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“Hysteria” in Clinical Neurology

Published online by Cambridge University Press:  18 September 2015

François M. Mai
François M. Mai*
Affiliation:
Departments of Psychiatry and Medicine, University of Ottawa, Ottawa
*
Chief, Department of Psychiatry, Ottawa General Hospital, Room 4418, 501 Smyth Road. Ottawa. Ontario, Canada K1H 8L6
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Abstract

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Hysteria is an ancient word for a common clinical condition. Although it no longer appears in official diagnostic classifications, “hysteria” is used here as a generic term to cover both “somatoform” and “dissociative” disorders as these are related psychopathological states. This paper reviews the clinical features of four hysterical syndromes known to occur in a neurologist’s practice, viz conversion, somatization and pain disorders, and psychogenic amnesia. The presence in the clinical history of a multiplicity of symptoms, prodromal stress, a “model” for the symptom(s), and secondary reinforcement all suggest the diagnosis, and minimise the need for extensive investigations to rule out organic disease. Psychodynamic, behavioral, psychophysiologic and genetic factors have been proffered to explain etiology. Appropriate treatment involves psychotherapeutic, behavioral and pharmacological techniques. A basic requirement is to avoid errors of commission such as multiple specialist referrals and invasive diagnostic and treatment procedures. Hysteria is a remediable condition if identified early and managed appropriately.

Type
Review Articles
Information
Canadian Journal of Neurological Sciences , Volume 22 , Issue 2 , May 1995 , pp. 101 - 110
Copyright
Copyright © Canadian Neurological Sciences Federation 1995

References

1.Veith, I.Hysteria. A History of a Disease. University of Chicago Press, 1965.Google Scholar
2.Briquet, P.Traité de l’hystérie bailliere. Paris, 1859.Google Scholar
3.Mai, FM., Merskey, H.Briquet’s concept of hysteria: a historical perspective. Can J Psychiatr 1981; 26: 57–63.CrossRefGoogle ScholarPubMed
4.Mai, FM., Merskey, H.Briquet’s treatise on hysteria. Arch Gen Psychiatr 1980; 37: 1401–1405.CrossRefGoogle ScholarPubMed
5.Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) American Psychiatric Association, Washington, 1994.Google Scholar
6.Walsh, F.Diagnosis of hysteria. Br Med J 1965; 1: 1395–1399.Google Scholar
7.Perkin, G.An analysis of 7836 successive new outpatient referrals. J Neurol Neurosurg Psychiatry 1989; 52: 447–448.CrossRefGoogle ScholarPubMed
8.Kleinman, A.The Illness Narratives. Suffering, Healing and the Human Condition. NY: Basic Books Inc. 1988, Chapter I.Google Scholar
9.Mechanic, D.The concept of illness behaviour. J Chron Dis 1972; 15: 189–194.CrossRefGoogle Scholar
10.Arkonac, O., Guze, S.A family study of hysteria. N Engl J Med 1963; 268: 239–242.CrossRefGoogle Scholar
11.Rahe, RH., Gunderson, E., Arthur, R.Demographic and psychosocial factors in acute illness reporting. J Chron Dis 1970; 23: 245–255.CrossRefGoogle ScholarPubMed
12.Rubin, R., Gunderson, E., Arthur, R.Life stress and illness patterns in the US navy. J Psychosom Res 1971; 15: 277–288.CrossRefGoogle Scholar
13.McWhinney, J.Beyond diagnosis. N Engl J Med 1972; 287: 384–387.CrossRefGoogle ScholarPubMed
14.Eisenberg, L.What makes persons “patients” and patients “well”? Am J Med 1980; 69: 277–286.CrossRefGoogle ScholarPubMed
15.Engel, G.Conversion symptoms in “Symptoms and Signs in Clinical Medicine.” In: E MacBryde, C., & Blacklow, R. eds. 5th ed. Philadelphia: JB Lippincott, 1970: 650–668.Google Scholar
16.Kellner, R.Somatization. Theories and research. J Nerv Ment Dis 1990; 178: 150–160.CrossRefGoogle ScholarPubMed
17.Lipowski, Z.Somatisation: the concept and its clinical application. Am J Psychiatr 1988; 145: 1358–1368.Google ScholarPubMed
18.Chodoff, P.“The hysterical personality disorder.” In: Roy, A., ed. Hysteria. New York: John Wiley, 1982: 277–285.Google Scholar
19.Ford, C.The Somatizing disorders: Illness as a Way of Life. Elsevier Biomedical. New York, 1982.Google Scholar
20.Pryse-Phillips, W., Murray, TJ.Examination for functional disorders. In: Essential Neurology (4th Edition). Appleton and Lange NorwalkConn. 1992:71–78.Google Scholar
21.Weinstein, E., Eck, R., Tyerly, O.Conversion hysteria in Appalachia. Psychiatry 1969; 32: 334–341.CrossRefGoogle ScholarPubMed
22.Lader, M., Sartotius, N.Anxiety in patients with hysterical conversion symptoms. J Neurol Neurosurg Psychiatry 1968; 31: 490–495.CrossRefGoogle ScholarPubMed
23.Rice, DG., Greenfield, NS.Psychophysiological correlates of la belle indifférence. Arch Gen Psychiatr 1969; 20: 239–245.CrossRefGoogle ScholarPubMed
24.Pincus, J.Hysteria presenting to the neurologist. In: Roy, A., ed. Hysteria. New-York: John Wiley & Sons Ltd., 1982: 131–143.Google Scholar
25.Weintraub, Michael I.Hysterical conversion reactions: a clinical guide to diagnosis and treatment. SP medical and scientific books. Jamaica: New-York, 1984.Google Scholar
26.Keane, JR.Neuro ophthalmic signs and symptoms of hysteria. Neurology 1982; 32: 757–762.CrossRefGoogle ScholarPubMed
27.Mai, FM.Briquet’s syndrome (hysteria) and the physician. Can Med Assoc J 1982; 127: 99–100.Google ScholarPubMed
28.Fichter, C., Waddington, W.Suspicion of somatoform disorder in undiagnosed tabes dorsalis. Br J Psychiatr 1991; 159: 573–575.CrossRefGoogle Scholar
29.Jones, J., Barklage, N.Conversion disorder: camouflage for brain lesions in two cases. Arch Intern Med 1990; 150: 1343–1345.CrossRefGoogle ScholarPubMed
30.Caplan, L., Nadelson, T.Multiple sclerosis and hysteria. JAMA 1980; 243: 2418–2421.CrossRefGoogle ScholarPubMed
31.Roy, A.Hysterical seizures. Arch Neurol 1979; 36: 447.CrossRefGoogle ScholarPubMed
