
doing
so.
I
know
that
theoretically
I
could
say
these
things,
so
I
know
that
my
intentions
are
not
always
good.
(Alina)
Declaring
amnesia
for
shameful
actions
All
participants
except
Maria
reported
full
or
partial
amnesia
for
certain
actions
which
evoked
feelings
of
shame,
guilt,
and
fear
of
losing
control.
For
Alina,
Emily
and
Roma
these
were
often
rapid
and
short
moments
of
fury.
Later
on,
they
learned
from
someone
else
about
things
they
did
or
said.
Emily
stressed
this
only
happened
during
arguments
with
her
mother
or
boyfriend.
Unaware
of
having
any
hostile
feelings
towards
them,
she
felt
confused
about
her
actions.
I
can’t
remember
why
I
yelled
at
her.
She
said
I
told
her
she
was
a
wicked
mother.
I
could
never
say
that
to
my
mom.
Never,
ever
would
that
go
through
my
mouth.
She
told
me
later
that
I
said
nasty
things.
I
am
really
surprised.
My
mom
thinks
it
is
because
I
listen
to
bad
music
and
because
I
was
possessed.
(Emily)
Pat
said
she
lost
her
temper
after
some
accusations
from
family
members
and
later
lost
awareness
of
what
she
was
doing.
She
remembers
running
to
a
garden,
where
she
screamed
and
threw
herself
on
the
ground,
but
she
only
heard
from
witnesses
what
she
did
and
said.
Roma
was
afraid
of
doing
things
in
extreme
circumstances
without
remembering
them.
She
shared
a
story
which
could
have
had
tragic
consequences.
My
sister
really
upset
me
and
I
threw
a
mug
at
her.
She
retaliated
and
I
got
furious.
I
grabbed
a
knife.
My
children
saw
me
and
ran
from
the
kitchen.
I
stabbed
her
shoulder
a
few
times
before
my
husband
caught
me.
Luckily
she
was
dressed
and
only
got
bruises.
I
do
not
remember
this.
My
mother
also
told
me
I
once
held
a
knife
and
screamed
that
I
would
kill
everyone
because
I
could
not
take
it
any
longer,
but
I
don’t
remember.
(Roma)
Mira
found
out
she
had
offended
friends
during
online
discussions
for
which
she
claimed
to
have
no
memory.
Alina
experienced
remorse
and
guilt
for
vulgar
messages
she
sent
to
her
spiritual
director
during
the
night.
She
said
she
was
shocked
when
she
discovered
them
next
morning,
as
she
did
not
remember
writing
to
the
priest.
Sometimes
text
messages
with
different
accusations
and
insults
were
sent
from
my
phone
to
this
priest.
I
do
not
remember
writing
them.
They
contained
vulgar,
derogatory,
things
that
would
never
come
from
my
mouth;
I
also
called
him
‘prick’
or
‘motherfucker’,
things
like
that.
(Pat)
High
absorption
in
inner
experiences
and
trance-like
states
could
also
lead
to
memory
problems.
In
stressful
situations
some
participants
stopped
paying
attention
to
what
was
happening
around
them
and
concentrated
on
bodily
sensations
or
feelings.
Joan
described,
for
instance,
how
nervous
she
was
during
confessions,
because
the
priest
didn’t
approve
of
her
extramarital
relationship
or
the
affair
she
had
at
work.
She
felt
tightness
in
her
throat
preventing
her
from
confessing
sins,
experienced
derealisa-
tion,
and
did
not
remember
conversations
with
her
confessor.
I
could
not
say
anything
during
confession,
so
he
just
gave
examples
and
I
nodded.
I
felt
a
lump
in
my
throat.
We
then
prayed
together.
After
some
time
he
would
ask:
‘‘Do
you
remember
this
or
that?’’
He
realised
I
was
often
spaced-out
for
a
few
moments.
My
body
is
there
but
I
am
not
aware
of
what’s
happening.
(Joan)
In
religious
environments,
these
expressions
of
hostility
towards
priests,
or
reluctance
to
participate
in
confession
or
prayers,
was
sometimes
interpreted
by
the
religious
community
as
disgust
for
sacrum
and
attributed
with
supernatural
forces
(see
Theme
2).
Religious
norms
conflicting
with
sexual
behaviour
or
desires
For
every
participant,
endorsement
and
identification
with
religious
values
and
norms
evoked
internal
conflicts
related
to
sexuality:
masturbation,
extramarital
and
homosexual
rela-
tionships.
Only
Roma
and
Emily
had
partners
and
could
talk
openly
about
sexuality.
However,
their
relationships
were
not
approved
by
the
church,
because
Roma
divorced
her
former
husband
and
Emily
remained
unmarried
but
maintained
intimate
contact
with
her
boyfriend.
