hypnosis-acute stress-NEPRINTAT

hypnosis-acute stress-NEPRINTAT - A rticle Hypnotizability...

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Article 600 Am J Psychiatry 158:4, April 2001 Hypnotizability in Acute Stress Disorder Richard A. Bryant, Ph.D. Rachel M. Guthrie, M.Psychol. Michelle L. Moulds, M.Psychol. Objective: This study investigated the re- lationship between acute dissociative re- actions to trauma and hypnotizability. Method: Acutely traumatized patients (N=61) with acute stress disorder, subclini- cal acute stress disorder (no dissociative symptoms), and no acute stress disorder were administered the Stanford Hypnotic Clinical Scale within 4 weeks of their trauma. Results: Although patients with acute stress disorder and patients with subclin- ical acute stress disorder displayed com- parable levels of nondissociative psycho- pathology, acute stress disorder patients had higher levels of hypnotizability and were more likely to display reversible posthypnotic amnesia than both pa- tients with subclinical acute stress dis- order and patients with no acute stress disorder. Conclusions: The findings may be inter- preted in light of a diathesis-stress process mediating trauma-related dissociation. People who develop acute stress disorder in response to traumatic experience may have a stronger ability to experience dis- sociative phenomena than people who develop subclinical acute stress disorder or no acute stress disorder. (Am J Psychiatry 2001; 158:600–604) T he introduction of acute stress disorder in DSM-IV has resulted in renewed interest in the role of dissociation in acute stress reactions. Acute stress disorder comprises dis- sociative, reexperiencing, avoidance, and arousal symp- toms (1). The rationale for the acute stress disorder diagno- sis was that dissociative symptoms in the acute phase would impede access to and resolution of traumatic mem- ories and their associated affect and consequently contrib- ute to ongoing posttraumatic stress disorder (PTSD) (2). Prospective studies have indicated that approximately 80% of people who meet criteria for acute stress disorder subse- quently develop chronic PTSD (3–7). These studies have also reported that most people who meet all the acute stress disorder criteria except for dissociation also develop PTSD (5, 6). On the basis of these findings, it has been pro- posed that there are multiple pathways to development of PTSD; whereas some acutely traumatized people who later develop PTSD display acute dissociation, others can de- velop PTSD without acute dissociation (8). These findings raise the question of why some people respond to trauma with dissociation and others do not. It has long been argued that dissociation occurs in the face of overwhelming stress in people who are constitu- tionally predisposed to dissociative mechanisms (9). More recently, it has been proposed that dissociative tendencies may not predispose people to developing a mental disor- der but may shape the nature of a disorder should one de- velop after a trauma (10, 11). More specifically, it has been proposed that individuals who are prone to dissociation
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hypnosis-acute stress-NEPRINTAT - A rticle Hypnotizability...

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