Autohypnosis, hypnotic anaesthesias, hypnoid states, hidden ego states, depersonalization and other dissociative phenomena underlying anorexia and bulimia case studies: methods of treatment

p. 037-045This paper reflects years of clinical experience with a group of patients with diagnosed eating disorders. Three cases are described in which a connection is made between their eating behaviors and dissociation. The primary emphasis is on the phenomena of dissociation, including autohypnosis (self-hypnosis), hypnotic anaesthesias, hypnoidal states, ego states, and depersonalization as an operational component of anorexia nervosa, bulimia nervosa, and purging symptomatology. The primary focus of this anecdotal study is on the unconscious misuse of autohypnosis, hypnotic anaesthesias, and dissociation, which seems to be the predominant constituent behind the onset of these eating anomalies. The usefulness of this observation can be an essential precursor in the determination of an appropriate treatment strategy which incorporates autohypnosis into the overall therapeutic process. By virtue of years of unrecognized applications of dissociation, autohypnosis, and hypnotic anaesthesias, these three cases illustrate the likelihood that individuals suffering from anorexia nervosa and bulimia nervosa could reverse their aberrant eating behaviors by using positive autohypnotic suggestions. In the case of anorexic patients who believe that the only thing they are able to control is their eating, the decision to use autohypnosis over classical hypnosis makes more sense. This does not force the patients to suffer the subjective experience of relinquishing control to other persons

Dissociative symptoms among patients with eating disorders: associated feature or artifact of a comorbid dissociative disorder?

p. 028-036We examined the relationship between eating disorders and dissociative symptoms. Seventy-six subjects were 52 females diagnosed as having either an eating disorder without a comorbid dissociative disorder (n = 14), an eating disorder with a comorbid dissociative disorder (n = 14), a dissociative disorder without a comorbid eating disorder (n = 14), or were normal controls (n = 14). All subjects were administered a variety of objective assessment instruments measuring dissociative and eating disorder symptomatology. Pathological dissociative experiences as measured by the Dissociative Experiences Scale were generally found only among the patients with dissociative disorders (with or without an eating disorder). However, both eating disorder groups endorsed a variety of eating-related dissociative experiences. None of the observed effects appeared to be moderated by depressive symptomatology. The data do support the hypothesis that dissociative phenomena, independent of a comorbid dissociative disorder, may be related to the psychopathology of eating disorders. These data also add to the body of evidence demonstrating the ability of objective assessment instruments to accurately identify patients with dissociative disorders

Asymmetries and visual field summaries as predictors of glaucoma in the ocular hypertension treatment study

PURPOSE. To evaluate whether baseline visual field data and asymmetries between eyes predict the onset of primary open-angle glaucoma (POAG) in Ocular Hypertension Treatment Study (OHTS) participants. METHODS. A new index, mean prognosis (MP), was designed for optimal combination of visual field thresholds, to discriminate between eyes that developed POAG from eyes that did not. Baseline intraocular pressure (IOP) in fellow eyes was used to construct measures of IOP asymmetry. Age-adjusted baseline thresholds were used to develop indicators of visual field asymmetry and summary measures of visual field defects. Marginal multivariate failure time models were constructed that relate the new index MP, IOP asymmetry, and visual field asymmetry to POAG onset for OHTS participants. RESULTS. The marginal multivariate failure time analysis showed that the MP index is significantly related to POAG onset (P &lt; 0.0001) and appears to be a more highly significant predictor of POAG onset than either mean deviation (MD; P = 0.17) or pattern standard deviation (PSD; P = 0.046). A 1-mm Hg increase in IOP asymmetry between fellow eyes is associated with a 17% increase in risk for development of POAG. When threshold asymmetry between eyes existed, the eye with lower thresholds was at a 37% greater risk of development of POAG, and this feature was more predictive of POAG onset than the visual field index MD, though not as strong a predictor as PSD. CONCLUSIONS. The MP index, IOP asymmetry, and binocular test point asymmetry can assist in clinical evaluation of eyes at risk of development of POAG.</p