Is high hypnotizability a necessary diathesis for pathological dissociation?

During the 19th century, high hypnotizability was considered to be a form of psychopathology that was inseparable from hysteria. Today, hypnotizability is considered to be a normal trait that has no meaningful relationship with psychopathology. Psychiatric patients generally manifest medium to low hypnotizability. Nevertheless, several psychiatric diagnoses are marked by an unexpectedly large proportion of patients with high hypnotizability. This is especially true of the diagnostic categories that were subsumed by the 19th-century concept of hysteria: dissociative identity disorder, somatization disorder, and complex conversion disorders. These hysteria-related modern diagnoses are also highly dissociative. A review and analysis of the literature regarding the relationship between hypnotizability and dissociation indicates that high hypnotizability is almost certainly a necessary diathesis for the development of a severe dissociative disorder. Such a diathesis has significant implications for (a) the psychiatric nosologies of the American Psychiatric Association and the World Health Organization, (b) the hypnosis field, and (c) the etiology and construct validity of dissociative identity disorder and other severe dissociative disorders. Specifically, the dissociative disorders (excepting depersonalization disorder, which is not classified as a dissociative disorder by the World Health Organization) are manifestations of hypnotic pathology.     

Corpus callosum size,hypnotic susceptibility and empathy in women with alleged mediumship: a controlled study

AimEvidence indicates that highly hypnotizable subjects may have larger area of the rostrum of the corpus callosum (CC). Mediumship can be defined as the alleged ability to communicate regularly with deceased personalities, and self-hypnosis is postulated as an underlying mechanism for this ability. Therefore, we aimed to investigate the CC area, hypnotic susceptibility, self-reported dissociation, and empathy in alleged mediums in comparison with healthy, non-medium controls.MethodsThe study sample consisted of 16 Spiritist mediums (medium group (MG)) and 16 non-medium controls. Magnetic resonance imaging scans were performed to measure the CC areas (total and subdivisions). The Harvard Group Scale of Hypnotic Susceptibility was used to assess hypnotizability, and self-reported measures were used to investigate anomalous experiences, mental health using the Self-Reporting Questionnaire-SRQ, dissociative experiences using the Dissociative Experiences Scale, and empathy using the Interpersonal Reactivity Index.ResultsNo between-group differences were found in the total or subdivided CC areas or in hypnotizability, with both groups showing intermediate levels. The rostrum of the CC area and hypnotizability were not correlated. The MG presented with significantly more anomalous experiences, but the two groups had similar scores for dissociation, empathy, and mental health.ConclusionThe normal CC areas found in the MG are in contrast with the abnormal results typically observed in subjects with psychotic and dissociative disorders. Although hypnotizability was not different between groups, further studies are needed to replicate these findings in other samples.     

EEG phase synchronization during hypnosis induction

Hypnosis is a mental state or set of attitudes usually induced by a procedure known as hypnotic induction. In order to provide the basic physiological conditions for potentially successful hypnosis treatment of medical and psychological problems, the determination of a subject’s hypnotizability level is important. Currently, the hypnotizability level is determined using different standard subjective tests. To avoid the different drawbacks of these subjective clinical tests, a practical objective method based on the correlation between electroencephalograph (EEG) phase synchronization and hypnosis susceptibility levels is presented in this study. This method can be used by clinicians instead of the traditional subjective methods to classify hypnotizability level. Thirty-two subjects with different hypnosis susceptibility levels contributed to this research. Using statistical analyses, it was concluded that, in highly hypnotizable people, the EEG phase synchronization between different paired channels, located on the frontal lobe, is significantly different from that in subjects with medium or low hypnotizability.     

EEG phase synchronization during hypnosis induction

Hypnosis is a mental state or set of attitudes usually induced by a procedure known as hypnotic induction. In order to provide the basic physiological conditions for potentially successful hypnosis treatment of medical and psychological problems, the determination of a subject's hypnotizability level is important. Currently, the hypnotizability level is determined using different standard subjective tests. To avoid the different drawbacks of these subjective clinical tests, a practical objective method based on the correlation between electroencephalograph (EEG) phase synchronization and hypnosis susceptibility levels is presented in this study. This method can be used by clinicians instead of the traditional subjective methods to classify hypnotizability level. Thirty-two subjects with different hypnosis susceptibility levels contributed to this research. Using statistical analyses, it was concluded that, in highly hypnotizable people, the EEG phase synchronization between different paired channels, located on the frontal lobe, is significantly different from that in subjects with medium or low hypnotizability.     

