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Am Fam Physician. 1999;60(1):56-61

to the editor: Patients with hyperemesis gravidarum are commonly seen by family physicians. Up to 90 percent of pregnant women have symptoms of “morning sickness,” and some develop full-blown hyperemesis gravidarum.1 This condition often leads to serious risks for the mother and her fetus, as well as lengthy and costly hospitalizations. Medical hypnosis may be a powerful adjunct to the typical medical treatment regimen, and empiric studies of the efficacy of this treatment approach for hyperemesis gravidarum are well documented.23

In a study of 138 hyperemesis gravidarum patients who were completely recalcitrant to conservative medical treatment (consisting of antiemetic drug therapy, isolation by hospitalization and intravenous rehydration), 88 percent stopped vomiting completely after one to three sessions of medical hypnosis.4 Therefore, it may not come as a surprise that medical hypnosis has also been shown to be an effective treatment for hyperemesis secondary to chemotherapy5,6 and hyperemesis secondary to “motion-sickness.” In my clinical experience with hypnosis in the treatment of 30 to 40 patients with hyperemesis gravidarum, symptoms fully remitted within three or four treatment sessions in the overwhelming majority of patients.

Hypnosis may effectively treat hyperemesis gravidarum in at least two ways. One component of the treatment mechanism is that, in a hypnotic state, patients may be induced into a deep state of physiologic relaxation. This decreases sympathetic nervous system arousal, and symptoms associated with hyper-sympathetic arousal tend to remit. Further, it is well established that patients often respond to hypnotic suggestions that are independent of sympathetic or parasympathetic arousal and, interestingly, responsiveness is often independent of the patients' conscious awareness or memory of the suggestion. Patients may be given both indirect and direct suggestions to relax their stomach and throat muscles, causing their nausea, gagging and vomiting to subside. By suggesting that muscle tension in the stomach and throat and/or nausea become a hypnotic cue either to engage in particularly pleasant imagery or to hold cognitions that mentally reframe the experience, the nausea can immediately subside.

Before embarking on hypnotherapy to treat hyperemesis, patients should have a thorough medical evaluation to rule out other diagnoses. The differential diagnosis for hyperemesis gravidarum includes the following: gastroenteritis, cholecystitis, pancreatitis, hepatitis, peptic ulcer disease, pyelonephritis, fatty liver of pregnancy, pelvic inflammatory disease, appendicitis and hyperthyroidism. Patients may also benefit from a psychiatric evaluation if psychiatric co-morbidity is suspected, in which case a referral to a mental health practitioner may be warranted. Finally, while in 1958 the American Medical Association declared hypnosis to be a legitimate form of medical treatment, it should be emphasized that only an appropriately trained practitioner of medical hypnosis should apply this treatment.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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