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Hysteria – Series of articles “How to treat the soul?” Part 17

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Hysteria is a long-observed phenomenon – the first descriptions date back to around 2000 BC. They mention various emotionally unbalanced states and behaviors that ancient philosophers associated with “womb hunger.” Later, Hippocrates named such conditions with the word “hysteria” (from the word “hystera”, which is translated from the ancient Greek language as “womb”), because he explained them with the nature of women and the “wandering of the uterus” throughout the body. 🙂 In those days, it was believed that “when the uterus wanders around the body and starts its movement”, tremors, cramps, sweating appear, but when it moves to the specified organ, symptoms from this organ also appear, for example, various types of pain or strange movements. Until the 19th century the scientific community held the opinion that hysteria is closely related to disorders of the female genital organs, because sexual function disorders were often observed in patients with hysterical disorders, so sometimes they tried to treat it surgically – by removing the ovaries and/or by burning the clitoris. 🙁
Later in the 20th century such scientists as Ž. M. Charko, Z. Freud, P. Jeanet, etc., who no longer considered “wandering of the uterus” and disorders of the reproductive system to be the reasons, but psychological problems. Jeanne believed that the “psyche” or consciousness splits in a hysterical patient, and one part of the “psyche” functions independently in the form of a hysterical symptom – this process was called “dissociation”. Freud, on the other hand, believed that hysteria is based on childhood conflicts, which are pushed out of consciousness and turned into a somatic symptom. This is how the second concept – “conversion” appeared. Both words currently denote a group of hysterical disorders – dissociative (conversion) disorders (F44). As well as hysterical disorders, somatoform disorders (F45) can be added – hypochondria, somatoform vegetative dysfunction, chronic somatoform pain, somatization, which was discussed in previous articles “How to treat the soul?”. 😉

Signs of hysterical disorder:

Hysterical personality type – such people have a desire to be in the center of attention, a tendency to cause excitement and amazement of others, which is achieved with their external appearance, with exaggerated, theatrical emotions, dramatization. On the other hand, such people are easily offended, they have changeable moods, they tend to be careless towards others because they are too focused on themselves.

Psychogenic attacks and convulsions are characterized by the fact that a person suddenly performs chaotic, inadequate and expressive actions – shouts, cries, rolls on the ground, beats the floor with hands and feet, bends the body, pressing the back of the head and heels against the ground, stutters or does not speak. Such attacks require the presence of spectators. Today, in the practice of doctors, psychogenic attacks are more like an epileptic attack – with loss of consciousness and convulsions for a few minutes.

Functional paresis and paralysis – this is weakness in any muscle group; in the arms, legs or facial muscles.

Gait disorders can be different – the patient drags one leg along the floor, walks, sometimes bending the knees or crossing the legs.

Motor disorders – hand tremors, head movements back and forth, upward rotation of the eyes, which decrease if you do not pay attention to it, but increase with anxiety.

Sensory disturbances and loss of sensation – sudden loss of sensation in any part of the body can accompany visual disturbances, but vision loss is usually rarely complete.

Speech disorders – from stuttering, gurgling to inability to speak.

Pain syndromes – psychogenic pain can be in any part of the body, but usually several places hurt at once, the pain is usually described as very strong and intense, due to which the patient is often hospitalized acutely, however, imaging and neurographic examinations do not show anatomical changes in the organs, nerves or skeleton . Such pain can occur suddenly and pass just as suddenly.

Breathing disorders – it is also called hyperventilation syndrome, when there is a desire to breathe faster and deeper, because the patient feels that he cannot inhale fully, there is a lack of air.

The feeling of a lump in the throat is a very common phenomenon in hysterical people.

Vomiting, nausea, as a reaction to an event that cannot be accepted or demands that are unpleasant.

Hysterical fever – usually easily tolerated by patients, is characterized by a small pulse frequency that does not correspond to the temperature, as inflammatory fevers usually have an accelerated pulse.

Dissociative amnesia, episodes of confusion – sudden loss of memory for a certain period of time or about oneself, tend to appear in disorientation in time and space.

Dissociative fugue – a rare phenomenon, but quite interesting, it has served as the plot basis for several films in which the main character suddenly, usually after a tragic event, forgets who he was before and starts a new life.

Usually, in the case of hysterical disorders, one patient has at least 2-3 symptoms at the same time, and the diagnosis can be established if other organic diseases are excluded. However, all symptoms are highly dependent on the culture in which the patient lives, because in essence, the hysterical symptom is a desire to express one’s problem with body language and unconsciously gain a certain benefit.

Why does hysteria develop?

The explanation of the psychological mechanism for dissociative disorders follows from its name – dissociation and conversion. Dissociation is a psychological defense mechanism during which a person looks as if from the outside at an emotionally saturated situation in which he is, or feels it as if it were happening to someone else, but not to him. On the one hand, it helps to exclude from consciousness the experiences of an emotionally unacceptable situation or traumatic event, on the other hand, this “broken” experience is not recognized and integrated into the personal emotional experience, it is not mourned and accepted, and one cannot reconcile with it and live on, but the tension created by this traumatic event or unpleasant situation tends to turn into a physical symptom.
This defense is not necessarily bad, as it tends to help adapt and act rationally in extreme situations, however, the tendency to use dissociation too often and in everyday situations is usually characteristic of people with the hysterical personality type, and it is based on a certain upbringing in childhood.
Quite similar to dissociation is the mechanism of repression or repression, when certain already existing experiences are blocked so as not to feel them. The tendency to often use this mechanism in one’s life is formed in adolescence, when parents ignore the child’s sexuality, struggle with it and do not allow it to be expressed in any way. Such conditions require the adolescent to hide and push away this part of his inner world, fulfilling the parents’ demand to “stay in childhood” longer. Over time, repressing any adventures and one’s desires becomes the dominant defense mechanism, because it is already a common thing.

