Cultic Studies Journal, Vol. 13, No. 1, 1996, page 44
Table 1. True State
Diagnosis Experienced ICA and is amnesic Did not experience ICA
Repressed memory
of ICA
38 100
No repressed
memory of ICA
2 570
As you can see from the table, all but two of the women who experienced ICA and are
amnesic for it will be identified. However, 100 patients (.15 x 670) will be incorrectly
identified as suffering from ICA even though they were not abused as children. Thus, given
these assumptions, 100 of 138 patients (73%) diagnosed as having repressed memories of
ICA will be false positives. To put it another way, using these assumptions, of 40 patients
diagnosed as hidden presentations of ICA, 29 will be false positives.
To create a range for the proportion of false positives, we will do a second analysis using
more moderate assumptions about diagnostic specificity and prevalence rates. Studies of
childhood sexual abuse indicate that a significant minority of children show few or no ill
effects 18 months after the abuse (see Levitt &Pinnell, 1995, for a recent review). We will
assume that 20% of women coming for therapy have experienced ICA serious enough to
create long-term disturbances. Again assuming that 12% are amnesic for the experience
(Williams, 1994), this would result in a prevalence of 24 abused amnesic women per
thousand. We will continue to use a sensitivity estimate of .95, but decrease our specificity
estimate to .80, which is still good for any psychological or psychiatric diagnosis, never
mind a hidden, etiologic factor.
Table 2. True State
Diagnosis Experienced
ICA and is
amnesic
Did not
experience ICA
Repressed
memory of ICA
23 160
No repressed
memory of ICA
1 640
This time only one patient suffering ICA was missed. But Table 2 yields 160 false positives
of 183 patients diagnosed as having a hidden presentation of ICA, a rate of 87.4%, or 35
false positives out of 40 typical patients who might have experienced ICA. Thus, of 40
patients diagnosed as having repressed memories of ICA, our two estimates suggest that
between 29 and 35 of the 40 patients will be false positives. Using different assumptions, a
recent analysis by Kihlstrom (in press) resulted in an estimate of the proportion of false
positives in the same range.
To repeat, in the case of the hidden presentation of ICA, we seek an etiologic factor above
and beyond that which is overt. This makes the diagnostic task far more difficult, but we
have assumed this hidden aspect of women‟s experience can be diagnosed with accuracy

Cultic Studies Journal, Vol. 13, No. 1, 1996, page 45
similar to that for overt presentations. Even so, the results indicate a very high rate of false
positives. As when using any unreliable and questionably valid assessment protocol, the
problem lies in the practitioner‟s belief in and use of the procedure.
Further, the major problem is not even the proportion of false positives it is with their
implications. If a therapist errs and initially identifies dysthymic disorder as generalized
anxiety disorder or thinks someone is suffering from an obsessive/compulsive disorder when
they are not, time may be wasted and unnecessary suffering allowed. This is unfortunate,
but rarely tragic as long as therapists correctly identify and respond to life-threatening
situations. The process of psychotherapy is, as noted above, generally beneficent.
Further, when diagnosis is based on DSM-IV criteria, overt symptoms should be continually
assessed and, despite confirmation bias, self- correction is possible. However, when a
patient is misdiagnosed as a hidden ICA victim, the disastrous sequence discussed at the
beginning of this paper may unfold. At the least, basic familial relationships will be brought
into question and may often be severely disrupted (Esman, 1994 McElroy &Keck, 1995).
Multiple Personality Disorder (MPD): Childhood Defense or Adult Role?
For those studying ICA and related phenomena, SRA cases such as that of Joan Borawick
are interesting because they seemingly contain high levels of fantasy. There is no evidence
for the existence of a multigenerational satanic cult that performs ritual murders and
abortions while it programs young women with multiple personalities. Despite enormous
effort by law enforcement officials to track down such a cult, no trace has ever been found.
The witches‟ sabbaths regularly described by alleged victims are similar to those that were
described in the Middle Ages. Conversely, careful historians and anthropologists have
established that such orgiastic festivals of evil didn‟t happen in the Middle Ages either
(Mulhern, 1994). They were the product of vivid imagination then as well as now. As
Lanning, the agent in charge of the FBI‟s investigation of this putative cult, wrote “this is
not a law enforcement problem” (Lanning, 1991).
One of the intriguing aspects of fantasies of satanic ritual abuse is that, almost universally,
those expressing this fantasy are diagnosed as having multiple personality disorder (MPD).
Patients who recall SRA constitute a significant minority of those currently diagnosed as
multiple personalities (Braun, 1992 Hammond, 1992 Ofshe &Singer, 1994). In the view
held by mental health professionals who routinely diagnose MPD, the disorder results when
a child is overwhelmed by the horror of a traumatic situation, escapes by dissociating, but
leaves a part of herself to deal with the horror. This part then becomes autonomous, an
alter, and the original self becomes amnesic for the traumatic events. The alter reemerges
in later instances where the child has to cope with similar traumas. If new traumas occur
with which neither the original self nor its alter can cope, another alter will be “born” (Kluft,
1991, Putnam, 1989).
Like hypnosis, MPD has a checkered history with periods of strong interest and excessive
claims followed by barren periods in which the phenomenon is ignored. Multiple personality
disorder also resembles hypnosis in that it seems to take on the characteristics expected by
the patient and therapist. Prior to 1970, an MPD diagnosis did not necessarily imply a
severe and disabling condition. If one examines classic cases, such as Morton Prince‟s case
of Miss Beauchamp, multiple personalities included only two or three alters who were not
seriously harmful. For example, Miss Beauchamp‟s Devil alter, Sally, is described as a
mischievous imp, not an immoral devil. Prince also notes, “For although the characters of
the personalities widely differ, the variations are along the lines of mood, temperament, and
tastes. Each personality is incapable of doing evil to others” (Prince, 1908, 1957, as cited in
Orne &Bates, 1992). Prince‟s other cases were similar with all the alters being relatively
beneficent, although one might be morose and the other flamboyant.