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<l, bulimia neroosa ,andpurgingsymfr who meet the DSM-Ill-R (American Psychiatric Association tomawlogy. Thtprimaryf()(;'U$ ofthis anecdotalstudy is on theuncon­ 1987) diagnostic criteria for anorexia ncrvosa or bulimia ner­ scious misuse ojautohytmosis, hypnotic anaestlusias, and dissoci­ vasa and in whom the primary operational components of ation, which stems to be Iheprtdominant constituent behind the onset these eatingdisorders appeared to be autohypnosis, hypnotic ofthese eating anomalies. The usejulne5S ofthis obseroation can be anaesthesias, depersonali7.ation, hypnoidal states, ego states, an essential precursor in the determination ofan appropriate treat­ identity duality, absorption, time distortions, derealization ment strategy which incorporales autohypnosis into the overall ther­ and other dissociative phenomena. apeutic process. By virtue ofyears ofunrecognized applications of dissociation, autohypnosis, and hypnotic anaesthesias, these three CURRENT RESEARCH SUPPORTING THE cases illustrate the likelihood that individuals ruffmngfrom anorex­ HYPOTHESIS OF DISSOCIATION IN ANOREXIA ia nervosa and llulimia nervosa could reverse their aberrant eating NERVOSA AND BUUMIA NERVOSA AND THE USE behaviCtr$ by usingpositive autohyptUltic suggestions. In the case of OF HYPNOSIS IN ITS TREATMENT anorexic patients who belieue that the only thingthey are able to con­ trol is their eating, tM de<:i.sion to use autohyptwSis uver classical In recentyears, there has been an upsurge in the report­ hypnosis m.akes more sense. This does not force tJu patients Eo suf ingofindividuals with anorexia nelVosa and bulimia nelVosa fer tJu subjective experiena ofrelinquishing control to otherpersons. who have reported hislories of childhood trauma, such as sexual abuse. incest and/or olher forms ofabuse (Folsoni. INTRODUCfION etal., 1989; Damlouji & FC'b'Uson, 1985;Torem, 1986). There have been reports ofposl-traumatic stress underlying eating Despite numerous advances in the understanding ofeat­ disorders (Putnam, 1984; Spiegel, 1984, 1988; Coons & ing disorders. their etiologies remain unclear (Torem, Milstein, 1984; and Putnam. 1984). Therehave, as well, been 1990). As dissociation and the dissociative disorders are in­ reports of hidden ego states presenting as eating disorders creasingly understood, links between those phenomena in some individuals (Torem. 1986). Conversely, several and the eating disorders have appeared worth exploring. researchers have demonstrated the presence ofeating dis­ In the past decade, lhere have been a number ofrepons orders and gastrointestinal symploms in those patients diag- 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