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'I've Been Abducted by Aliens' Cases That Test Your Skills ‘I’ve been abducted by aliens’ Patricia Kinne, MD, and Venna Bhanot, MD Ms. S is afraid to sleep at night because that’s when How would you the aliens come. Is she psychotic, or do her nocturnal handle this case? Visit CurrentPsychiatry.com experiences have another cause? to input your answers and see how your colleagues responded CASE ‘I’m not crazy’ fi culty falling asleep, so I add melatonin, 3 Ms. S, age 55, presents for treatment because to 6 mg at bedtime. Her sleeping pattern she is feeling depressed and anxious. Her is improved, but still variable. She also tries ® symptoms include decreased concentration, Dowdenquetiapine, 25 Healthmg at bedtime, Media but soon dis- intermittent irritability, hoarding, and diffi - continues it due to intolerance. culty starting and completingCopyright tasks. SheFor also personal As our rapport use strengthens, only Ms. S reveals has chronic sleep diffi culties that often keep that she has had multiple encounters with her awake until dawn. aliens beginning at age 3. Although she has Fatigue, lack of focus, and poor compre- not had an “alien experience” for about 5 years, hension and motivation have left her un- she does not feel safe sleeping at night and in- employed. She and her teenage daughter stead sleeps during the day. Her eff orts to stay live with Ms. S’s elderly mother. Ms. S feels awake at night strain her relationship with her tremendous guilt because she cannot be the mother. mother and daughter she wants to be. Initially, I (PK) diagnose Ms. S with major How would you respond to a patient who depressive disorder and prescribe sertraline, claims she has been abducted by aliens? 100 mg/d, which improves her mood and en- a) explain that there are no such things as aliens ergy. However, her inability to stay organized b) insist that she was dreaming results in her being “let go” from job training. c) issue a mental hygiene warrant and sign a certifi cate for immediate hospitalization Ms. S reports similar diffi culties in school as d) explore the experiences in a supportive, a child. I determine that she meets DSM-IV-TR respectful manner and rule out organic or criteria for attention-defi cit/hyperactivity dis- substance-induced etiology order (ADHD). Adding methylphenidate, 10 mg bid, improves her concentration and abil- The authors’ observations To read more about sleep disorders, see ity to complete tasks. It also reduces the im- Approximately 1% of the U.S. population “Sexual behavior pulsivity that has disrupted her relationships. report alien abduction experiences (AAE)— during sleep: Despite a strong desire to normalize her an umbrella term that includes alleged con- Convenient alibi sleep schedule, Ms. S continues to have dif- tact with aliens ranging from sightings to or parasomnia,” abductions.1 Patients rarely report AAE to page 21-30 Dr. Kinne is a fellow, department of child and adolescent mental health professionals. In our soci- psychiatry, University of Louisville, Louisville, KY. Dr. Bhanot is ety, claiming to be an “abductee” implies associate professor, department of psychiatry, West Virginia Current Psychiatry University, Charleston. that one might be insane. A survey of 398 Vol. 7, No. 7 81 For mass reproduction, content licensing and permissions contact Dowden Health Media. 081_CPSY0708 081 6/18/08 10:37:01 AM Cases That Test Your Skills Canadian students that assessed attitudes, HISTORY Terrifying experiences beliefs, and experiences regarding alien Ms. S elaborates on her alien experiences, abductions found that 79% of respondents relating a particularly terrifying example believed they would have mostly negative from her teen years. She was lying awake in consequences—such as being laughed at or bed, looking at the ceiling, where she saw a socially isolated—if they claimed to have jeweled spider with a drill. As the spider de- encountered aliens.1 scended from the ceiling and spread its legs, Persons who have AAE may attend sup- she recalled a noise like a dentist’s drill. As port groups of fellow “abductees” to accu- the spider neared her face, it grew larger and mulate behavior-consonant information larger. Terrifi ed, Ms. S was unable to scream (hearing other people’s abduction stories) for help or move anything except her eyes as and reduce dissonance by being surround- the spider clamped its legs around her head Clinical Point ed by others who share a questionable be- and bored into her skull. She reported that al- lief.2 A survey of “abductees” found that though she could feel the drill go in, it wasn’t A survey of 88% report at least some positive aspects painful. ‘abductees’ found of the experience, such as a sense of im- Other experiences included giving birth, that 88% described portance or feeling as though they were undergoing examinations or probes, and at least some chosen to bridge communication between communicating with aliens. Although she is positive aspects extraterrestrials and humans.3 very