Maria
had
lived
with
a
girlfriend
for
two
years
but
felt
it
was
wrong
and
decided
to
break
up.
She
thought
her
confessor
was
partly
responsible,
having
suggested
the
same-sex
relationship
may
be
the
reason
for
her
health
problems
and
family
difficulties.
She
thought
homosexual
acts
were
sinful
and
forbidden,
yet
struggled
with
loss
and
felt
angry.
This
was
my
downfall.
I
lived
with
another
woman
and
we
had
sex
together.
I
was
happy
and
fulfilled
for
a
while,
but
I
stopped
attending
religious
groups.
Living
with
another
woman
was
against
the
Bible
and
Christian
beliefs.
.
.
you
know,
the
concept
of
sin
and
forbidden
pre-marital
sex.
After
a
while
I
started
to
feel
guilty
and
we
broke
up.
We
tried
to
remain
friends
but
I
could
not
totally
accept
this
situation.
It
felt
horrible;
I
was
angry
because
she
was
so
close
to
me.
(Maria)
Four
women
had
never
had
intimate
relationships
and
all
participants
reported
conflicts
related
to
masturbation,
which
they
justified
in
relation
to
religious
beliefs.
Alina
said
she
was
unable
to
stay
pure
but
found
comfort
in
her
confessor,
who
encouraged
her
to
maintain
control.
I
have
never
had
a
partner.
I
am
Catholic.
I
know
people
have
different
understanding
of
what
it
means
to
maintain
purity
before
marriage.
Personally,
it
is
important
for
me
to
keep
these
values,
right?
[.
.
.]
When
I
masturbate,
I
have
this
conflict
between
what
I
believe
in
and
what
I
am
doing.
Theoretically,
this
is
normal
behaviour
but
I
must
mention
it
during
confession.
My
confessor
said
this
was
kind
of
natural
but
I
need
to
work
on
keeping
discipline.
(Alina)
I.J.
Pietkiewicz,
U.
Kłosin
´ska,
R.
Tomalski
et
al.
European
Journal
of
Trauma
&
Dissociation
5
(2021)
100204
5
Although
masturbation
helped
Mira
soothe
her
distress,
she
thought
it
was
bad
and
felt
guilty.
Confession
gave
her
temporary
relief,
until
the
next
time
she
could
not
resist
herself.
In
another
part
of
the
interview,
she
ascribed
her
aggressive
and
sexual
thoughts
to
evil
forces
tempting
her
to
commit
sin.
I
have
problems
with.
.
.
self-touch.
When
I
get
stressed
at
work,
I
thought
if
I
masturbated
my
emotional
pain
would
disappear.
.
.
and
it
worked.
Afterwards,
I
had
this
feeling
when
you
did
something
but
you
didn’t
want
to
do
that,
but
you
had
this
temptation,
right?
First,
there
is
normally
pleasure
followed
by
a
feeling
you
did
something
bad
and
you
must
confess.
(Mira)
She
sometimes
discussed
it
with
a
friend
from
the
religious
community
who
felt
the
same
way.
To
liberate
that
friend
from
evil
temptations,
Mira
prayed
and
imagined
making
a
pact
with
the
devil
to
carry
the
burden
alone.
Subsequently,
in
moments
of
distress
she
sought
relief
in
auto-erotic
behaviour
or
cutting
herself
and
writing
pacts.
In
her
religious
community,
this
confirmed
that
her
problems
were
associated
with
supernatural
influence.
My
friend
had
problems
with
pornography
and.
.
.
[masturba-
tion].
I
prayed
for
her
but
she
said
it
didn’t
help,
so
I
spoke
to
Satan.
[.
.
.]
That
night
I
cut
myself,
wrote
a
pact
and
signed
it
with
my
blood.
They
say,
it
should
be
written
with
your
blood.
(Mira)
Writing
pacts
and
signing
them
with
blood
evoked
attention
and
awe
among
her
friends
and
priests.
They
ritually
burned
these
pacts
and
discussed
her
actions
during
confession.
I
wrote
these
pacts
several
times
and
took
them
to
the
exorcist.
Everyone
said
they
must
be
burned.
.
.
Later
on,
I
started
burning
them
by
myself.
I
first
went
to
confession
and
after
a
few
days
wrote
a
pact.
[.
.
.]
I
felt
this
compulsion
and
need
to
sacrifice
my
soul.
Everyone
who
knew
about
that
was
panicking.
(Mira)
Unsatisfactory
relationships
All
participants
declared
difficulties
establishing
and
maintain-
ing
close
relationships.
They
exhibited
very
low
self-esteem,
perceived
thems