Near Death -- or Near Wit's End?

From the WebMD Archives

Feb. 3, 2000 (Boston) -- Those who believe in an afterlife may scoff at the idea, but people who report having out-of-body sensations after returning from the brink of death to the world of living may actually be describing normal responses to extreme stress, suggests a psychiatrist from the University of Virginia.

Reports of near-death experiences bear many of the hallmarks of what psychiatrists call "dissociative experiences," in which the self and the body seem to temporarily part ways. A person who daydreams or becomes so involved in a movie or book that he forgets about the outside world is experiencing a normal and harmless form of dissociation. But dissociation can also be a powerful mental defense mechanism in response to extreme trauma from accidents, sexual abuse, or physical assaults, writes Bruce Greyson, MD, in the Feb. 5 issue of the British journal The Lancet.

Survivors of severe trauma may develop amnesia about the event itself or have inaccurate, distorted memories. In extreme cases, some people may even develop the sense of being outside their own bodies -- watching what happens to them as detached observers, he says.

Greyson, who is with the division of personality studies in the department of psychiatric medicine at the University of Virginia in Charlottesville, conducted a study comparing people who had reported near-death experiences with others who had been close to death but did not experience the characteristic sensations of floating away from their bodies and transcending "the confines of time and space." He found that people who had near-death experiences had significantly more dissociative symptoms than the comparison group, as measured by responses to a standard test for dissociative experiences.

Greyson tells WebMD that the association between near-death experiences and dissociation was moderate. "It wasn't overwhelming, but it wasn't negligible either; it was enough so that we can say that these people definitely do dissociate more than people who don't have near-death experiences, but it's nowhere near in the range of people with psychopathology," he says. Among the people who reported near-death experiences, 18% were determined to be "high dissociators," as defined by a score of 30 or more on a standard test. In contrast, only 5% of subjects in the comparison group were high dissociators.

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"[Near-death experiences] do not seem to be a pathological type of dissociation or a manifestation of a dissociative disorder; they seem to be a non-pathological experience that involves the psychological mechanism of dissociation as a normal response to intolerable trauma," Greyson writes.

But Marlene Steinberg, MD, a leading authority on dissociative disorders who provided WebMD with an objective analysis of the study, points out that if "18% of people with near-death experiences are high dissociators, there may very well be a number of those people who have a lot of similarity with people with pathological dissociative disorders." Steinberg, author of a handbook for the assessment of dissociation, is an associate professor of psychiatry at the University of Massachusetts Medical Center and is in private practice in Northampton, Mass.

She points out that the test used by Greyson is a screening tool that is helpful at revealing symptoms but is not diagnostic for dissociative disorders and that Greyson's cutoff score of 30 is not uniformly agreed upon. "Had he used a cutoff of 20-25, he would have found an even higher percentage of dissociators," she says.

Steinberg says that near-death experiences most closely resemble dissociative disorders in their common feature of depersonalization -- the feeling of being an outside observer of one's own mental processes or body. She emphasizes, however, that further research using standard diagnostic tools is needed to determine what proportion of individuals with near-death experiences have dissociative disorders.

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