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The use of hypnosis with dissociative disorders.

The dissociative disorders are characterized by difficulties in the integration of memory and/or identity. Typically this is manifested by amnesia and either the development of alternate identities or an estrangement from one's own identity. Spontaneous and self-generated dissociative states and phenomena sharing much in common with those that can be induced with hypnosis are thought to play a major role in their development, symptomatology, and perpetuation. Medical heterohypnosis offers a powerful tool to reestablish a functional continuity of memory and identity in many such cases. The application of hypnotic interventions in the treatment of such conditions will be discussed, explored, and illustrated with clinical vignettes.

Adaptation, Psychological

Clinical phenomenology of child and adolescent dissociative disorders.

A comparison of two separately diagnosed samples of children and adolescents with dissociative disorders demonstrates good construct validity for these diagnoses in childhood. Descriptive analyses of the total sample reveal a clinical profile characterized by a plethora of affective, anxiety, conduct, posttraumatic, and dissociative symptoms. Children with multiple personality disorder (MPD) differ from those with dissociative disorder not otherwise specified (DDNOS) in having more amnesias, identity disturbances, and hallucinations. Adolescents were more symptomatic than children age 11 or younger and more likely to receive a diagnosis of multiple personality disorder.

Adolescent

Embodied alternative identities. Bearing witness to a world that might have been.

In all cultures, embodied alternative identities provoke powerful reactions among those who observe and interact with them. Although these entities are invariably understood to reflect intense subjective experiences, they represent much more than a public expression of a pathologic mental disorder. They form an integral part of the meaningful, highly complex, symbolic systems that both inform and reflect the local cultures in which they emerge. Consequently, an understanding of just how these entities learn to understand themselves may be the cross-cultural key to an understanding of just what they are.

Anthropology, Cultural

Factors that predict scores on the Dissociative Experiences Scale.

Bernstein and Putnam (1986) recently developed the Dissociative Experiences Scale (DES), a reliable and valid measure of dissociative experiences. The purpose of this study was to determine the relationship of the DES to other measures of psychopathology and cognitive functioning. Seventy-six female and 43 male university students were administered the DES, the Hopkins Symptom Checklist (HSCL-90), the Maudsley Obsessional-Compulsive Inventory (MOCI), the Tellegen Absorption Scale (TAS), and the Barnes-Vulcano Rationality Test (BVRT). A standard multiple regression was computed that used the DES as the criterion variable and the HSCL-90, MOCI, TAS, and BVRT as predictor variables. The results showed that 61% of the variance for DES scores could be predicted by three subscales of the HSCL-90 (Phobic Anxiety, Anger-Hostility, Somatization) and the TAS and BVRT. The importance of the relationship between the predictor variables and the DES for understanding dissociative disorders, especially multiple personality disorder, was discussed.

Adult

Schneiderian symptoms and childhood trauma in the general population.

The Dissociative Disorders Interview Schedule (DDIS) was administered to a sample of 502 adults in the city of Winnipeg, Manitoba, Canada. Findings indicate that Schneiderian symptoms are highly related to childhood trauma and other dissociative symptoms clusters in the general population, as they are in clinical populations. Implications of the findings are discussed.

Adult

Patients reporting ritual abuse in childhood: a clinical syndrome. Report of 37 cases.

Thirty-seven adult dissociative disorder patients who reported ritual abuse in childhood by satanic cults are described. Patients came from a variety of separate clinical settings and geographical locations and reported a number of similar abuses. The most frequently reported types of ritual abuse are outlined, and a clinical syndrome is presented which includes dissociative states with satanic overtones, severe post-traumatic stress disorder, survivor guilt, bizarre self abuse, unusual fears, sexualization of sadistic impulses, indoctrinated beliefs, and substance abuse. Questions relating to issues of reliability, credibility and verifiability are addressed in depth, and the findings and implications are discussed.

Abreaction

Early indicators of pathological dissociation in sexually abused children.

