International Handbook of Clinical Hypnosis - E-Lib FK UWKS

206 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
found that patients with bulimia were signi®cantly more hypnotizable than patients
with anorexia nervosa. Grif®th 1989) reported the successful use of a hypnobehavioral
model in the treatment of bulimia nervosa, and Gross 1984) reported the
successful use of hypnosis in the treatment of patients with anorexia nervosa, thus
indicating that patients bearing the diagnosis of anorexia nervosa should not
automatically be ruled out as candidates for hypnotherapy.
This chapter will describe speci®c issues involved in effective assessment of the
patient with an eating disorder before the decision to utilize hypnosis is implemented.
Then follows a description of a variety of hypnotherapeutic techniques and
their utilization in the treatment of patients with eating disorders.
PATIENT ASSESSMENT
The comprehensive and in-depth assessment of patients with an eating disorder is
of great value for understanding the underlying dynamics of the condition, the
patient's character, and the crafting of an effective treatment plan. The clinical
literature identi®es a variety of psychodynamics attributed to the psychopathology
of eating disorders such as:
1. A fear of growing up and reaching full sexual maturation Bruch, 1973, 1974;
Gross, 1984).
2. Obsessive perfectionism and distorted body image Bruch, 1973, 1974, 1978).
3. Family enmeshment and struggle for autonomy Minuchin, Rosman & Baker,
1978).
4. A fear of pregnancy, a fear of acting out hostile impulses as well as a need for
self-punishment Evans, 1982).
5. An unresolved past trauma Damlouji & Ferguson, 1985; Goodwin, 1988;
McFarlane, McFarlane & Gilchrist, 1988; Torem & Curdue, 1988; Goodwin &
Attias, 1993).
6. A dissociative mechanism Pettinati, Horne & Staats, 1982, 1985; Pettinati,
Kogan, Margolis et al., 1989; Schwartz, Barrett & Saba, 1985; Council, 1986;
Sanders, 1986; Torem, 1986a,b, 1989a; Chandarana & Malla, 1989).
7. Underlying splitting and multiplicity Torem, 1984; Torem & Curdue, 1988,
Torem, 1989b, 1990, 1993; Kluft, 1991; Ross, 1989; Goodwin & Attias, 1993;
Gutwill, 1994).
In listening to the patient I speci®cally explore the possibility of ambivalence
and internal con¯icts regarding the eating disorder symptoms and behaviors,
looking for any clues that the behaviors are ego-dystonic. In previous publications
Torem, 1989a), I have delineated the following examples of clues to an underlying
dissociative mechanism in the patient's description of her symptoms: