Butler L D, Duran R E, Jasiukaitis P, Koopman C, Spiegel D
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Calif, USA.
Am J Psychiatry. 1996 Jul;153(7 Suppl):42-63. doi: 10.1176/ajp.153.8.A42.
The authors propose a diathesis-stress model to describe how pathological dissociation may arise from an interaction between innate hypnotizability and traumatic experience.
To support the proposition that pathological dissociation may reflect autohypnotic process, the authors highlight clinical and research data indicating parallels between controlled hypnotic dissociative states and uncontrolled pathological dissociative symptoms and summarize evidence of hypnotizability in persons with psychiatric disorders that manifest these symptoms. The authors present this evidence by examining dissociative symptomatology in four psychological domains: perception, behavior and will, affect, and memory and identity. In addition, modern cognitive and neuropsychological models of dissociation are briefly reviewed.
Several lines of evidence converge in support of the role of autohypnosis in pathological dissociation. There is considerable evidence that controlled formal hypnosis can produce a variety of dissociations of awareness and control that resemble many of the symptoms in uncontrolled pathological dissociative conditions; and it is possible to discern in dissociative pathology the features of absorption, dissociation, and suggestibility/automaticity that characterize formal hypnotic states. There is also accumulating evidence of high levels of hypnotic capacity in all groups with dissociative symptomatology that have been systematically assessed. In addition, the widespread and successful therapeutic use of hypnosis in the treatment of many dissociative symptoms and conditions (and the potential for hypnosis to induce dissociative symptomatology) also supports the assumption that hypnosis and pathological dissociation share an underlying process.
High hypnotizability may be a diathesis for pathological dissociative states, particularly under conditions of acute traumatic stress.
作者提出一种素质-应激模型，以描述病理性分离如何源于先天催眠能力与创伤经历之间的相互作用。
为支持病理性分离可能反映自我催眠过程这一观点，作者强调临床和研究数据，这些数据表明受控催眠性分离状态与不受控病理性分离症状之间存在相似之处，并总结了表现出这些症状的精神障碍患者的催眠能力证据。作者通过检查四个心理领域的分离症状来呈现这些证据：感知、行为与意志、情感以及记忆与身份。此外，还简要回顾了现代分离的认知和神经心理学模型。
多条证据线索汇聚起来支持自我催眠在病理性分离中的作用。有大量证据表明，受控的正式催眠可产生各种意识和控制的分离，这些分离类似于不受控病理性分离状态中的许多症状；并且在分离性病理学中可以辨别出构成正式催眠状态特征的专注、分离以及易受暗示性/自动性等特征。在所有经过系统评估的有分离症状的群体中，也有越来越多证据表明其具有高水平的催眠能力。此外，催眠在治疗许多分离症状和病症方面广泛且成功的治疗应用（以及催眠诱发分离症状的可能性）也支持了催眠与病理性分离共享一个潜在过程的假设。
高催眠能力可能是病理性分离状态的一种素质，尤其是在急性创伤应激条件下。
