Cultic Studies Review, Vol. 2, No. 2, 2003, Page 90
Clinical and Diagnostic Issues of Cultism: Group
Dependence Disorder
Miguel Perlado
Attention and Research on Social Addictions (AIS)
Vía Layetana 45, Esc. A, 1º 1ª Barcelona 08003 Spain
Email: miguel_perlado@hotmail.com
Abstract
This paper reviews some diagnostic proposals on the clinical complexity of
cults. The diagnostic criteria of group dependence disorder employed in the
therapeutic service of Attention and Research on Social Addictions (Attention
e Investigación de Socioadicciones -AIS) are introduced. A psychoanalytically
based psychopathological model derived from the research is also presented.
Keywords: sect, cult, diagnosis, follower, group dependency, psychological
manipulation, social addiction
The history of diagnosis goes back to Hippocratic medicine of the fifth and fourth century
B.C., when the need appeared to assign words to illnesses for treatment. At that time,
diagnosis had two meanings: on the one hand, diagnosis as a path of knowledge of the
difference (diagignôskein), and on the other, diagnosis as profound knowledge (diágnôsis).
These two meanings have carried through to current times, and thus we can find diagnosis
as a classification (medical-psychiatric diagnosis) and diagnosis as knowledge of what is
happening to the patient (psychological-psychoanalytical diagnosis) (Echevarría &Font,
1991).
The psychiatric-medical diagnosis is based on detecting, classifying, and differentiating a
disorder, with the establishment of specific syndromes. Alternatively, the psychological-
psychoanalytical diagnosis is progressively established as we enter into a relationship with
the patient (thus, for example, we can understand psychotherapy as a complete diagnostic
process).
Although establishing a diagnosis helps put order to thinking and information, as well as to
communicating and doing research, it can also fulfill certain counter-therapeutic functions:
erase the patient‘s anxiety toward the uncertainty that his or her suffering can generate and
produce in the therapist a sense of omnipotence and of control over the problem. These
functions may calm the patient and make the therapist feel much better, but they don‘t
necessarily solve the patient‘s problem.
Regarding the present subject, we are not concerned in justifying one or another type of
diagnosis as suitable—since both can be complementary—but rather in developing an
approach to the problem of diagnosis in cult commitments, and reviewing diverse proposals
along with the one employed by our group.
All of the proposals are oriented toward defining a specific disorder that a follower
committed to a ―cult group‖ might possibly present, which does not indicate that all
followers will automatically suffer this disorder.
Thought Reform and Dissociative States
From his recent literature review, Cubero (2001) shows us that psychiatry as a discipline
seems to be little interested in the psychopathological complexity of cults. Only a few
professionals have become interested in this field and have offered us different clinical
descriptions, though these have received little attention.

Cultic Studies Review, Vol. 2, No. 2, 2003, Page 91
The model that underlies the diverse diagnostic proposals that have been offered is the
model of thought reform. Closely related are the dissociative model (thought reform would
be a form of a dissociative state) and the dependence model (thought reform gives way to
dependency).
In the first theoretical line (thought reform), we find proposals such as that of West &
Singer (1990), which concurs with the observations of Delgado (1977) and helped to
delineate the diagnosis of Cult Indoctrinee Syndrome:
1. Sudden, drastic alteration of the victim‘s value hierarchy, including abandonment of
previous academic or career goals. The changes are sudden and catastrophic, rather
than gradual changes that might result from maturation or education.
2. Reduction of cognitive flexibility and adaptability. The victim answers questions
mechanically, substituting stereotyped, cult-specific responses for what his own
responses might have been.
3. Narrowing and blunting of affect. Spontaneous feelings of interpersonal affection or
love are suppressed. The victim may appear emotionally flat and lifeless or almost
frantically cheerful and ebullient.
4. Regression. The victim becomes childishly dependent on the cult leaders, and desires
that they make decisions for him.
5. Physical changes. These often include weight loss, considerable deterioration in the
victim‘s physical appearance, and a strange or mask-like facial expression, with a
blank stare or darting, evasive eyes.
6. In some cases, clear-cut psychopathological changes may appear, including
dissociation, obsessional ruminations, delusional thinking, hallucinations, and various
other psychiatric signs and symptoms.
In the second theoretical line (dissociative model), there is a marked reference to atypical
dissociative disorder (or dissociative disorder not otherwise specified) included in DSM III
and IV (APA, 1983). The DSM diagnosis refers only to ―dissociative states that can present
themselves in individuals that have been subjected to periods of prolonged and intense
coercive persuasion (ex. brainwashing, thought reform or indoctrination in subjects in
captivity),‖ but at no point are the specific symptoms listed that would conform to this
residual category. Galper‘s research (1983) offers more content concerning the dissociative
disorder related to the complications of cults:
1. Identity loss group context mobilizes an identity crisis to achieve a profound and
rapid identification with the group ideology: group process leads to rejecting a
previous identity the follower is impelled to adopt a new ideological system by
identifying with the aggressor.
2. Psychological regression, decrease of secondary process of thinking, accompanied by
an intensification of primary processes: capacity for rational analysis diminishes,
cognitive flexibility is lost, primitive fusional aspects appear, a strong group feeling is
experienced, with the predominance of omnipotent thought.
3. Extraordinary narrowing and intensification in the phenomenological field of
conscious attention: strong group investing, relationships become potential spaces
for recruitment, affective alterations.
4. The group dynamics devalue the development of personal individuality and
uniqueness: internalizing norms stunts personal development.