Differential frontal-parietal phase synchrony during hypnosis as a function of hypnotic suggestibility

Spontaneous dissociative alterations in awareness and perception among highly suggestible individuals following a hypnotic induction may result from disruptions in the functional coordination of the frontal-parietal network. We recorded EEG and self-reported state dissociation in control and hypnosis conditions in two sessions with low and highly suggestible participants. Highly suggestible participants reliably experienced greater state dissociation and exhibited lower frontal-parietal phase synchrony in the alpha2 frequency band during hypnosis than low suggestible participants. These findings suggest that highly suggestible individuals exhibit a disruption of the frontal-parietal network that is only observable following a hypnotic induction.     

A pilot study of hypnosis in the treatment of patients with psoriasis.

BACKGROUND: The use of psychological therapies for patients with psoriasis has been proposed based on observations that the severity of their disease may correlate with emotional stress. The aim of this pilot study was to evaluate the effect of hypnosis as a treatment modality for patients with psoriasis. METHODS: We performed a 3-month randomized, single-blind, controlled trial of the use of hypnosis in adults with stable, chronic, plaque-type psoriasis. Highly or moderately hypnotizable subjects were randomized to receive either hypnosis with active suggestions of improvement (5 patients) or neutral hypnosis with no mention of their disease process (6 patients). After this period, the study was unblinded, and all the patients were treated for an additional 3 months with hypnosis with active suggestions of improvement. RESULTS: Highly hypnotizable subjects showed significantly greater improvement than did moderately hypnotizable subjects, independent of treatment group assignment (active suggestion or neutral hypnosis). CONCLUSION: Although this study included a very limited number of patients, the results suggest that hypnosis may be a useful therapeutic modality for highly hypnotizable subjects with psoriasis, and merits further testing in a larger patient population.     

EEG correlates of hypnotic susceptibility and hypnotic trance: spectral analysis and coherence

EEG was recorded monopolarly at frontal (F3, F4), central (C3, C4) and occipital (O1, O2) derivations during A-B-A conditions of waking rest, hypnosis (rest, arm immobilization, mosquito hallucination, hypnotic dream), and waking rest. Stringently screened on several measures of hypnotic susceptibility, 12 very low hypnotizable and 12 very highly hypnotizable, right-handed undergraduate, subjects participated in one session. Evaluations were Fast-Fourier spectral analysis, EEG coherence between selected derivations and maximum spectral power within EEG bands. In eyes open and closed conditions in waking and hypnosis, highly hypnotizable subjects generated substantially more mean theta power than did low hypnotizable subjects at all occipital, central and frontal locations in almost all conditions of waking and hypnosis, with a larger difference in frontal locations. Both low and high hypnotizables showed increased mean theta power in hypnosis, suggesting an intensification of attentional processes and imagery enhancement. Mean alpha power was never a predictor of hypnotic susceptibility. Interactions with hypnotic susceptibility showed that highly susceptible subjects had more beta activity in the left than right hemispheres, while low susceptible subjects showed only weak asymmetry. No main effects for or interactions between waking/hypnosis and hypnotic level were found for coherence between derivations or maximum spectral power within theta, alpha and beta EEG bands.     

Hypnotizability,dissociation and trauma in patients with a conversion disorder: an exploratory study

Little research has been conducted on the assumed high hypnotizability of conversion patients and on their dissociative experiences. Moreover, a relation is described between trauma, dissociation, somatization, psychopathology and conversion disorder. One hundred and two patients with motor conversion symptoms were tested for hypnotizability, dissociative experiences, trauma, somatization, general level of psychopathology and physical impairment. Our sample did not have higher levels of hypnotizability but they reported more dissociative experiences than normals. The trauma subgroup had higher levels of hypnotizability and dissociative experiences, psychopathology, somatization, and physical impairment than the non‐trauma subgroup. Uncorrected for general psychopathology, the trauma category ‘otherwise’ predicted 9.6% of the variance in the hypnotizability scores. After correction, only an additional 4.2%. The trauma category ‘emotional abuse’ contributed 18.9% to the prediction of the variance in the dissociation scores. After correction for general psychopathology, which explained 67.3% of the variance, only the sum score of the trauma categories contributed an additional 3.3%. Copyright © 2001 John Wiley & Sons, Ltd.     

