2. 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
edia
colleagues responded
ficulty falling asleep, so h
lt I Mmelatonin, 3
Hea Her add pattern
CASE ‘I’m not crazy’
Ms. S, age 55, presents for treatment because n
wde u still on
to 6 mg at bedtime. ly
sleeping
is improved, but se variable. She also tries
she is feeling depressed and anxious. Her o
t® Dquetiapine,a25 mg at bedtime, but soon dis-
l
igh - ersonit due to intolerance.
symptoms include decreased concentration,
intermittent irritability, hoarding, r
y and diffi continues
Cop For p As our rapport strengthens, Ms. S reveals
culty starting and completing tasks. She also
has chronic sleep difficulties 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 efforts 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
certificate for immediate hospitalization
Ms. S reports similar difficulties 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-deficit/hyperactivity dis- substance-induced etiology
order (ADHD). Adding methylphenidate, 10
mg bid, improves her concentration and abil- The authors’ observations To read more about
ity to complete tasks. It also reduces the im- Approximately 1% of the U.S. population sleep disorders, see
“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
associate professor, department of psychiatry, West Virginia
ety, claiming to be an “abductee” implies
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.
3. 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. Terrified, 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
Data collected over 17 years from Min- she benefited from others. For example, as a
of the experience
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-sufficiency 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 conflicts.1 Ms. S says she was a shy child who had dif-
Other common characteristics include ficulty 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
for discussing her experiences without fear of
Want to know more?
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
4. 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 difficulties, 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 floating (levitation), flying, and falling
Other Out-of-body experiences, autoscopy (seeing oneself from an external point),
and fictive motor movements, ranging from simple arm movements to sitting
up to apparent locomotion through the environment
Source: References 7,9 Clinical Point
ger panic. She also feels somewhat “different,” Myers-Briggs Type Indicator (MBTI), and
Ms. S’s symptoms
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
b) sexual abuse/trauma sleep disorder
experiences, Ms. S denied any memory of
c) schizoaffective 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
nonspecific, round, sharply contoured The authors’ observations
slow waves in the left frontal region) only Full-body paralysis normally accompanies
in the F7 electrode. In the absence of clini- rapid eye movement (REM) sleep, which
cal symptoms and when found in a single occurs several times a night.4 Sleep paraly-
lead, this is considered a normal variant. sis is a transient state that occurs when an
Current Psychiatry
Psychological testing—including MMPI, individual becomes conscious of this im- Vol. 7, No. 7 85
continued on page 90
6. Cases That Test Your Skills
Table 2
• They sought explanations for what
they perceived as anomalous experiences. Diagnostic criteria
• They “recovered” abduction memo- for sleep paralysis
ries in therapy (with the help of techniques
A. Patient complains of inability to move
such as hypnosis) or spontaneously (after
the trunk or limbs at sleep onset or upon
reading books or seeing movies or televi- awakening
sion shows depicting similar episodes).4
B. Brief episodes of partial or complete
Ms. S reported no daytime sleep attacks, skeletal muscle paralysis
cataplexy, or rapid onset of dreaming. Be-
C. Episodes can be associated with
cause her reported AAEs were spread out hypnagogic (preceding sleep)
and the last occurred approximately 5 years hallucinations or dreamlike mentation
ago, I decided against conducting a sleep
D. Polysomnographic monitoring
study because it likely would be low yield demonstrates at least 1 of the following: Clinical Point
and costly. I reached a diagnosis of sleep pa- 1. Suppression of skeletal muscle tone
ralysis-familial type, chronic based on: 2. A sleep-onset REM period
During sleep
• an absence of organic or psychiatric 3. Dissociated REM sleep paralysis episodes,
dysfunction E. Symptoms are not associated with individuals often
• a familial pattern of sleep disturbances other medical or mental disorders, such sense a threatening
• the temporal pattern and description as hysteria or hypokalemic paralysis
presence that some
of her symptoms (Table 2).11 Minimal criteria are A plus B plus E
describe as alien
All of Ms. S’s episodes occurred at night Note: If symptoms are associated with a
or times of quiet restfulness. She usually familial history, the diagnosis is sleep visitations
slept on her back, which may be a risk fac- paralysis-familial type. If symptoms are
not associated with a familial history, the
tor for sleep paralysis.12
diagnosis is sleep paralysis-isolated type
Severity criteria
Mild: <1 episode per month
TREATMENT Reassurance, therapy
Moderate: >1 episode per month
Effective treatment for Ms. S required helping but <1 per week
her to understand that an organic condition Severe: ≥1 episode per week
was the foundation of her experiences. I be- Duration criteria
gan by conveying the sleep paralysis diagno- Acute: ≤1 month
sis and my understanding of the occupational Subacute: >1 month but <6 months
and personal consequences that this condition Chronic: ≥6 months
had had for her. I explained the physiology of REM: rapid eye movement
Source: Reference 11
sleep paralysis and that memories or halluci-
nations (dreamlike mentation) are preserved
in an extremely vivid fashion because her eyes treatment, Ms. S cites multiple improvements,
are open. I acknowledged the realistic charac- with no recurrence of sleep paralysis episodes.
