Am J Psychiatry 1996; 153:42-63
Copyright © 1996 by American Psychiatric Association
Hypnotizability and traumatic experience: a diathesis-stress model of dissociative symptomatology
LD Butler, RE Duran, P Jasiukaitis, C Koopman and D Spiegel
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Calif, USA.
OBJECTIVE: The authors propose a diathesis-stress model to describe how
pathological dissociation may arise from an interaction between innate
hypnotizability and traumatic experience. METHOD: To support the
proposition that pathological dissociation may reflect autohypnotic
process, the authors highlight clinical and research data indicating
parallels between controlled hypnotic dissociative states and uncontrolled
pathological dissociative symptoms and summarize evidence of
hypnotizability in persons with psychiatric disorders that manifest these
symptoms. The authors present this evidence by examining dissociative
symptomatology in four psychological domains: perception, behavior and
will, affect, and memory and identity. In addition, modern cognitive and
neuropsychological models of dissociation are briefly reviewed. RESULTS:
Several lines of evidence converge in support of the role of autohypnosis
in pathological dissociation. There is considerable evidence that
controlled formal hypnosis can produce a variety of dissociations of
awareness and control that resemble many of the symptoms in uncontrolled
pathological dissociative conditions; and it is possible to discern in
dissociative pathology the features of absorption, dissociation, and
suggestibility/automaticity that characterize formal hypnotic states. There
is also accumulating evidence of high levels of hypnotic capacity in all
groups with dissociative symptomatology that have been systematically
assessed. In addition, the widespread and successful therapeutic use of
hypnosis in the treatment of many dissociative symptoms and conditions (and
the potential for hypnosis to induce dissociative symptomatology) also
supports the assumption that hypnosis and pathological dissociation share
an underlying process. CONCLUSIONS: High hypnotizability may be a diathesis
for pathological dissociative states, particularly under conditions of
acute traumatic stress.