distressed by most memories, she feels she benefi ted from others. For example, as a of the experience Data collected over 17 years from Min- nesota Multiphasic Personality Inventory child, Ms. S’s math skills improved dramati- (MMPI) scores of 225 persons who report- cally after an AAE episode; she believes this ed AAE reveal common personality traits, was a gift from the aliens. Ms. S’s AAE mem- including: ories are as vivid to her as memories of her • high levels of psychic energy college graduation. She had been reluctant • self-suffi ciency to discuss these events with anyone outside • resourcefulness her family out of fear of being perceived as • a tendency to question authority and “crazy.” to be exposed to situational confl icts.1 Ms. S says she was a shy child who had dif- Other common characteristics include fi culty making friends. She was plagued with above-average intelligence, assertiveness, fatigue and worry about family members. She a tendency to be reserved and absorbed believed that aliens might attack her sisters in thought, and a tendency toward defen- and felt obligated to stay awake at night to siveness, but no overt psychopathology.1 protect them. Aside from alien experiences, After Ms. S reveals her alien experienc- Ms. S reports a happy childhood. es, I reassure her in a nonjudgmental man- She has always been an avid reader. At ner that we will explore her experiences age 8 or 9, after reading a book on alien ab- and determine ways to help her cope with duction, she concluded that she had been them. abducted. Later, she joined a group of pro- fessed alien abductees. She feels accepted and validated by this group and has a forum Want to know more? for discussing her experiences without fear of See these articles at CurrentPsychiatry.com ridicule or rejection. Irrational beliefs: Ms. S remains frightened by things that A ubiquitous human trait remind her of aliens. Although she wrote a FEBRUARY 2007 summary of her alien experiences, she can- Psychosis: Is it a medical problem? not draw a picture of an alien, and thoughts Current Psychiatry 82 July 2008 JANUARY 2007 or images of the prototypical “grey” alien trig- continued on page 85 082_CPSY0708 082 6/16/08 3:48:41 PM Cases That Test Your Skills continued from page 82 Table 1 4 types of sleep paralysis-related hallucinations Intruder Vague sense of a threatening presence accompanied by visual, auditory, and tactile hallucinations—noises, footsteps, gibbering voices, humanoid apparitions, and sensation of being touched or grabbed Incubus Breathing diffi culties, feelings of suffocation, bodily pressure (particularly on the chest, as if someone were sitting or standing on it), pain, and thoughts of impending death Vestibular-motor Sensations of fl oating (levitation), fl ying, and falling Other Out-of-body experiences, autoscopy (seeing oneself from an external point), and fi ctive motor movements, ranging from simple arm movements to sitting up to apparent locomotion through the environment Source: References 7,9 Clinical Point Ms. S’s symptoms ger panic. She also feels somewhat “diff erent,” Myers-Briggs Type Indicator (MBTI), and nervous, and distant from others. Wechsler Adult Intelligence Scale (WAIS suggested a III)—revealed no evidence of psychosis or diagnosis of What diagnosis do Ms. S’s symptoms and personality disorder, and intelligence was psychosis, seizures, history suggest? within the average range. Mental status false memory, or a a) seizure activity exam was normal. Aside from the alien sleep disorder b) sexual abuse/trauma experiences, Ms. S denied any memory of c) schizoaff ective disorder childhood trauma. Interviews did not reveal d) schizotypal personality disorder symptoms compatible with narcolepsy. e) sleep disorder Diagnostic testing ruled out hallucino- sis related to seizures. I also ruled out false The authors’ observations memory related to sexual abuse or trauma, Reviewing AAE literature led me to con- which is commonly found in patients who sider several diagnoses, including: present with AAE. • psychosis Collaborative information from relatives • seizures did not uncover a history of psychosis. She • false memory (sexual abuse, trauma) and family members reported, however, • narcolepsy that Ms. S’s father and 1 sister had periodic • sleep paralysis. sleep disturbances with associated halluci- A medical workup ruled out common nations. I began to suspect sleep paralysis. organic causes of psychosis. Results were normal for brain MRI, ECG, comprehensive What is the prevalence of sleep paralysis? metabolic panel, thyroid function tests, com- a) 5% plete blood count with differential, serum b) 17% alcohol, urinalysis, and urine drug screen. c) 20% Electroencephalography (during drows- d) 30% e) 60% iness) revealed abnormal activity (oc- currences of widely scattered bursts of nonspecifi c, round, sharply contoured The authors’ observations slow waves in the left frontal region) only Full-body paralysis normally accompanies in the F7 electrode.
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