AUTO HYPNOSIS, HYPNOTIC ANAESTHESIAS, HYPNOID STATES, HIDDEN EGO STATES, DEPERSO~AUZATION fu~D OTHER DISSOCIATIVE PHENOlIENA UNDERL\lNG .4NOREXlAAND BeLl IlIA CASE STUDIES: METHODS OFTREUMENT Becky Ellen Kau, ~I.S.w.
Becky Ellen Katz, M.S.W., is a private researcher in Boca and scientific investigations indicatinga connection between Raton, Florida, and a doctoral candidate in ps)'cho!ogy at spontaneous self-hypnosis and multiple personalities (Bliss. The Union Institute, in Cinncinati, Ohio. 1984; Kluft, 1982; Pumam, 1989; Braun, 1980). Similarcor relations have, as well, been made between hypnoidal states For reprints write Becky Ellen Katz, M.S.W., P.O. Box 2331, and multiple personalities (Dickes, 1965; Elliott, 1982; Boca Raton. FL 33486. Fagan, & McMahon, 1984; Kluft, 1984). hypnotic anaesthe sias and multiple personalities (Braun, 1988; Bliss, 1983; Portions ofthis paper were presented at the Tenth Interna Watkins & Watkins, 1990). depersonalization and multiple tional Conference on Multiple Personality/Dissociative personalities (Bliss 1984; Putnam,Guroff. Silberman, Barban, States. October 1993. Chicago, Illinois. & Post. 1986), dissociativc phenomena and multiple per sonalities (Bliss. 1984; Braun, 1984; Coons, 1984; Putnam, ABSTRACI' et al., 1986; Bernstein & Putnam. 1988). However, onlya few This pafJerrejk,ts yean ofdinicalexperinu:e witha group ofpatimts researchers have shown a relationship between dissociation with diagrwsed ealing disO'1'dm. Thra cases are lkscribed in which and eating disorders (Bliss, 1983; Torem 1986, 1990; Demi a connuticn is made bttwtm their eating behaviors and dissocia track, et al .• 1990), and only onc article was found indicat tion. The primary emphasis is em th€ phenomena ofdissociation, ing a connection between spontancous self-hypnosis and includingautohyfmosis (self-hypnosis), hyfmotic anaesthesias, hyJr anorexia nervosa and bulimia neIVosa (Bliss, 1983). noidal states, ego slalts, and dtpers(malization as an operational Thesubjectorthe currentstudy is a subgroup ofpatienl.S annponent ojanorexia ntlWS
37 l DISSOC1UJO\" \01 IX, ~o 1. \tMdlI~ DISSOCIATIVE SYMPTOMS AND ANOREXIA AND BULIMIA
nosed as having multiple personalities or olber dissociative had forced her lOseek medical attention following the report disorders (Bliss, 1983; Demitrack, etal" 1990; Torem, 1990; ed death ofKaren Carpenterfrom anorexia nervosa. During Vanderlinden & Vanderc}'cken, 1988). PcUinati, Home,and the first consultation, Kelley complained ofbloatingandgas Staats (1985) found that bulimics were more highly hypno tritis wheneversheate. She alleged she was allergic to all sorts tizable than were anorexics. They hypolhesized that their of foods, and claimed that the only things she was able to higher levels of hypnoti7-ability resulted from dissociative tolerate was lettuce, carrots, grapefntits, potatoes, and mechanisms. They further reported that the purging sub unleavened bread. She was obsessed with her bowel func group of anorexics had higher hypnotic capacity than the tion and used laxatives and diureticsseven times a day. Kelley abstaining anorexics. Torem (1991) introduces the idea of refused to eat any foods containing fat and knew the nutri using seLf-hypnosis with his anorexic and bulimic patients by tional value ofalmost everything. She refused to be weighed, pUlling it in the context of the patient's symptoms, com but agreed that the weight of 80 Ibs. that the family doctor plaints, ordesire for change and reports that he obtains favor had recorded was correct. Her heightwas5'9." Shewasema able results in its use. Vanderlinden and Vandereycken dated and in extreme danger. Kelley contracted to enter (1988) found that efforts to incorporate hypnotherapy in treatment under specific guidelines and was advised that if the treatment ofanorexia nervosa was extremely difficult if her weight continued to drop her family doctor would have not impossible especially in the beginning phase oftreatment, no choice but to hospitalize her. She agreed to return for (stage ofemaciation). Their sometimes extreme if not con future visits and treatment was scheduled once a week for tinuous preoccupation with food and body shape may com one hour sessions. pletely block these patients' ability to concentrate on even simple matters, let alone an hypnotic procedure. Stage One: Food For Tlwught Yapko (1986) found instanceswhen direct