Until fairly recently, hypnosis had been recommended rather unequivocally for use in the treatment of the dissociative disorders. The clear parallel between well-known hypnotic phenomena and the naturalistically-occurring phenomenology of the dissociative disorders (see Braun, 1983; Bliss, 1986); the argument that many manifestations of the dissociative disorders were the result of the unwitting abuse of autohypnosis (Breuer & Freud, 1955; Bliss, 1986); and the clear demonstrations that hypnotic interventions were therapeutically useful in work with amnesia and with dissociative identity disorder (from its first successful treatment [Despine, 1840]; numerous reports of the success of hypnosis in combat-related amnestic syndromes; and use of hypnosis with the first series of successfully treated dissociative identity disorder patients followed over time in the modern era [Kluft, 1982, 1984, 1986a, 1993a]) were among the arguments advanced in favor of utilizing hypnosis with this group of patients.
In the DSM-IV (American Psychiatric Association, 1994), the dissociative disorders consist of depersonalization disorder, dissociative amnesia, dissociative fugue, dissociative identity disorder, and dissociative disorder not otherwise specified. Dissociative trance disorder, currently classified as a form of dissociative disorder not otherwise specified, is an additional classification being studied for possible inclusion in future diagnostic manuals. It consists of either an apparent withdrawal into a trancelike state, or an episode of possession trance in which the customary sense of personal identity is replaced by a new identity. Currently these are classified as subtypes of dissociative disorder not otherwise specified.
In depersonalization disorder, hypnosis can play a role in reconnecting the afflicted individual with his/her body and/or his/her feelings. In dissociative amnesia, hypnosis traditionally has been used to retrieve memories for the period for which there is an absence of memory. In dissociative fugue, hypnosis can be utilized to access missing periods of time, and to attempt to contact an alternate identity should one be present. Such efforts frequently are only partially successful.
International Handbook of Clinical Hypnosis. Edited by G. D. Burrows, R. O. Stanley and P. B. Bloom © 2001 John Wiley & Sons, Ltd
For dissociative identity disorder, hypnosis traditionally has been used to access alternate identities, to facilitate communication across alternate identities, to retrieve memories for periods of amnesia, to abreact traumatic experiences, and to facilitate integration. Hypnosis is used by the vast majority of therapists treating this group of patients (Putnam & Loewenstein, 1993). However, in recent years there has been an emphasis on the use of hypnosis for supportive and crisis prevention interventions (Fine, 1991; Kluft, 1988a,b, 1989, 1995a), for ego state therapy applications (Watkins & Watkins, 1997), and for doing the newer fractionated abreaction techniques (Kluft, 1988, 1990, in press; Fine, 1991), which are more easily tolerated by patients vulnerable to severe distress, if not decompensation, as they reexplore traumatic material. The uses of hypnosis for dissociative trance disorder involve interrupting pathological trance states and restructuring the dissociative experiences, often with the use of autohypnotic techniques, so that the patient becomes the master of his or her proclivity for slipping into trance, instead of remaining its hapless victim (Spiegel & Spiegel, 1978). With dissociative disorder not otherwise specified, the uses of hypnosis are likely to follow the usages applied to the discrete dissociative disorders a particular variant most closely resembles.
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Hypnosis has been defined as a state of heightened suggestibility in which the subject is able to uncritically accept ideas for self-improvement and act on them appropriately. When a hypnotist hypnotizes his subject, it is known as hetero-hypnosis. When an individual puts himself into a state of hypnosis, it is known as self-hypnosis.