Hypnosis and Traumatic Dissociation: Therapeutic Opportunities

ABSTRACT

Hypnosis and the related phenomenon of dissociation have long been linked to trauma. Evidence is reviewed regarding the relationship between trauma and dissociation, the prevalence of these dissociative symptoms in the acute aftermath of trauma, and their salience in predicting the development of later PTSD symptoms. The evidence reviewed regarding the prevalence of dissociative and other symptoms in the immediate aftermath of trauma formed the basis for including Acute Stress Disorder (ASD) as a new diagnosis in the DSM-IV. Dissociative amnesia is described as the key commonality between formally induced hypnosis and dissociative symptomatology, and controversy regarding traumatic amnesia is discussed. Finally principles of psychotherapy involving hypnosis and related techniques for dissociative and other post-traumatic symptoms are reviewed.     

The path to dissociative experiences: A direct comparison of different etiological models

Severe dissociation is trauma-related, but a range of dissociative experiences are also prevalent in clinical populations that are not necessarily trauma-based (e.g., depression, anxiety disorders, and obsessive–compulsive disorders). These remain poorly understood as the dominant etiological model for dissociation relies on trauma. Importantly, dissociation in such samples predicts poor prognosis and high drop-out rates. We set out to better understand the aetiology of dissociative experiences in a mixed clinical (anxiety and depression) and community sample by exploring between- and within-subjects effects of two domains: psychological distress or negative affectivity (operationalized as anxiety and depression symptoms), and poor sleep quality, including disturbed dreaming. The idea that negative affectivity triggers dissociation (Distress Model) is inspired by the trauma model. The idea that poor sleep and unusual dreaming underlie dissociation (Sleep Model) has been suggested as a competing theory. We examined both models by exploring which domains oscillate alongside dissociative experiences. N = 98 adults, half of them diagnosed with depression and anxiety and half community controls, underwent a structured clinical interview and completed questionnaires monthly for 6 months. Support was found for both models in that each domain had a unique explanatory contribution. Distress evinced consistent effects that could not be explained by sleep or dreaming, both between individuals and across time. Oscillations in dissociation across months, when taking psychological distress into account, were better explained by unusual dreaming than traditional sleep quality measures. These findings cannot be generalized to highly-traumatized samples. A complex, integrated etiological model for dissociative experiences is warranted.     

Discriminating Dissociative Identity Disorder from Schizophrenia and Feigned Dissociation on Psychological Tests and Structured Interview

ABSTRACT

Objective: The purpose of this study was to evaluate the relative efficacy of a number of psychological tests and interviews in discriminating dissociative identity disorder (DID) from feigned dissociation and schizophrenia.

Method: Three measures of dissociation (SCID-D, DES, SDQ-5) two personality measures (MMPI-2, Millon-III) and a brief measure of hypnotic susceptibility (Spiegel & Spiegel's Eye-Roll Sign) were assessed for their ability to differentiate these diagnostic groups.

Results: Results indicate that the SCID-D was clearly the most efficacious instrument in discriminating DID from schizophrenia and from feigned dissociation. The DES-Taxon and the SDQ-5 were adequate in screening pathological dissociation from schizophrenia but were less discriminative of feigned dissociation. The commonly used personality inventories were unable to detect feigned dissociation and the DID group tended to have higher elevations on scales measuring psychotic symptoms than did the schizophrenic group. The Eye-Roll Sign discriminated feigned dissociation from those with dissociative disorders.

Conclusions: Structured interviews such as the SCID-D, although resource consuming, are essential in comprehensive assessment of dissociative disorders. Comprehensive assessment of psychotic disorders should include some measure of dissociation.     

Somatoform Dissociation

Abstract

In most of the recent scientific and clinical literature, dissociation has been equated with dissociative amnesia, depersonalization, derealization, and fragmentation of identity. However, according to Pierre Janet and several World War I psychiatrists, dissociation also pertains to a lack of integration of somatoform components of experience, reactions, and functions. Some clinical observations and contemporary studies have supported this view. Somatoform dissociation, which can be measured with the Somatoform Dissociation Questionnaire (SDQ-20), is highly characteristic of dissociative disorder patients, and a core feature in many patients with somatoform disorders and in a subgroup of patients with eating disorders. It is strongly associated with reported trauma among psychiatric patients and patients with chronic pelvic pain presenting in medical healthcare settings. Motor inhibitions and anesthesia/analgesia are somatoform dissociative symptoms that are similar to animal defensive reactions to major threat and injury. Among a wider range of somatoform dissociative symptoms, these particular symptoms are highly characteristic of patients with dissociative disorders. The empirical findings reviewed in this article should have implications for the contemporary conceptualization and definition of dissociation, as well as the categorization of somatoform disorders in a future version of the DSM.     