hypnoticsug Kelley returned to see me at my office for the next three gestions for the treatment ofanorexia are not always effec weeks at which time it had been decided that we would begin tive and suggested that more indirect hypnotic and strate to meet at Kelley's home for treatment. In my experience gic interventions might prove more successful. Barabasz working with individuals suffering from anorexia nervosa, I (1990) provides details of an easily replicable intervention had found that it was difficult to getan accurate enough pic using hypnosis in the treatment of bulimia. According to ture of their aberrant eating behavior by mere self-report. Gross (1986), if the eating disorder patient resists, even the Going to the patient's home helps to put the eating disor best hypnotherapist may fail in the induction of trance, let der into the context ofthe patient's living environment. alone achieving a therapeutic goal. He concluded that self The first home visit was conducted in Kelley'S kitchen. hypnosis might prove a means for better self-control. We sat at the dinette table directly in front ofthe refrigera Schwartz, Barrett, and Saba (1985) hypothesized the exi,s.. tor. The appointment time was scheduled at noon and it was tenceofadissociation process in bulimic patients. According agreed that we would have lunch together. Kelley'S anxiety to their theory, bulimic patients usually can identify two sep mounted to extreme levels as we established the goals ofthe arate 'voices,' which represent two fairly distinct parts oflhe visit. The following dialogue ensued between us. patient (Schwartz, Barrett, & Saba, 1985). In a study of 36 patients, McCallum, Lock, Kulla, Rorty, and Wetzel (1993) Therapist: "Kelley, I'd like to be introduced to your concluded that dissociative symptoms arc related to the refrigerator and its contents. Would it be okay with behaviors characteristic ofpatients with eatingdisorders and you ifl take a look inside your refrigerator to see thattr.lUma should be considered in those who presentwith what we could put together for lunch?" dissociative disorders. They further point out that these comorhid factors, dissociative phenomena, and trauma, &l1ey: (With surprise in her voice) "I guess so...but may alter treatment outcome of patients with eating disor I'm really not hungry." ders. Therapist: "We will not be making a large meal so CLINICAL CASE EXAMPLES you will only eat what you can handle."
Case One: Spontaneous AuJohyp"qsis and Hypnotic Kelley: (Following a deep sigh) "Okay, go ahead," Amtntherias as Precursors ofAlIlm~,..ia Nervosa Kelley (a pseudonym) was a 20-year-old married female. Kelley sat and watched as the refrigerator was opened. The She was referred by her family doctor for the evaluation of goal of this session was notjust to get Kelley to eat, but was her depression, food restriction, and dangerously extreme to teach her that eating did not have to be "fattening. ~ As weight loss. HospitaJization had been the doctor's preference, suspected, the refrigerator was close to·empty. Aside from but Kelley declined his recommendations and would only baking products, there was a LUrkey breast which was for her agree to come for a professional consultation. Her husband husband'sdinner, a few eggs, skim milk, matzos (unleavened
38 D1SS0ClATI01'i, \'01 IX.:'\o 1. Marth 19% bread).salad, and two poralOcs. Working with Lhe foods that am so bloated following our meal. Can't you see Kelley had available and which shewould eat; the matzo. two how enormous my stomach is? I couldn't bare to eggs, and milk were removed from the refrigerator. see how fat I look. I could be mistaken for a preg nant lady. Therapist: How 'bout some matzo brie? With considerable resistance, Kelley retreated to her bed &lley: Matzo brie? What's that? I never heard ofit room and returned wearing a very tailored outfiL before. Therapist: Let's see how you look in the full length Therapisl: Matzo brie is a mixtureofeggs. matzo and mirror in your hallway, Kelley. skim milk which is usually prepared by frying it. Kelley: With tears trickling down her cheeks andanos Ktlley: I'd rather die than cat greasy, oily food. I extended in frontofherslOmach.1 already told you might as well swallow a boule of poison since that I look like a pregnant lady. grease is just another one ofthose poisons that will get us in the end. Therapist: What else do you see?
