ritual abuse diagnosis research


The following is an excerpt from a chapter in: Lacter, E. & Lehman, K. (2008). Guidelines to Differential Diagnosis between Schizophrenia and Ritual Abuse/Mind Control Traumatic Stress. In J.R. Noblitt & P. Perskin (Eds.), Ritual Abuse in the Twenty-first Century: Psychological, Forensic, Social and Political Considerations, pp. 85-154. Bandon, Oregon: Robert D. Reed Publishers.

this page describes ritual abuse crimes

01. Leavitt and Labott (2000) compared Rorschach results of three groups of patients; 1) patients reporting child sexual abuse within Satanic cults; 2) patients reporting child sexual abuse without ritual abuse; and 3) non-abused patients. The first two groups had histories of amnesia for their sexual trauma, memory recovery after the age of 18 years, and an absence of psychotic or neurologic symptoms. Groups were compared for frequency of 41 Rorschach content responses related to Satanic ritual abuse, selected by four experts in ritual trauma. The group of patients reporting abuse within Satanic cults gave significantly more Rorschach responses with Satanic content. The following specific percepts significantly differentiated the groups: robe, mask, body mutilated, babies damaged, ritual ceremony, threatening eyes, blood everywhere, special knife, goat reference, bondage, torture, sacrifice, hooded figure, altar, blood rituals, and circle. A second study revealed that these results were unrelated to patients’ degree of media and hospital milieu exposure to the subject of Satanic ritual abuse. In fact, less media exposure was associated with production of more Satanic content in patients reporting ritual abuse, evidence that reports of ritual abuse are not primarily the product of exposure contagion.

In an earlier study, Leavitt and Labott (1998a) found that patients reporting Satanic ritual abuse provided more Satanic-content responses in a word association test than patients reporting non-ritual sexual abuse. They also provided fewer normative responses, understandable given the pervasive nature of ritual trauma and the paucity of normal childhood experience for so many of these victims.

Mangen (1992) performed approximately 25 psychological evaluations with patients already identified as having been victimized within Satanic cults, including the Wechsler Adult Intelligence Scale-Revised (WAIS-R), Rorschach, Thematic Apperception Test (TAT) or other story-telling test, a human figure drawings, and more.

Mangen found that the “testing” situation itself often induced great fear in these patients, related to the frequent “tests” of abilities within ritual abuse. Test stimuli, even benign or familiar stimuli, often acted as trauma reminders and precipitated trauma reactions and dissociative “switching” of personalities. He observed that “many responses given by these patients sound blatantly psychotic” (p. 154), but closer scrutiny revealed that these were derived from the ritual abuse and the traumatized level of functioning. He explains the importance of understanding ritual abuse practices, symbols, holidays, etc., as emphasized above.

Mangen found these individuals were of at least average intelligence. However, signs of cognitive slippage and inefficiency occurred as trauma impinged on thought processes. Idiosyncratic, personalized, and even bizarre responses to test stimuli were common. E.g., intelligence tests involving numbers, and in particular, having to repeat series of numbers backwards, often disorganized patients’ responses, since numbers and reversal of numbers and letters are common in ritual practices and programming. Mangen noted that words often lost their meaning as symbols, and were perceived as dangerous in themselves, related to abusers communicating deadly messages with words, and punishment by abusers for incorrect verbal responses. Visual images also disorganized thought processes. E.g., one woman froze when given puzzle pieces of a human figure to assemble. When asked what had happened, she “switched” into a young personality who explained that she had participated in rituals involving people being cut into pieces, but had never been told to try to put the people back together.

Mangen emphasized that such disorganized episodes are frequent, but exist side-by-side with trauma-free spheres of cognitive functioning. He suggests that the traumatized thought processes are state-dependent, and that these patients readily enter states of traumatized functioning.

Mangen’s Rorschach observations are especially revealing. Patients tended to provide images that were perceptually accurate (good form); i.e., they were largely consistent with shapes in the inkblot. In contrast, patients with Schizophrenia often have poor perceptual accuracy (poor form) on the Rorschach, a sign of more impaired perceptual and thought processes.

