International Handbook of Clinical Hypnosis - E-Lib FK UWKS

HYPNOSIS, DISSOCIATION AND TRAUMA 147
More examples of this kind of extreme dissociative response to trauma emerged,
leading to more systematic examination of the connection between trauma and
dissociation. The phenomenology of post-traumatic stress disorder involves, ®rst of
all, a traumatically stressful event APA, 1994). In the DSM-IV there are two
components. The ®rst is the actual experience: The person experienced, witnessed,
or was confronted with an event or events that involved an actual or threatened
death or serious injury, or a threat to the physical integrity of self or others p.
209). The second requirement is `the person's response involved intense fear,
helplessness, or horror' p. 209). The idea was to make it a stringent requirement.
There are problems, however, with this de®nition in that some peoples' reaction to
fear, helplessness or horror may come a long time after the trauma itself.
INTRUSION
Then there are three classes of symptoms. First are the intrusive symptoms. The
persistent and unbidden reexperiencing of the traumatic event, which includes
distressing recurrent images, recollections, ¯ashbacks, dreams, nightmares, delusions
or hallucinations. In the example given earlier of the armored car driver who
was shot, he said: `I don't just think about this guy. When an elevator door opens in
front of me, I see that guy.' This kind of intense reliving of the event, as though it
were happening, is typical of people with post-traumatic stress disorder, including
`intense distress at internal or external cues that symbolize or resemble an aspect of
the traumatic event' p. 210). Only one such intrusive symptom is required for the
diagnosis.
AVOIDANCE
The second class of symptoms are the avoidance symptoms, like the Oklahoma
City taxi driver who would not drive downtown much anymore: `Persistent avoidance
of stimuli associated with the trauma and numbing of general responsiveness'
p. 210). Examples include efforts to avoid thoughts or feelings about the event,
efforts to avoid activities that arouse recollections, inability to recall important
aspects of the trauma, feeling detached or estranged from others, diminished
interest in usually pleasurable activities, restricted range of affect, and a sense of a
foreshortened future p. 21). Three such symptoms are required for the diagnosis
of PTSD.
HYPERAROUSAL
The fourth criterion involves hyperarousal symptoms: trouble falling or staying
asleep, irritability or outbursts of anger, dif®culty concentrating, hypervigilance,
and an exaggerated startled response. Two such symptoms are required. The reader
may notice that in many ways these symptoms seem inconsistent. How can one be