Therapist: You happen to makesome interesting and Agonized over the request. she softly spoke. sound points. However, when eatcn in small quan tities, fat is an essential food source for our healthy Kelley: I see the image of a fat girl looking back at sustenance. me in the mirror.
Respecting Kelley's distaste for fat and oil, we decided Therapist: Does the fat girl have an age? to bake the matzo brie. In this thenl,peutic exercise. Kelley was shown how to use the foods she waswilling to eatinorder KeJky: (Barely audible) Thirteen. to produce a meal Lh.atshecould tolerate. In this way, behay ior modification was raking shape in a positive and effective Therapist: Is there any relation between the image meeting ofminds. Only the whites ofthe eggs were used since in the mirror and the person you were at age thir Kelley insisted that eating the yolks would make her ill. teen? Insteadofarguing over these issues and causing further resis rance, it was preferable tojoin Kelley in achieving our goal. Ktlley: Yes, when I was thirteen I was 145 lbs., fat, Kelley assisted in preparing the meal and we sat down to cat and ugly...and all the kids atschool would lease me. it together. During the meal it was learned that Kelley was That was when I decided to go on a diet. Ii0Sl the an avid baker and was known by friends and family for her weight and thought that my entire life would delectable pastries. This is a common aspect ofthe anorex change, but 1still felt fat and ugly every time I saw ic profile. Often, individuals with anorexia nelVosa are myself in the mirror. So I just stopped looking al known for preparing incredible meals foreveryone else, and myself in mirrors. forcing others to eatwhile they sit back and watch or nibble on bits of low calorie vegetables. When we completed our Therapist: You've done some excellent work today. meal together we discussed further goals and established a I would like you lo think about what it is that makes weight gain offive pounds within the next two weeks. Kelley you dislike yourself so much; then write your was reassured that we would nOt go tOO quickly and that she thoughts on a sheel of paper and bring it to your would not be forced to gain weight unless she agreed to iL nextappoinnnenL When we meet nextweek we can Together we planned the week's menu and before leaving, begin to look at how your mirror image got so dis the following dialogue ensued between us: torted.
Therapist: How'bout using the last fifteen minutes We agreed to meet at the nearby supermarket for our next ofoursession to do some bodyimage work? Would session. you be willing to change out ofthe baggysweatshirt you are wearing, and put on an outfit that would Sla~ Two: To Market We Go show your true shape? We met at the supermarket for our therapy session and together we embarked on the second stage ofKelley'sjour KeUey: With hands placed over her belly. I really do ney to recovery. The purpose ofgoing food shopping was to not know what that would accomplish now that I help Kelley work through her resistance and to teach behav-
39 DISSOClATIO'l, VuI.IX. Nu. 1, 'larcb 1996 DISSOCIATIVE SYMPTOMS AND ANOREXIA AND BULIMIA
iOT modilication techniques as we went along. We took two market with Kelley'S groceries and planned to meet for our separate shopping carts and went down each aisle selecting nextsession back at the office for a picnic lunch that Kelley Ihe foods that were on Kelley's safe IisL When Kelley's cart was to prepare for both of us. was completely full, the focus lhen switched to the empty By incorporating eating into the treatment hour, it was cart. We repeated our shopping a se<:ond time, with Kelley possible to provide a more supportive environment for wheeling her full cart next to the empty one. In this exer Kelley's fear ofgetting fat. Respecting Kelley's food choices cise, Kelley was asked to imagine what it would be like to be and working with lhem instead ofagainst them enabled us able 10 eatanythingshe wamed and never have to worryabout to establish a trusting environment. In this way, she was less gaining weighL She was then asked to put into the empty resistant to explore the deeper issues underlying her aber carlall the foods thatshe would want (0 eat under these imag rant eating behaviors. inary circumstances. Together we walked up and down the aisles as Kelley filled the shopping cart with food. When this Slage Three: Disawering and Unwvering.Dissociative exercise was completed, we stoodoITto the side and discussed Phenomena the overall experience. Kelley's