How to recognize hysteria? TEST: Dissociative Experience Scale (DES)!

In the following test below, each statement has a percentage scale from 0 to 10, where 1 corresponds to “never” and 10 to “always”. Please answer 28 questions – to what extent from 0 to 10 the statement corresponds to your personal experience.
  • While traveling in a bus, car or train, you suddenly realize that you partially or completely do not remember what happened during the trip.
  • When listening to someone else or talking to another person, you suddenly realize that you do not remember all or part of what it was about.
  • Suddenly you don’t understand and you don’t remember how you got to where you are.
  • Suddenly you realize that you are wearing clothes, but you don’t remember how you put them on.
  • You find a new item in your belongings, but you don’t remember buying it.
  • Suddenly, strangers come up to you, call you by a different name and claim that you have met before.
  • You feel as if you are standing next to yourself and observing yourself from the outside.
  • It has happened that you are not recognized by family members or friends.
  • You do not remember important events in your life (such as a wedding or graduation).
  • You have a tendency to lie, even though you think you are telling the truth.
  • When you look in the mirror, you don’t recognize yourself.
  • You feel the unreality of surrounding objects, yourself or even the whole world.
  • There is a feeling that your body does not belong to you.
  • You relive some situation or event from the past as if it were happening again in the present.
  • You feel doubt that some events have actually happened or it is just a fantasy.
  • Being in a familiar and familiar place, you get the feeling that you are seeing this place for the first time.
  • You get so engrossed in the content of a movie or TV show that you don’t even notice what’s going on around you.
  • You feel that fantasies and dreams are reality.
  • You don’t notice the physical pain.
  • When you look at one point, you don’t think about anything at that moment and you don’t notice time.
  • When you are alone, you find yourself talking out loud to yourself.
  • You behave so differently in similar situations that you seem to be two different people.
  • It becomes very easy for you to function in situations that normally cause difficulties (communication, school, work, etc.).
  • You suddenly cannot remember whether you have actually done something or just wanted to do it.
  • You suddenly notice that you did something, but you can’t remember how you did it .
  • You sometimes find your notes or drawings, but you don’t remember that you wrote or drew them.
  • You sometimes hear strange “voices” in your head commenting on what you are doing or telling you to follow commands.
  • You sometimes feel that you are looking at the world through smoke or as if everything is shrouded in fog, that people and objects seem unclear and as if they are somewhere far away.
Now add up all the points and multiply the total by 10, then divide by 28. That is, [total number of points x 10 / 28 = Your score].
If the result is greater than 30, then there is a high probability that in your life you very often use the defense mechanism of dissociation and pushing experiences out of consciousness, which can serve as the cause of various disorders. Perhaps you would benefit from the consultation of a psychotherapist or psychiatrist to improve the quality of your life and well-being.

Panacea for hysterical disorders!

Since the manifestations of these disorders sometimes resemble the manifestations of somatic diseases, doctors of various specialties, especially neurologists, very often have to deal with hysterical patients. As soon as the possibility of other diagnoses is ruled out, the patient received recommendations to consult a psychotherapist or a psychiatrist.

The most effective method for hysterical disorders is psychoanalytic and psychodynamic psychotherapy, during which a person learns to integrate painful experiences, communicate with the surrounding world more effectively, realize his desires and achieve their fulfillment in a more effective way than in the form of physical symptoms.

Medications such as antidepressants and antipsychotics are also sometimes used to reduce the internal anxiety caused by emotional conflicts, which relieves the symptoms.

Authors of the article: Doctor Alina Kuznetsova, Psychiatrist Pēteris Zālītis.

Used literature:

  • Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, Second Edition by Nancy McWilliams
  • International Classification of Diseases (ICD-10). World Health Organization, 2016. http://www.spkc.gov.lv/ssk10/index1e60.html?p=%23119#g_119
  • Janet P. The Major Symptoms of Hysteria. London, 1907.
  • Carlson, EB & Putnam, FW (1993). An update on the Dissociative Experience Scale. Dissociation 6(1), p. 16-27. Note: Dissociative Experiences Scale-II included in Appendix. Downloaded from http://traumadissociation.com/des Authors EB Carlson & FW Putnam have given permission for the Dissociative Experiences Scale to be copied, distributed or reproduced for research or clinical use.
  • Фрейд З. Иследования истерии. St. Petersburg, 2005.
  • Psychogenic driving disorders in historical aspect. Г.М. Dyukova, V.L. Голубев. Первый МГМУ им. I.M. Sechenova. http://www.parkinsonizm.ru/files/21_1_2012_Block_Bulletin.pdf
  • Conversion and somatoform disorders in general medical practice. G. M. Dyukova. http://www.med-sovet.pro/jour/article/viewFile/890/890