International Handbook of Clinical Hypnosis - E-Lib FK UWKS

HYPNOSIS, DISSOCIATION AND TRAUMA 151
reported in about a third of the survivors of the Hyatt Regency skywalk collapse
Wilkinson, 1983), and in a similar proportion of survivors of the North Sea oil rig
collapse Holen, 1993). This is consistent with our ®ndings among survivors of the
Loma Prieta earthquake Cardena & Spiegel 1993). A quarter of a sample of
normal students reported marked depersonalization during and immediately after
the earthquake, and 40% described derealization, the surroundings seeming unreal
or dreamlike. While the most common reported memory problem was intrusive
recollection, 29% of the sample reported dif®culties with everyday memory.
Dissociative symptoms have also been retrospectively reported to occur during
combat. Bremner et al. 1992) administered the Dissociative Experiences Scale
DES) to 85 Vietnam veterans, 53 with PTSD and 32 with medical problems. They
found that the DES scores of 53 Vietnam veterans with PTSD were twice as high
as those obtained among a comparison sample of 32 other veterans. Veterans with
PTSD have been found to obtain higher scores on measures of hypnotizability as
well Stutman & Bliss, 1985; Spiegel, 1988).
DISSOCIATIVE SYMPTOMS AS PREDICTORS OF PTSD
Dissociative symptoms, especially numbing, have been found to be rather strong
predictors of later post-traumatic stress disorder McFarlane, 1986; Solomon,
Mikulincer et al. 1989; Koopman et al., 1994, 1996; Classen et al., 1997).
McFarlane found that the time course of dissociative symptoms is critical in the
prediction of subsequent PTSD McFarlane, 1997). Automobile accident victims'
dissociation scores on the day of the trauma did not predict subsequent PTSD
symptoms, their dissociation scores at 10 days did. Thus a failure to readjust
quickly after trauma seems to place people at higher risk for later PTSD. Thus,
physical trauma seems to elicit dissociation or compartmentalization of experience,
and may often become the matrix for later post-traumatic symptomatology, such as
dissociative amnesia for the traumatic episode. Indeed, more extreme dissociative
disorders, such as Dissociative Identity Disorder, have been conceptualized as
chronic Post-traumatic Stress Disorders Spiegel, 1984, 1986; Kluft,1985). Children
exposed to multiple trauma are more likely to use dissociative mechanisms
which include spontaneous trance episodes Terr, 1991). Recollection of trauma
tends to have an off-on quality involving either intrusion or avoidance Horowitz,
1976) in which victims either intensively relive the trauma as though it were
recurring, or have dif®culty remembering it. Thus, physical trauma seems to elicit
dissociative responses.
ACUTE STRESS DISORDER
This evidence reviewed above regarding the prevalence of dissociative and other
symptoms in the immediate aftermath of trauma formed the basis for including