cart was filled with vegeta In her third month of treatment, Kelley related a story bles, fruits, pastas, whole grains, bread, poultry, and fish. The in which she referred to herself as having incredible mysti othercartwas filled with desserts, candies, chips, nut~, frozen cal powers. The following is a segment of the conversation wames, pancakes, french fried potatoes, watermelon, hon with Kelley: eydew, grapes, and a large rib steak. Nthough Kelley select ed foods high in fat and sugar contenl, she insisted lhat the Kelley: When I was seventeen years old, I had been very thoughtofeating lhem repulsed her. However, she was preparing dinner for my parents. I burnt my finger confused by her selections. She described this exercise as if on the stove and did not even feel the heat under another person inside her had chosen the foods in the sec my hand. When blisters formed on the skin I put ond carL What was even more perplexing to Kelley was that myself into a "deep psychic spiritual experience... she barely remembered doing this part ofthe exercise. "1t's and when I came out ofthis spiritual experience," like my mind completelynumbed oUl,"sheconfided. In fact, the blisters were completely gone. I just stood in this was the same struggle that went on inside her for years. the same spot for what seemed like an eternity try "One partofme wants to eatand the other partofme won't ing to understand what hadjust taken place.l never let... told anyone about this because I feared that I'd be It is notsurprisingto hearanorexicsdescribe their inner taken for being crazy. struggle with food in this way. In fact, all ofus have had the experience, at one time or another, ofstruggling with dif Therapisl: I do not think you arecrazy. In fact, I find ferent aspects ofourselves. One part ofus may be craving to this rather interesting, Kelley, and wonder if you eat something we know is fattcning while the other part of have ever had any other similar experiences that us tries to control the impulse. YCt we eat it anyway andjust you would like to share. tell ourselves that we will eat less tomorrow. In Kelley's case, this inner struggle became more exaggerated and eventu Kelley: Yes, there have been others. When I wenton ally manifested itself in the shaping of dissociative mecha a diet last year I was able to convince myself that I nisms such as autohypnosis, hypnotic anaesthesias, deper was not hungry even when my stomach was growl sonalization, and other dissociative phenomena. In Kelley's ing. Whenever I would feel hungry 1would suck on words, she "numbed out" and her subconscious mind took an ice cube and the freezing cold feeling ofthe ice over without herawareness. It was pointed out to Kelley that hitting my stomach would make me forget about the foods in hercart were sound nutritional choicesand that my hunger and eventually my hunger pains would eating those food sources would help to sustain her nour justdisappear. I could even make a table filled with ishmentand health. The foods in theothercart., for the most all sorts ofenticing food disappear. part, were fattening and nutritionally unsound. It was fur ther explained that ifKelley were to eat the recommended The more Kelley spoke the more it became apparent that portions of most nutritionally sound foods that she would she was a virrnoso at autohypnosis, and this might perhaps be able to maintain a lean shape, that would neither be tOO be an asset in our treatment plan. Recognizing that Kelley heavy or tOO thin. With a proper balance ofgood nutrition had a need to be in control at all times, the idea of using and exercise she would feel stronger and less anxious and hypnosis with her was broached cautiously in the following fearful about her life. We spoke about how stanration dis dialogue between us: torts the lhinking process, how it attributes to irrationallhink ing and all SOrts of psychological difficulties, not to ignore Therapist: I am quite interested in your profound the havoc it causes to the body physically. We left the super- "psychic spiritual experiences" and wonder if you
