This diagnostic category includes both temporary marked alterations in the state of consciousness or loss of personal identity and instances in which another entity replaces the customary sense of personal identity. The former are considered the trance subtype, the latter the possession trance subtype. The former are world-wide. The latter are often determined by the mores and beliefs of particular cultures, and may constitute culture-bound syndromes.
Trance disorders often occur in the aftermath of trauma and extreme stress. The triphasic model described above should be applied. In the absence of contraindications, hypnosis may initially be used supportively. The patient, who is having spontaneous and/or triggered trance states, can be taught mastery of his or her autohypnotic talents and vulnerabilities by learning to enter and exit trance by choice. While practicing autohypnotic exercises, the patient learns to use this skill to reduce the tensions and pressures that precipitate trances, and to exit from and/or preempt spontaneous trance phenomena. This restores a sense of an internal rather than an external locus of control. As the patient feels increased control and strength, and feels less at the mercy of spontaneous or triggered trances, hypnosis can be used to explore and alleviate the conflicts and/or traumata that precipitate trance phenomena, and to master new strategies of managing their residual impacts.
With regard to possession trance states, when the possession has been transient, it is crucial to deal with the precipitating stressors in a manner that demonstrates sensitivity to the unique cultural contributants. When the possession is ongoing or repetitive, some of the techniques used with dissociative identity disorder, modified with a sensitivity to cultural considerations, may prove effective.
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