CONVERSION DISORDERS (HYSTERIA)

  1. What is conversion disorder?

A. Conversion disorder or Hysteria is a disorder whereby a person expresses emotional turmoil by converting it into a bodily symptom. It is now called as PSYCHOLOGICAL FACTORS AFFECTING MEDICAL CONDITIONS. The term "hysteria" is no longer used.

Q. How does a patient with hysteria present?

A. Hysteria may present as affliction of organ of special senses i.e. as hysterical deafness, hysterical blindness. It may also affect the voluntary nervous system and patient may present with hyperventilation, convulsions, paraesthesias etc.

Q. A patient has come with inability to walk suddenly. How do I know whether the patient actually has a problem?

A. There are two ways to diagnose a conversion disorders: -

  1. Positive diagnosis whereby a temporal relationship between psychological stress and onset of symptoms is established. Associated features established are those of elicitable gain. The patient has dramatic symptoms without associated physical signs.
  2. Negative diagnosis – The patient has multiple symptoms where the disability is out of proportion to any elicitable disorder. Conversion disorder is diagnosed as absence of any physical cause.

Conversion disorders are more common in females. They are often seen in families with unstable relationships. Patients may also have common associated symptoms like :-

  1. Multiple hospitalisations for symptoms without signs.
  2. Willingness to go through painful investigations.
  3. In females, it may be associated with menstrual problems.

During the history taking, you may get a vicarious feeling as if the patient is enjoying the symptoms.

Q. How does hysteria occur?

A. There are two types of hysteria :

  1. Conversion disorders whereby the emotional turmoil is expressed unknowingly as a bodily symptom
  2. Dissociative states
  1. Fugue
  2. Amnesia
  3. Dual personality disorders – e.g Jekyll & Hyde personality

Q. How do I know whether a child has hysteria or she is just faking her symptoms?

A. Faking is not hysteria. Hysteria is a true psychiatric disorder. PERSON DOES NOT DO IT VOLUNTARILY. When a person is faking a symptom knowingly, it is called malignering.

Q. How common is hysteria?

A. Hysteria is not common in children. It is common in females, in teens and in young adults.

Q. How does a parent deal with such problem in her child ?

A. The most appropriate way to deal with such a child is to be persuasive and firm. Do not pamper the child. Let not the child gain any empathy and sympathy. The child should learn that he or she is not going to get anything out of being sick.

Q. What is the treatment of hysteria?

A. Hysteria is of 2 types :-

    1. Primary – due to substancial personality disorder. It is difficult to treat.
    2. Secondary – due to anxiety, depression. Treated by treating the primary cause. Anxiolytics and antidepressants may help in these patients.

Q. Would making the patient smell onions, ether or smelly socks abort the attack?

A. No

Q. Is hysteria more common in girls? And if yes, why?

A. Yes. It probably depends on the way children are brought up. In a male dominated society, girls are always trained to inhibit their social ways and the only way out for them is to get things done by sympathy.

Q. What are the long-term consequences of hysteria?

A. A Child with hysteria has to learn a lot. Conversion disorders can lead to long term disturbances like chronic maladaptive behaviour. As adults these individuals may like to flirt, are vivacious but frigid. They may get into lot of conflict with people. They would always be attention seeking and may even be sort of an exhibitionist. They would have essentially interpersonal difficulties, would not be able to stick to a single job. In the extreme case, they may even develop schizophrenia.

Last created on 22-10-2001
Last updated on 18-11-2006

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