The onset may be sudden or gradual, and the course is chronic. There usually is a history of repeated physical and sexual abuse in childhood and/or adulthood. In a series of eight cases, seven were female who also had daytime states of dissociation with self-mutilating behaviours, such as genital cutting, self-burning, and punching through windows/44) One male patient had exclusively nocturnal episodes in which he acted like a jungle cat.
A typical spell during polysomnographic monitoring involves complex and lengthy behaviours that emerge during well-established EEG wakefulness, after a prior episode of sleep.(44) The nocturnal episodes appear to be re-enactments of previous assaults.
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