Dissociation induced by self observation in asylum seekers and refugees with severe mental disorders
Objective: In a third line psychiatric referral centre for asylum seekers and refugees in the Netherlands a tendency among inpatients to avoid mirrors was observed. This “Mirror Sign” phenomenon is considered to be caused by alienation from the own reflection in psychotic patients. The study was devised to establish the role of this phenomenon in the observed behavior and its relation to the clinical diagnosis of psychosis.
Methods: During an 18 month period all inpatients of the clinic (N=85) were asked what it was like for them to look at themselves in a mirror, and whether they recalled having unusual experiences while doing so. Their answers were compared to the DSM-IV-TR classification of their disorder at discharge.
Results: 35.3% of the included patients reported experiences consistent with alienation; 27.1% reported having seen visions of traumatic events in mirrors. Both reaction types were stress related; at high levels of arousal they were accompanied by experiences suggesting a temporary constriction of consciousness, a sense of motion, decreased visuospatial cognition and a breakdown of reality testing. 10.5% of the patients had delusions in which these experiences were incorporated.
Of all included patients 50.5% was classified as having a psychotic disorder. In the group reporting alienation 53.4% was classified as such and in the group reporting visions 60.8%.
Conclusions: Self observation in mirrors induces dissociative reactions like depersonalization and flash backs in this population. This does however not correlate with a DSM-IV-TR classification of psychotic disorder.