Though form was generally adequate, associations to the blots were replete with traumatic imagery. E.g., a perception of a person might fit the blot, but the associations might include themes of cutting and murdering babies, eating flesh, evil, etc., additions that would appear bizarre if not for the ritual trauma. Such trauma-driven associations might be made with flat affect or flooded affect. In some cases, perceptual distortions (poor form) were more central, but even these were often resolved in light of the abuse. For example, one patient perceived a person with women’s breasts and a penis, an incongruous combination (INCOM) that might indicate psychosis, if not for the fact that some sexual rituals involve people costumed to appear bi-gender. Yellow was perceived by an other patient as angry and as urine “poured all over me”. This response becomes understandable if the clinician knows that abusers often urinate on the victim, in some cases with the intent to dominate the spirit of the victim with their own spirits.

Mangen explains that drawings also contain elements that would appear bizarre without an understanding of the underlying trauma. For example, trees may contain eyes, hidden people, and blood dripping from severed limbs. Moore (1994) notes that in human figure drawings of ritual abuse victims, arms often abruptly end, appear torn off or jagged, or have unusual endings unlike hands. Ritual acts, symbols, candles, pentagrams, inverted crosses, robes, dripping blood, etc., may be graphically represented, particularly if the abuse is conscious. Cohen and Cox (1995) include a series of drawings depicting the unfolding of memories of an adult woman ritually abused as a child, replete with graphic memories of abusive rituals, ritual artifacts, her terror, phallic symbols of sexual abuse, and dissociative responses, such as multiple self-representations in one drawing, and changes in developmental level across drawings in relation to the age of the personality making the picture.

Mangen reports that ritual abuse victims demonstrate a damaged experience of self on projective tests, such as the Rorschach and TAT. Responses demonstrate a lack of self-agency, that is, a sense of lack of control over one’s life and actions. Figures are often perceived as helpless or passive. Body integrity is often impaired; figures are seen as broken, devoured, harmed, etc. Self affect is inconsistent and incongruent. For example, a figure may be described as frightened and laughing, evil and good, etc. Dissociative processes are evident in illogical shifts and transpositions. TAT stories include confusion in regard to time, states of waking and sleeping, life and death, here and not here, and sudden changes in what characters know, think, and want.

TAT stories reflect interpersonal estrangement and malevolence. Themes of caring and kindness tend to be fleeting. Themes of deception and betrayal are common; “things are not what they seem”. Kind adults turn threatening. Child figures may feign compliance, but are described as actually pretending or escaping in their minds (dissociating). Responses are consistent with the devastating and pervasive abuse these victims have experienced, so often including immediate family members.

Affect dysregulation and emotional intensity pervade test responses. Primitive violent imagery related to ritual trauma is common in Rorschach responses and TAT stories. There is a paucity of positively tinged affective experiences, such as love and hope. Terror and despair dominate. Fear of annihilation and abandonment are more common than fear of loss of love. Some responses may reflect identification with aggressors.

Dissociative responses are observed throughout the evaluation process. Blocking of affect may occur as trauma is described. Overwhelming stimuli can precipitate switching of personalities. There may be obvious changes in vocal presentation and general demeanor. Personalities may identify themselves by name. They may relay accounts of horrible abuse unknown to the host and the host may return with complete amnesia for the event. Or dissociative episodes may be more subtle, and not distinguished unless the evaluator looks for amnestic gaps, such as the repetition of test questions later in the evaluation process to determine if prior responses are recalled.

Mangen explains that the patient may not be able to reveal the “secret” of the abuse and that personalities who identify with the cult experience tend not to present themselves. Thus the clinician must work with the patient to “help make the invisible visible” (p. 155). However, he states that much more research is needed on the use of psychological testing in identifying severe trauma, dissociation, and in particular ritual trauma, to help clinicians to recognize patients who are still preserving the “secret” and not yet revealing their ritual abuse.


Cohen, B.M., & Cox, C.T. (1995). Telling without talking: Art as a window into the world of multiple personality. New York: Norton.

Leavitt F., & Labott, S. M.(1998a). Revision of the Word Association Test for assessing associations of patients reporting Satanic ritual abuse in childhood. Journal of Clinical Psychology, 54(7), 933-943.

Leavitt, F., & Labott, S.M. (2000). The role of media and hospital exposure on Rorschach response patterns by patients reporting satanic ritual abuse. American Journal of Forensic Psychology, 18(2), 35-55.

Mangen, R. (1992). Psychological testing and ritual abuse. In D.K. Sakheim & S.E. Devine (Eds.), Out of darkness: Exploring Satanism and ritual abuse (pp. 147-173). New York: Lexington.

Moore, M.S. (1994). Common characteristics in the drawings of ritually abused children and adults. In V. Sinason (Ed.), Treating survivors of satanic abuse (pp. 221-241). London, and NY, NY: Routledge.


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