Demographic and Seizure Variables,But Not Hypnotizability or Dissociation,Differentiated Psychogenic from Organic Seizures

Abstract

Early detection and differential diagnosis of psychogenic non-epileptic seizures (PNES) and epileptic seizures (ES) is a major clinical issue in comprehensive epilepsy centers. Using blind conditions with patients with PNES (N= 10) and ES (N= 31) before diagnosis, we tested the hypotheses that individuals with PNES would exhibit significantly greater dissociativity, hypnotizability, absorption, and history of early abuse than ES patients. Although PNES patients tended to show greater dissociative phenomena, only the last of our hypotheses was fully supported. Although absorption did not discriminate between the two diagnostic groups, it was significantly higher among those reporting early abuse. A logistic regression analysis using scores on dissociation, hypnotizability and absorption showed them to be poor predictors of diagnosis; however, other analyses revealed that female gender, reports of multiple trauma incidents lasting months or years, initial seizure onset in late teens or twenties, and daily seizure attacks significantly differentiated PNES from ES patients. Thus, demographic and seizure variables proved to be much better predictors of diagnosis than psychological dimensions often associated with PNES.     

Co-Occurrence of Dissociative Identity Disorder and Borderline Personality Disorder

The literature indicates that, among individuals with borderline personality disorder, pathological dissociation correlates with a wide range of impairments and difficulties in psychological function. It also predicts a poorer response to dialectical behavior therapy for borderline personality disorder. We hypothesized that (a) dissociative identity disorder commonly co-occurs with borderline personality disorder and vice versa, and (b) individuals who meet criteria for both disorders have more comorbidity and trauma than individuals who meet criteria for only 1 disorder. We interviewed a sample of inpatients in a hospital trauma program using 3 measures of dissociation. The most symptomatic group was those participants who met criteria for both borderline personality disorder and dissociative identity disorder on the Dissociative Disorders Interview Schedule, followed by those who met criteria for dissociative identity disorder only, then those with borderline personality disorder only, and finally those with neither disorder. Greater attention should be paid to the relationship between borderline personality disorder and dissociative identity disorder.     

A factor-analytic examination of the relationship of personality variables to hypnotizability

This study was designed to determine whether a factor-analytic approach, as opposed to a simple correlational approach, might identify more successfully the personality factors related to hypnotizability. The Clinical Analysis Questionnaire, the Harvard Group Scale of Hypnotic Susceptibility and a marijuana usage questionnaire were administered anonymously to 119 Ss. Two of nine rotated factors were found to be related to hypnotizability. The first factor was that of general intelligence. The second factor was composed of the variables of affectothymia, shrewdness, and psychasthenia. In addition, a regression equation was developed to predict hypnotizability from scores on the Clinical Analysis Questionnaire. Implications were discussed.     

Differentiating Dissociative Disorders from Other Diagnostic Groups Through Somatoform Dissociation in Turkey

Abstract

This study aimed to assess the reliability, validity, and psychometric characteristics of the Turkish version of the Somatoform Dissociation Questionnaire (SDQ-20). In this context, it investigated whether somatoform dissociation differentiates dissociative disorders from other diagnostic groups and non-clinical individuals. The Turkish Version of the SDQ-20 was administered to 50 patients with a dissociative disorder, 94 patients with psychiatric disorders other than dissociative disorder, and 175 non-clinical participants. To confirm the clinical diagnosis, all patients in the dissociative disorder group had been evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders. The internal consistency and the test-retest correlation of the SDQ-20 were excellent. The scale had strong correlations with the DES and the DIS-Q. There was a statistically significant difference between dissociative patients and other diagnostic groups on the SDQ-20 total score. The discriminative power of the SDQ-20 was as robust as that of the DES. There was no significant difference between the mean SDQ-20 total scores of Turkish and Dutch patients, but Turkish dissociative patients reported pseudoseizures more frequently than Dutch patients. The specificity of the short version of the scale (SDQ-5) was weak among Turkish patients. Dissociative disorders can be differentiated from other diagnostic groups through somatoform dissociation. The good psychometric characteristics of the SDQ-20 among Turkish participants support its cross-cultural validity.     

