The validity of DSM-IV dissociative disorders categories in south-west Uganda.

Abstract

There is little systematic research on the cross-cultural validity of the dissociative disorders, especially in non-western countries. This study evaluates the fit of the DSM-IV classification and concepts of these disorders with local concepts, experiences and local presentations in south-west Uganda. We conducted focus group discussions with medical students, traditional healers, religious leaders, counselors, community members and other health workers (n=48). They were supplemented by key informant interviews with religious people, traditional healers and leaders (n=11). The responses were subjected to thematic analysis. Dissociative amnesia and depersonalization were generally recognized and seen as the result of traumatic experiences and were useful categories in Uganda. However, dissociative fugue did not match local concepts and was confused with spirit possession and other conditions such as alcoholic fugues and dementia. The description of dissociative identity disorder was always interpreted as a possession trance disorder by the local healers. We found only partial support for the validity of the DSM-IV classification of dissociative disorders in Uganda.