40 DISSOCIATION, Vol. IX. No I, )t~rrb jQ96 would be willing tosharewith me how you goabom aUlohypnosis. She was further infonned abom autohypno iL Have you hadanyexperience using hypnosis clin sis and was asked ifshe would be willing to proceed in treat ically in the past? ment, learning to use autohypnosis to improve her physical status, to help her relieve heranxieties, and alleviate her fear &Uey: o. 1 never have been hypnotized. of losing control over her food and her life. Kelley agreed to give it a try. Slowly she raised her eyes all the way up into her head (the Spiegel Eye Roll) and took in very deep breaths. With Final Stage: Cognitive Restructuring And Reframing her high upward gaze an internal squint occurred. It was an When Kelley returned for the next session, permission amazing experience watching Kelley as she had complClely was obtained to assist her in initiating a trance. An attempt entered trance. Her breathing became slow and deep; her was made to induce a tnmcestate, but Kellywasresistant and face muscles relaxed, her head fell forward, and her body was unable to enter trance. She was then asked to try it on slumped down in a relaxed state. her own without help and she went deeply into trance. Under autohypnosis, Kelley was asked to envision a table laden with Therapist: So that is !.he way you enter your "pro all sorts ofenticingfood thatshe once had been able to make found spiritual experience." I am glad thatyou have completelydisappear.ltwas further suggested that itwas not been able to share this with me. Now would you be necessary to make theentire table laden with food disappear; willing to learn some techniques that would help that she could learn to selectively choose her foods without you to feel less bloated when you eat? losing control over her eating. "From now on," 1 told her, "when you feel hungry you will no longer have to numb your &lJey: (With her eyes slill dosed, nodded her hunger pains with ice. Just imagine that your hunger pain head.) Yes. is an alarm which cannot be turned off until you eat some thing. You will notgorge yourselfor stan'e yourself. You will Therapist: I would like you to imagine yourself sit eatjust enough to shut the alarm off. And you will feel sati ting down to a meaL You can relax yourselfby tak ated and in good spirits.- ing long, deep breaths prior to your eating. Behavior modification under autohypnosis was accom Concentrate on your breathing.. .feel your abdom plished when Kelley returned the following week. to report inal muscles becominglooser as the tension in your thatshe was able to eata tiny piece ofcake and two teaspoons bodyjust melts away. JUSt imagine yourself eating of ice cream at her sister's birthday party and was able to any food ofyour choice. As you conlinue to take exercise self-control without fearing that her eating would long, deep breaths, imagine yourselfplacinga very get out ofcontroL We continued to use autohypnosis as an small piece offood into your mouth. Chew it slow adjunct to the treatment as a means ofexploring the power ly and carefully and don't swallow it until you have ofthe subconscious mind over Kelley's eating behaviors and chewed it thoroughly. Slowly count to 50 and when overall mental state. you are ready let the food slip down into yourstom This set of experiences led to my exploration of the ach where it will rest peacefully as it gets digested potential for using autohypnosis in the treatmentofanorex and you will not even be aware ofitinside you. You ia nervosaand bulimia nelVosa.ln the course oftreatingilldi will feel satiated, calm and peaceful. viduals suffering from anorexia nervosa, it became more apparent that the fear of relinquishing control under hyp Kelley smacked her lips to the count offifty, took a deep nosis was a major issue. This was minimized when the breath and smiled. Then she madea swallowing sound deep patients put themselves into trance without any assistance. in her throat, took another deep breath and opened her Patients were taught how to use amohypnosis in a positive eyes. way and to eliminate some ofthe negative dissociative appli cations that they had been using for years. The ease at which KeJJe,: Glancing at her watch. I think it is time to individuals with anorexia nervosa seemed to be able to use go. autohypnosis became an asset in the reduction of clinical resistance and in their increased willingness to explore the We spoke for several minutesabout this experience and underlying issues relevant to theiraberranteating behaviors. Kelley was encouraged to practice at home the exercise we had juSt done. She admitted that she had no recall ofwhat had been discussed (hypnotic amnesia). She was encouraged not to be concerned about it. When Kelley came to the next session, it was explained to her that this "profound psychic experience~ was called