Although reported cases of adult multiple personality disorder (MPD) are increasing, confirmation of MPD and related dissociative disorders in children remains rare. Since MPD can cause severe impairment and psychological distress, and is thought to originate in childhood, early recognition of pathological dissociation and predictors of MPD is critical. Sexual abuse in childhood has similarly been under-reported until recently, and is highly associated with the development of dissociative disorders. This paper reviews factors in the professional neglect of these syndromes as well as recent diagnostic developments in childhood dissociative disorders. The identification of subtle dissociative symptomatology in children is illustrated and two case examples are presented.

Adolescent

Dissociative experiences among psychiatric inpatients.

The Dissociative Experiences Scale was administered to 299 inpatients on an acute care general adult psychiatric ward over a 2-year period. The average score was 14.6, which is significantly higher than the mean for the general population. About one in six inpatients reported very high scores above 50 on the seven most common items in the scale, indicating a high level of dissociative psychopathology. Based on the responses to four items which form a scale factor called Activities of Dissociated States, an estimate is made that 6%-8% of general adult inpatients may have multiple personality disorder. Dissociative psychopathology is common on inpatient units.

Adult

Multiple personality. A single case study with a 15 year follow-up.

A review of the literature relating to multiple personality is presented together with a study of a single case of hysterical aetiology that demonstrates the development of multiple personality from a fugue amnesic state. A re-examination of this case after 15 years without significant psychotherapeutic intervention demonstrates a tendency towards remission. The view that multiple personality is a form of fugue, not necessarily hysterical, in which an alternative personality is adopted and that this behaviour is reinforced by the attention that it receives, is discussed.

Adolescent

Disintegrated experience: the dissociative disorders revisited.

We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.

Depersonalization

Dissociation and displacement: where goes the "ouch?".

Hypnosis is widely used to relieve pain. Current theory emphasizes its dissociative features. Multiple personality patients can eliminate pain in the primary personality by displacing it into underlying alters. The Hilgards demonstrated that normal hypnotized subjects can similarly dissociate pain into a covert cognitive structural system which they called the "hidden observer." The Watkins discovered that "hidden observers" appeared to be the same phenomenon as "ego states." "Ego-state theory" assumes that human personality develops through integration and differentiation. At one end of the continuum, "differentiation" is adaptive. Ego states possess relatively permeable boundaries as in normal moods. At the other end ego-state boundaries become less permeable. Normal "differentiation" becomes maladaptive "dissociation" and multiple personalities may be created. In the intermediate range of the differentiation/dissociation continuum, "covert" ego states can be found in many normal subjects who volunteer for hypnotic laboratory experiments. Normal individuals, like multiple personalities and "hidden observer" subjects, can displace (dissociate) pain into "covert" ego states. The pain is not eliminated. This suggests that when we remove pain by hypnosis we may not be getting away "scot-free."

Dissociative Disorders

Enhancing the hospital treatment of dissociative disorder patients by developing nursing expertise in the application of hypnotic techniques without formal trance induction.

Many symptoms suffered by dissociative disorder patients are unresponsive or incompletely responsive to medications. This poses a unique challenge to the staff of specialized dissociative disorder units, in which many such patients who require hospital care suffer serious distress that may not respond predictably to the pharmacological interventions that are available. However, the majority of their symptoms are dissociative in nature, and dissociative disorder patients generally are quite hypnotizable. Anticipating the need for nonpsychopharmacological interventions that we could use in the absence of the treating psychiatrist, we taught the unit's nursing and social work staff to rely on the inherent trance-proneness of these patients to utilize hypnotic techniques without the formal induction of hypnosis. Their implementation facilitated crisis resolution, led to a greater sense of safety on the part of the patients, enhanced the staff's sense of mastery, and minimized the need for emergency sedation and restraints.

Dissociative Disorders

The interface between multiple personality, spirit mediumship, and hypnosis.

In this paper I draw parallels between multiple personality, spirit mediumship, and hypnosis from historical, anthropological, and clinical perspectives. I emphasize Milton H. Erickson's view of multiple personalities as not necessarily pathological but as potential resources. He employed hypnosis to gain access to personalities and to transform their behavior from involuntary to voluntary actions. I discuss similarities between this view and the use of spirits as a resource with mediums. Natural trance therapies in other cultures offer a new perspective for viewing the normalcy or pathology of "other selves."

Dissociative Disorders