ter of her experiences and the resulting symp- She continues to take sertraline, which relieves
toms of posttraumatic stress disorder (PTSD). her depression and anxiety, and methylpheni-
I refer Ms. S to a therapist for psychother- date to improve her attention and concentra-
apy. The therapist begins by using trauma tion. She has taken on more responsibility at
informed techniques to address Ms. S’s PTSD. home, cleaning, preparing meals, helping her
As she improves, her therapy evolves into a daughter choose a college, and attending to
combination of narrative and supportive psy- her mother’s health issues. Ms. S still has dif-
chotherapy, and then family systems therapy to ficulties with her sleep patterns, and her new
address issues with her daughter and mother. psychiatrist is exploring the possibility of a bi-
Current Psychiatry
In a follow-up visit 1 year after beginning polar component to her mood disorder. Vol. 7, No. 7 91
continued
7. Cases That Test Your Skills
The authors’ observations Related Resources
Like other traumas, AAE can induce symp- • American Academy of Sleep Medicine. International
classification of sleep disorders, revised: diagnostic and coding
toms of acute or chronic PTSD. The various manual. Chicago, IL: American Academy of Sleep Medicine;
psychoses, personality disorders, and dis- 2001:166-9.
sociative disorders that could account for • Cheyne JA. Sleep paralysis and associated hypnagogic
and hypnopompic experiences. http://watarts.uwaterloo.
abduction experiences are characterized ca/~acheyne/S_P.html.
by delusions, so conduct ongoing assess- Drug Brand Names
ment for these conditions in patients who Methylphenidate • Ritalin Sertraline • Zoloft
Quetiapine • Seroquel
report AAE. However, evidence suggests
Disclosure
that serious psychopathology is no more
The authors report no financial relationship with any
common among “abductees” than among company whose products are mentioned in this article or
the general population.12 with manufacturers of competing products.
Clinical Point Persons reporting AAE exhibit physi-
the UFO abduction phenomenon: hypnotic elaboration,
ologic reactivity as profound as that of extraterrestrial sadomasochism, and spurious memories.
No drugs are survivors of combat or sexual assault.13 Psychol Inq 1996;7(2):99-126.
FDA-approved This reactivity confirms that the emotional
3. Bader CD. Supernatural support groups: who are the UFO
abductees and ritual-abuse survivors? J Sci Study Relig
for treating sleep power of the memory is as evocative and 2003;42(4):669-78.
4. Clancy SA, McNally RJ, Schacter DL, et al. Memory distortion
paralysis, but use problematic as the physiologic reactions in people reporting abduction by aliens. J Abnorm Psychol
2002;111(3):455-61.
pharmacotherapy attributable to genuine (documented) 5. Girard TA, Cheyne JA. Individual differences in lateralization
traumatic events. Because patients have of hallucinations associated with sleep paralysis. Laterality
to address anxiety 2004;9(1):93-111.
difficulty differentiating these hallucina- 6. Cheyne JA. The ominous numinous: sensed presence and
and depression tions from actual events, they experience “other” hallucinations. Journal of Consciousness Studies
2001;8(5-7):133-50.
emotional pain and suffering. Fifty-seven 7. Cheyne JA, Newby-Clark IR, Rueffer SD. Relations among
hypnagogic and hypnopompic experiences associated with
percent of sleep paralysis patients who re- sleep paralysis. J Sleep Res 1999;8:313-7.
port AAE attempt suicide.14 8. Cheyne JA, Rueffer SD, Newby-Clark IR. Hypnagogic
and hypnopompic hallucinations during sleep paralysis:
Offer patients with AAE psychotherapy neurological and cultural construction of the night-mare.
Conscious Cogn 1999;8(3):319-37.
to deal with long-term effects of trauma 9. Cheyne JA. Sleep paralysis and the structure of waking-
and problems with mood, sleep, daily nightmare hallucinations. Dreaming 2003;13(3):163-79.
10. Spanos NP, Cross PA, Dickson K, et al. Close encounters:
functioning, and/or relationships. an examination of UFO experiences. J Abnorm Psychol
1993;102(4):624-32.
There are no FDA-approved medica-
11. American Academy of Sleep Medicine. International
tions for treating sleep paralysis. Phar- classification of sleep disorders, revised: diagnostic and coding
manual. Chicago, IL: American Academy of Sleep Medicine;
macotherapy can be used to address 2001:166-9.
psychiatric symptoms such as the depres- 12. Holden KJ, French CC. Alien abduction experiences: some
clues from neuropsychology and neuropsychiatry. Cognit
sion and anxiety Ms. S exhibited. Neuropsychiatry 2002;7(3):163-78.
13. McNally RJ. Applying biological data in forensic and policy
arenas. Ann N Y Acad Sci 2006;1071:267-76.
References
14. Stone-Carmen J. A descriptive study of people reporting
1. Patry AL, Pelletier LG. Extraterrestrial beliefs and experiences:
abduction by unidentified flying objects (UFOs). In: Pritchard
an application of the theory of reasoned action. J Soc Psychol
A, Pritchard DE, Mack JE, et al, eds. Alien discussions: proceedings
2001;141(2):199-217.
of the abduction study conference held at MIT. Cambridge, MA:
2. Newman LS, Baumeister RF. Toward an explanation of North Cambridge Press; 1994:309-15.
Bottom Line
Assess patients who report alien abductions for psychosis, seizures, false memory,
narcolepsy, and sleep paralysis. During sleep paralysis, patients may sense a
threatening presence they interpret as intruders or aliens—and experience visual,
tactile, and auditory hallucinations—that they perceive as real. Psychotherapy and
Current Psychiatry
92 July 2008 pharmacotherapy can help patients manage the impact of these episodes.