41 DlSSOWTlOK Vol IX. ~o 1, MaKh 1996 CASE 1WO: SPONTANEOUS AUTOHYPNOSIS, had her parents convinced thal she was allergic to all sorts HYPNOTIC ANAF..STHESIAS. ABSORPTION, TIME offoods and they took her to see an allergisL DISTORTIONS, AND DEPERSONALIZATION AS Like Kelley, Melenie presented a vast array ofdissocia OPERATIONAL COMPONENTS OF ANOREXIA tive features which contributed to her anorexic profile. Her NERVOSA description of a distorted body image (depersonalization), as well as her ability to lose track of time or time distortion Melenie (a pseudonym) was a 15-year-old female who due to her constant rumination and preoccupation with food was referred by herfamily doctor for suspected anorexia ner (ahsorption) were among the dissociative features that man vosa. She was 5'8" tall. She had dropped to 77 100., a loss of ifested themselves in heraberranteating behaviors. Herabil over 25% of her original body weight. She did not want to ity to fonnulate images of food that would cause her to be in therapy and made it clear that her mother had forced become ill (amohypnosis) and to numb and shut out her her into keeping the appointment. Melenie was reassured pangs ofhunger (hypnotic anaesthesia) became an integral that her reluctance to trustwas understandable and that she part of the operational components that perpetuated her was in control ofwhat she would bring to the therapy ses anorexic behaviors. Starvation in the face ofreal hungerand sions. Asmile instantly appeared on her face and she began plentiful food has been the fealUre that has made this eat to talk about how accomplished she felt when it came to her ing disorder an anomaly to researchers through the years. ability to control her eating. Amohypnosis became an adjunct to psychotherapy, "When 1 was a little kid/ she said, "I remember how 1 which included cognitive restructuring. Autohypnosis made would pass by a bakeshop with my motherand the very smell it possible for Melenie to regain appropriate conuol over offresh bakedcak.es would compel us to enterthe bakeshop her life. Suggestions were made I) to fonnulate more posi and force us to buy a cookie or even a whole cake which we tive images offood in lieu ofdirectlystimulating herappetite, would eventually gorge ourselves on. When I was thirteen, and 2) to replace the moreaversive images that Melenie used my dad made fun of my pot belly and would make oinking to destroy her appetite. Suggestions were made to help sounds. A partofme recognized that he wasjoking, butanoth Melenie to reestablish her relationship to food as a means er part of me felt like I was letting my father down. I was of survival rather than as a means ofself-destruction. With always daddy's little girl and I would do anything to keep it this unconsciowand innateability to dissociate, Melenie had mat way. So I made up my mind that 1 had to do something been able to accomplish a major loss of appetite. She had to get rid of my belly. I loved to eat and savored the won successfully been able to alter her mental images offood by derful aromas of my mother's cooking. When I first began numbing and anaeslhetizing the sensations of hunger. In to diet, my stomach would growl all night long and kept me this way, she was able to desensitize herselffrom the pain of aWake with hunger pains. I would stay awake all night think hunger. The therapeutic use ofautohypnosis helped to sen ing about food and every waking moment I would fantasize sitize her selfto heroTg".mic needs for nourishment. She was the foods I wanted to eat. Before long I became so preoc able to make suggestions to herself that enabled her to cupied with my food that I could not concentrate on any become morc independent and less in need of her father's thing else and I even found myself missing appointments approval. Autohypnosis helped her to become less fearful because I lost track ofwhat time it was. And with all that, I ofgrowing up and helped to release her from the grips ofa still felt so fat and bloated. My hips would stick out too much hidden ego state or state ofmind that wanted forever to be and I did not know why my parents and everyone kept try "daddy's little girl." ing to make me think like them. No matter what, you will never be able to convince me that I can be tOO thin." CASE THREE: HIDDEN EGO STATES AND IDENTITY Melenie stayed in therapy for six more months. During DUALITY AS A MECHANISM OF BULIMIA NERVOSA this time she described how painful hunger had been to her and how desperate she had felt in trying to control iL Sophia (a pseudonym) was a tllirty-five-ycar old, married Eventually she became an animal activist and stopped eat woman with two daughters, aged 13 and 