Hysteria: Causes, Symptoms & Treatment

Few terms exist that have been misinterpreted and reinterpreted more often and caused more discussions than that of hysteria. Already used by the famous ancient physicians Hippocrates and Galen, the term has a very different meaning today and is better researched than it was two and a half thousand years ago. But there is still much work ahead for scientists and psychologists.

What is hysteria?

Hysteria derives from the ancient Greek word for uterus, “hystera,” and today refers to a striking, extremely extroverted behavior triggered by a mental disorder. With the conversion disorders as well as the dissociative disorders, two symptom groups are distinguished today. The former involve traumatic experiences that the mind cannot process and which are therefore “transformed” into physical complaints. The dissociative disorders have the same trigger, but express themselves in disorders of consciousness. However, in ancient times – and for a long time afterwards – the cause of the disease was not thought to be in the brain, but in the uterus, and was thus attributed exclusively to women. Famous physicians such as Hippocrates, for example, assumed that the symptoms were caused by the migration of the uterus to other organs. Therefore, to treat hysteria, they prescribed sexual intercourse and pregnancy to re-position the uterus properly.

Causes

Although the causes of hysteria are still not fully understood, it is now thought to develop in early childhood, around the ages of 4 to 6. At this time, researchers see an enormously important step in the child’s development, both physically and psychologically. At this point, the child has already acquired many motor and mental skills, but faces the problem of beginning to integrate into the adult world. If, at this stage, there is a lack of strong role models to make this world, which is new and still unknown to her, seem interesting – for example, if a parent or other important caregiver is missing – this can lead to the development of hysteria.

Symptoms, complaints and signs

One sign of hysteria as defined by histrionic personality disorder is a strong desire for attention. This need is met through various means. According to Alarcon (1973), seven central features of hysteria can be distinguished. One of these is theatrical behavior. Histrionic personalities tend to exaggerate and often stage themselves in order to arouse sympathy or to put themselves in the spotlight. Another symptom of hysteria is emotional lability. Histrionic personalities often experience drastic mood swings, with individual feelings usually being very pronounced. As a result, they can appear moody and unpredictable. The feelings displayed do not always fit the situation; they may also be socially inappropriate. Another sign of hysteria is that sufferers voluntarily make themselves dependent on one or more other people. In doing so, however, they do not completely subordinate themselves. Often this creates a paradoxical situation in which the histrionic personality on the one hand wants to make self-determined decisions and on the other hand is looking for someone to take care of them like a child. Overreactions, egocentrism and influenceability are further symptoms typical of hysteria. Influence may come not only from others, but also from the histrionic personality itself. In addition, many histrionic personalities behave in a sexually seductive manner in order to elicit attention and admiration in this way as well.

Diagnosis and course

The biggest problem in diagnosing hysteria is the classification of symptoms, whether psychological or physical, as a result of just that. If, for example, visual disturbances or paralysis symptoms occur, its causes are usually first sought in other areas. The same applies to disorders of consciousness, which can also occur as a result of many other diseases of the central nervous system. Misdiagnoses are therefore quite common and are also difficult to avoid. A diagnosis can actually only be made reliably by an experienced therapist who is familiar with the field of hysteria.

Complications

Psychiatry understands the actually obsolete term hysteria as a neurotic disorder. This is associated with unstable and superficial affects, need for recognition, manipulative behavior, and a pronounced need for approval. Today, it is more commonly referred to as conversion disorder or histrionic personality disorder. This explains why complications can arise in connection with these behaviors, especially with the environment. Affected persons demand excessive attention, are subject to unpredictable emotional fluctuations and push themselves to the fore. People around them usually find this annoying and keep their distance. This is especially true when they see through the manipulation techniques hidden behind it. However, people with histrionic personality disorder in particular are unable to understand this reaction and reinforce the strategies they learned early on, resulting in a vicious circle. Patients who are prone to hysteria are either often ostracized because of this or sometimes find fellow patients who exhibit co-dependency. However, this is also unfavorable for the therapeutic process. Stable, healthy relationships are very difficult for those affected to establish. Since these are behavior patterns whose roots go back to childhood, they are difficult to influence therapeutically. They are deeply anchored in the personality of those affected. The therapeutic process is long and tough. Even experienced therapists have to be careful not to let themselves be taken in.

When should you see a doctor?

There is no diagnosis with the term hysteria nowadays, as it is an old terminology. Nevertheless, a doctor should be consulted as soon as the complaints associated with the expression appear. Behavior that is perceived as off the norm in direct comparison to other people should be professionally evaluated by a doctor. A particularly aggressive demeanor or behavior that endangers oneself are reasons to see a doctor. Worrying are states of experience in which the affected person strongly overreacts emotionally, can no longer fulfill his everyday duties and his usual level of performance is no longer achieved. Apathy, sexual abnormalities, or a loss of memory ability must be investigated and treated. False memories or memory lapses are unusual and may also indicate organic problems. Therefore, medical examinations should be initiated as soon as possible in these cases. If sensory disturbances or changes in personality occur, a physician should be consulted. A strong experience of fear, loss of reference to reality or very egoistic behavior are indications of existing disorders. A visit to the doctor is necessary to prevent further deterioration of health. With a mental illness, there is often a lack of insight into the illness. This is one of the symptoms and must be taken into account accordingly. A good relationship of trust with caregivers as well as with the physician are of particular importance.

Treatment and therapy

The treatment of hysteria is also not exactly simple and cannot be carried out according to a fixed scheme. Rather, the therapist must specifically address the subjective disorders – and their causes – of each individual patient. In the course of numerous sessions, the therapist must first and foremost find out what triggers the respective symptoms and then look closely at which psychoanalytic approaches are most likely to bring about an improvement. Because of the often very possessive and engaging nature of hysteria, therapy in most cases proves to be very lengthy and difficult to carry out.

Prevention

Due to the not yet completely researched triggers for hysteria, its possible prevention is also not yet really clear. However, a sheltered parental home as well as a solid social environment during early childhood could – based on the current state of research – counteract psychological repression and a possibly resulting hysteria. Since the causes and the starting point of hysteria are better known today and the ancient ideas have been largely refuted as a result, new terms such as dissociative disorder or histrionic personality disorder have become established in medicine.The exact reasons, on the other hand, are still partly unclear and thus also complicate treatment.

What you can do yourself

Hysteria is an outdated term for a mental disorder. Because it is very imprecise, the possibilities for self-help in everyday life must be evaluated individually. To obtain a differentiated diagnosis, cooperation with a psychotherapist or psychologist is necessary. Subsequently, methods and various individual behavioral techniques for self-help can be determined together. Generally speaking, the affected person shows an appearance deviating from the norm, which he cannot regulate sufficiently himself. The mental illness leads to the fact that the patient is not aware of his own behavior. As a result, self-regulation measures are very low. Some sufferers pose a risk to themselves and others. Despite education, there is a lack of insight into the disease and the patient’s own behavior cannot be controlled. In many cases, the relatives and people in the close environment are strongly influenced by the mental disorder in their way of life. It is recommended to inform them comprehensively about the symptoms of the disease. This improves their interaction with each other and promotes mutual understanding. Emotional demarcation is facilitated and sensitivity for necessary intervention is learned. In many cases, people with the disease are unable to cope with everyday life without help from others. They are dependent on support and need caregivers whom they can trust.