Synonyms
Hysterical neurosis Conversion neurosis, dissociative disorder, histrionic personality disorder
Definition
Hysteria, or dissociative disorder, is not a uniform clinical picture, but rather a group of different mental illnesses which have in common that the connection and cooperation between body and mind is disturbed. Thus, the awareness of one’s own identity, whether in the case of a multiple personality or depersonalization, can be disturbed. On the other hand, the boundary between psyche and body can also disappear, so that psychic sensation manifests itself in physical symptoms, even or especially when the person is not aware of the psychic problem.
Concept and history
The concept of hysteria can be traced back to antiquity. There the term was used for all those clinical pictures which today fall into the field of psychiatry. In other words, those that could not be explained or described by physical or organic changes.
Nevertheless, hysteria was ascribed to a specific organ, namely the uterus. This makes it clear that especially “hysterical” women were observed. This opinion was held until the 19th century.
However, the meaning of the term has changed again and again, so that ancient Greek hysteria is not congruent with the clinical picture discussed here. In the course of time, the disease has been narrowed down more and more with increasing medical progress. Hysteria was one of the most important topics in psychoanalysis, where it was first investigated in empirical clinical studies, especially by Charcot.
There, the disease was attributed to unsatisfied sexual needs. Fortunately, some of the treatment practices of the researchers of that time, such as the so-called “ovarian press”, are nowadays only bizarre anecdotes. Due to the misogynistic origin and history, as well as the confusingly inconsistent definition of the term, it is nowadays replaced by the above-mentioned synonyms.
Symptoms
The symptoms of the different forms of hysteria are manifold. Both the exact appearance and the severity of the symptoms vary greatly from patient to patient. This can be explained by the fact that conversion neurosis is a psychogenic disease, i.e. a disease that originates from the psyche.
Its diseases are as diverse as the human character. Here are some of these subforms with typical symptoms of hysteria. The main symptom of psychic amnesia is a loss of memory, which can be limited to a specific time or subject or can cover larger areas.
In dissociative stupor, therefore, rigidity of movement is the main symptom. Both diseases belong to the disorders of movement and sensory perception. In addition, the memory or the entire personality can also be disturbed.
The latter manifests itself as multiple personality, the existence and definition of which is disputed by experts. All in all, it can be said that the symptoms represent a detour or a valve. The patients repress their mental crisis and often see it as an unacceptable weakness.
A physical weakness is more likely to be socially accepted because it seems inevitable (i.e. tragic) and thus justifies and even demands the compassion of the environment. Hysterical blindness is often attributed to a refusal to see certain mental problems. The paralysis just mentioned would therefore be a powerlessness in the face of seemingly unsolvable tasks of which the person affected does not always have to be aware.
What patients suffering from hysteria have in common is that they regard changes in bodily functions as the basis of their suffering. This makes it not always easy for the doctor to find the true cause. But here are some possibilities.
For example, the areas of skin perceived by patients as numb usually do not correspond to the actual areas where the nerves are supplied. Nevertheless, it is important to take the patients seriously and exclude possible dangerous physical diseases by examination and possibly also by imaging. Especially with older patients, it can happen that one of the examinations carried out is positive for a physical illness, but it certainly cannot explain the extent of the symptoms presented by the patient.
In addition, there are some differential diagnoses of hysteria that must be considered. Psychosomatic diseases first show similar symptoms and disease development.Nevertheless, they are clearly different from conversion disorders, as they are accompanied by actually tangible changes in the body, which are missing in the case of the latter. A somatoform (not due to organic disease) pain disorder or a hypochondriac disorder must also be considered.
However, the depersonalization mentioned above can also occur as a symptom in other psychiatric disorders, such as depression and schizophrenia. However, these disorders also occur together with other mental illnesses.