10. She was a suc ing meat completely, saying that it was the cruelest thing in cessful artist and li\'ed in an upper middle-class residential the world to "kill animals for man's survival." She had been community. From the outside, everything looked perfect, but convinced that she would rather starve to death than eat an on the inside, Sophia was falling apart. She was self-referred animal. Her cravings for her favorite pastries and breads and came to see me after a tremendous inner struggle with ended when she no longer could stomach the thought of her decision to get help. Sophia weighed 135 lbs. and was poisoning her body with such "toxic foods" that cause "teeth 4'9" in height. She was terribly upset over her weight since to decay and bellies to bulge." Evenrually the wonderful aro she had gained over 30 lbs. in the last four months. In our mas of her mother's cooking began to make her sick. She initial session, she denied laxative or diuretic abuse as well developed severe headaches and felt repulsed at the smells as purging after meals. However, after one month ofthera that would come from her motller's kitchen. Beforelongshe py, Sophia admitted to taking 20 laxatives a few times a week
42 [)[SSOCL\TION, Val IX, iIlo I, MaRn 1996 and two diuretics a day. In addition, she also owned up to operational component responsible for Sophia's binge purging following Ihe bingingepisodesduring which shelost purge behavior. Therapeutic use of autohypnosis enabled complete comro!' Sophia to come to terms with herguilt, shame, humiliation, Her eating problem was making her miserable. She and anger and eventually freed her from the grips of her would wake up in the morning and make a pactwith herself perpetrator. In other words, by being able to communicate not to eatall day, but then something alwa~ seemed to hap direct.ly with the "subconscious mind," Sophia was able to pen to ruin things. ~It's like this other personjust takes over more clearly understand the dichotomy ofherbinge/purge and forces me to eat even if I am not really hungry. I can't behavior. It further helped to establish a more integral under take the struggle any longer. I keep telling myself I don't standing of her ego state and the role it had played in the want to eat but this voice inside me keeps telling me it wams dynamics ofSophia's binge/purge behavior. One year from to eat. I feel like I am going crazy." the date that Sophia entered treatment, her weight was sta Sophia continued to feel guilty throughout our sessions ble at 100 lbs. and she was no longer using laxatives or tak because she had everything to be happy about: a professional ing diuretics. She no longer felt like she needed to get rid husband, two beautiful daughters, a magnificent home, and of an undesirable part of herself or her father, and her plenty ofmoney. When asked about her childhood and her binge/purge activity ceased. She remained in therapy for relationship with her parentsand siblings, she initially paim another six months, during which we concentrated on cog ed a beautiful portraitofher childhood years. We met week nitive restructuring and rcframing. ly for four months before, Sophia broke down and confid ed Lhatshe had done somethingvery "naughty" and thatshe DISCUSSION could not share with me or anyone else. As Sophia spoke, her posture assumed a child-like stance. Her shoulders Cognitive restructuring and reframing is a method of drooped, her face pouted, and her voice sounded much coming to tenns with a problem. The individual is taughllo younger. She burst into sobs as she related an incestuous develop a new perspecti\!e with which to view an old prob experience she had with her father when she was seven. lem (Spiegel & Spiegel, 1978). It is my understanding that Incestuous experiences had continued throughout her mind and body come together in the resolution ofconflict childhood years into her adolescence. The only person and in symptom recovery. The conception that mind and Sophia had ever told was her husband. It was at this point body are an integral pan ofone's whole being is what lies that we had discussed using autohypnosis as an adjunct to behind the powerful outcomeofthis process. In otherwords, our therapy. Sophia agreed that she could no longer stand the person is neither his/her body nor is he/she entirely the pain she was going through and was now willing to try his/her mind. In essence, the goal of the individual is to anything to make herself feel better and bring relief to this become in hannony with his/her