Is high hypnotizability a trouble in balance control?

Hypnotizability is a cognitive trait measured by standard scales and associated with peculiar physiological responses to cognitive and physical stimulations. Hypnotizability-related differences can also be observed in non-hypnotic state and in the absence of specific suggestions. In the normal bipedal stance subjects with high hypnotizability (Highs) exhibit a higher tolerance of alteration of the visual and leg/neck proprioceptive input with respect to low hypnotizable individuals (Lows). Aim of the study was to investigate whether this characteristic represents a disadvantage during highly demanding postural tasks. Sixteen Highs and 16 Lows of both genders participated in an experimental session consisting of maintaining balance while standing with open or closed eyes on a seesaw platform allowing roll movements. The results did not show significant differences between Highs and Lows in inclination area and time, with the exception of a greater ability of Highs with respect to Lows when they began the task displacing the body weight from the left to the right leg. Thus, high hypnotizability does not represent a disadvantage for balance control during highly demanding postural tasks. Together with previous studies, the present findings suggest that the Highs’ postural control might shift from a very “economic”, preeminently centrally driven functioning mode, characteristic of easy postural tasks, to an efficaciously periphery-controlled mode, required by difficult postural tasks.     

Ganser Syndrome,Organic Dementia and Hypnosis–A Case Study

ABSTRACT

Ganser Syndrome is a rare and controversial disorder, a form of pseudodementia, which has often been associated with prison environments. It is classified under dissociative disorder, not otherwise specified in the DSM-IV, and as a dissociative disorder with its own code in the ICD-10. In the literature, it has also been described as a psychotic illness, a factitious disorder, a histrionic disorder, and an organic illness. Despite special interest in dissociative disorders, we have diagnosed only one case of Ganser Syndrome during six years in Mental Hospital for Prisoners (that houses) with about 300 treatment periods per year of 3,000 male prisoners from a base population of five million people. While dissociative symptoms were clear, the patient also suffered from progressing organic dementia. Antipsychotic medication had no beneficial effect, but hypnosis clearly ameliorated the patient's symptoms. We conclude that Ganser Syndrome is rare, and may co-occur with organic dementia. The positive effect of hypnosis, apparently here described for the first time, may confirm the dissociative nature of the syndrome.     

Dissociative Identity Disorder Among Adolescents: Prevalence in a University Psychiatric Outpatient Unit

The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients. A total of 116 consecutive outpatients between 11 and 17 years of age who were admitted to the child and adolescent psychiatry clinic of a university hospital for the 1st time were evaluated using the Adolescent Dissociative Experiences Scale, adolescent version of the Child Symptom Inventory-4, Childhood Trauma Questionnaire, and McMaster Family Assessment Device. All patients were invited for an interview with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) administered by 2 senior psychiatrists in a blind fashion. There was excellent interrater reliability between the 2 clinicians on SCID-D diagnoses and scores. Among 73 participants, 33 (45.2%) had a dissociative disorder: 12 (16.4%) had DID, and 21 (28.8%) had dissociative disorder not otherwise specified. There was no difference in gender distribution, childhood trauma, or family dysfunction scores between the dissociative and nondissociative groups. Childhood emotional abuse and family dysfunction correlated with self-reported dissociation. Of the dissociative adolescents, 93.9% had an additional psychiatric disorder. Among them, only separation anxiety disorder was significantly more prevalent than in controls. Although originally designed for adults, the SCID-D is promising for diagnosing dissociative disorders in adolescents, its modest congruence with self-rated dissociation and lack of relationship between diagnosis and childhood trauma and family dysfunction suggest that the prevalence rates obtained with this instrument originally designed for adults must be replicated. The introduction of diagnostic criteria for adolescent DID in revised versions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, would refine the assessment of dissociative disorders in this age group.     

Hypnotic modulation of flow-mediated endothelial response to mental stress.

Post-ischaemic flow mediated dilation of peripheral arteries (FMD) is transiently reduced during mental stress. This experiment was aimed at assessing whether hypnosis, which is a powerful relaxation technique, modulated the FMD response to mental stress in subjects with different hypnotic susceptibility. Results showed that hypnotic relaxation prevented the expected stress-related reduction of FMD only in highly hypnotizable subjects, suggesting a protective role of hypnotisability against vascular damage.