body. Thoughts and sen endless nightmare. sations arc recognized regardless ofany pain that might be In her first autohypnosis session, Sophia was taught pro attached to them. The individual is encouraged to reestab gressive relaxation exercises which she agreed to practice at lish and restructure his/her relationship between him home between sessions. I explained to her that there were self/herselforhis/her body. Problem-solving and resolution many different ways to enter trance. I assured her that once occur when the individual creatively finds solutions to she had become more familiar with this process, she would enhance the relationship between mind and body and be able to alter it to her immediate needs and could select achieves a harmony between the selfand the body. Problem the methods thatshe was mostcomfortable with. Sophiawas solving is not a contest between the mind and body or an instructed to use autohypnosis twice a day. When she atlempt to denyor push away the problem. It is a method in returned, she appeared to have a new vigor. She reponed which the individual views the problem openly and honest thatshe had practiced the autohypnosis twice a day through ly. examines its consequences, and reconciles himselflher the week and it had helped her enormously to reduce her selfto find acceptable solutions. anxiety. She even felt a bit bener. We continued to use autO According to Dejerine and Gauckler (1913), true men hypnosis in our sessions, with Sophia putting herself into tal anorexia occurs when individuals successfully alter their trance and taking control of the process. Autohypnosis mental images offood in order to destroy their appetite and enabled us to explore the egostate thatwas behind heraber· achieve their goal of thinness. In view of the power of the rant eatingbehaviors. In addition, itenabled Sophia to work mind to alter the body's physiological need for food, it is on some of the more painful repercussions of incest with useful to look allhe phenomenon ofdissociation as an oper her father. She was taught relaxation skills using autohyp ational componem of these eating disorders. This premise nosis. Autohypnosis was not used for purposes of probing .has been derived from years ofclinical experience and obser· or searching for answers. Autohypnosis was used to help vation. What I discovered was that individuals with these dis Sophia achieve cooperation from her "subconscious mind" orders demonstrate an extraordinary ability to numb and in integrating the detached ego state. This ego state was the anaesthetize their pain ofhunger (hypnotic anaesthesia), to
43 DISSOCIATION, Vol IX, No. 1, ~larfh 1996 DISSOCIATIVE SYMPTOMS AND ANOREXIA AND BULIMIA
alter and distort their perceptionsoftheir body image (deper AUTHOR'S NOTE sonalization) and their externalworld (derealization) as well I would like to thank Dorothy Minor and the staff at the as to alter their perceptions of hunger and influence their Library for the Blind in Daytona Beach, Florida, Ann aberrant eating behaviors (autohypnosis). Robinson at the Governor's Commission on Advocacy, and In the case of individuals suffering with anorexia ner John Deposati at the Division ofBlindServices, for their over vosa and/or bulimia nervasa, the usefulness of cognitive whelming support of my many research prqjects. I am restructuring and reframing cannot be overemphasized. indebted to the state ofthe art technoloh,)' for the blind which Utilizing autohypnosis, the individuals with aberrant eating the Division ofBlind Services has provided me with. Without behaviors can teach themselves to respect their bodies since it this research would be near impossible to do.• they cannot live without them. Individuals learn to experi ence their bodily sensations in new ways, and that the sen REFERENCFS sations of the body can be altered. Anorexics and bulimics have a profoundability to alter their images offood and their American Psychiatric Association (1987). Diagnostic and statistical perceptions of hunger. The clinician helps them own their manual of mental disorder.l. 3rd ed. (Revised). Washington, DC: Author. body perceptions of hunger. They appreciate that they already know how to alter their body's sensations through Barabasz, M. (1990) Case report: Treatment of bulimia with hyp starvation, bingeing, and purging. Since they already are nosis involving awareness and control in clients with high dissoci familiar with being able to alter their body's sensations in a ation. 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