32.Woodruff, R., Clayton, P., Guze, S.Studies of diagnosis outcome and prevalence. JAMA 1971; 215: 425–428.CrossRefGoogle ScholarPubMed
33.Swartz, M., Landerman, R., George, LK. et al. Somatisation disorder. Psychiatric disorders in America. New-York: Free Press, 1991; 220–257.Google Scholar
34.Perley, M., Guze, S.Hysteria – the stability and usefulness of clinical criteria. N Engl J Med 1962; 266: 421–426.CrossRefGoogle ScholarPubMed
35.DeVaul, R., Faillace, L.Surgery proneness: a review and clinical assessment. Psychosom 1980; 32: 295–299.CrossRefGoogle Scholar
36.Kirk, CA., Saunders, M.Primary psychiatric illness in a neurological outpatient department in north-east England: an assessment of symptomatology. Acta Psychiat Scand 1977; 56: 294–302.CrossRefGoogle Scholar
37.Merskey, H., Brown, J., Brown, A., et al. Psychological normality and abnormality in persistent headache patients. Pain 1985; 23: 35–47.CrossRefGoogle ScholarPubMed
38.Martin, P., Marie, G., Nathan, P.Psychophysiological mechanisms in chronic headaches: investigation using pain induction and pain reduction procedures. J Psychosom Res 1992; 36: 137–148.CrossRefGoogle ScholarPubMed
39.Arena, J., Blanchard, EB., Andrasik, F., et al. Psychophysiological comparisons of three kinds of headache subjects during and between headache states. J Psychosom Res 1985; 29: 427–441.CrossRefGoogle ScholarPubMed
40.Merskey, H.Hysterical mechanisms and pain. In: Roy, A., ed. Hysteria. New York: John Wiley & Sons Ltd., 1982.Google Scholar
41.Lindsay, P., Wyckoff, M.The depression-pain syndrome and its response to antidepressants. Psychosom 1981; 22: 571–577.CrossRefGoogle ScholarPubMed
42.Feinmann, C., Harris, M., Cawley, R.Psychogenic facial pain: presentation and treatment. Br Med J 1984; 228: 436–438.CrossRefGoogle Scholar
43.Lascelles, R.Atypical pain and depression. Br J Psychol 1966; 112: 651–659.CrossRefGoogle ScholarPubMed
44.Feinmann, C.The long-term outcome of facial pain treatment. J Psychosom Res 1993; 37: 381–387.CrossRefGoogle ScholarPubMed
45.Kopelman, M.Amnesia: organic and psychogenic. Br J Psychiatr 1987; 150:428–442.CrossRefGoogle ScholarPubMed
46.Nemiah, J.In: Kaplan, H. & Sadock, B., eds. Comprehensive Text book of psychiatry. 4th ed. Williams and Wilkins, 1985; 948–949.Google Scholar
47.Das, P., Saxena, S.Classification of dissociative states in DSM-III-R and ICD-IO. Br J Psychiatr 1991; 159: 425–427.CrossRefGoogle Scholar
48.Saling, M.Psychogenic amnesia? [letter] Br J Psychiatr 1991; 159: 585.CrossRefGoogle ScholarPubMed
49.Kilsh, LG.Pseudodementia. Acta Psychiat Scand 1961; 37: 336–351.Google Scholar
50.Nott, PN., Fleminger, JJ.Presenile dementia: the difficulties of early diagnosis. Acta Psychiat Scand 1975; 51: 210–217.CrossRefGoogle ScholarPubMed
51.McEvoy, JP., Wells, CE.Case studies in neuropsychiatry II: conversion pseudodementia. J Clin Psychiatr 1979; 40: 447–449.Google Scholar
52.Liberini, P., Flaglia, L.Hysteria – 100 years after Charcot. Can J Psychiatr 1993; 38: 237–238.CrossRefGoogle ScholarPubMed
53.Ron, MA., Toone, BK., Garralda, ME., Lishman, MA.Diagnostic accuracy in presenile dementia. Br J Psychiatr 1979; 134: 161–168.CrossRefGoogle ScholarPubMed
54.Breuer, J., Freud, S.The psychic mechanism of hysterical phenomena from Studies in Hysteria. Nervous and Mental Disease Publishing Co. N.Y. 1936: 1–13.Google Scholar
55.Marmor, J.Orality in the hysterical personality. J Am Psychoanal Assoc 1953; 1: 656–672.CrossRefGoogle ScholarPubMed
56.Easser, B., Lesser, S.Hysterical personality: a re-evaluation. Psychoanal Quart 1965; 344: 390–413.CrossRefGoogle Scholar
57.Aufreiter, J.Psychiatric nosology and hysteria. Can Psychiat Assoc J 1969; 14: 569–577.CrossRefGoogle Scholar
58.Munford, P., Liberman, R.Behaviour therapy of hysterical disorders. In: Roy, A., ed. New-York: Hysteria. John Wiley and Sons Ltd., 1982; 287–303.Google Scholar
59.Celami, D.An interpersonal approach to hysteria. Am J Psychiatr 1976; 133: 1414–1418.Google Scholar
60.Bird, J.The behavioral treatment of hysteria. Br J Psychiatr 1979; 134: 129–137.CrossRefGoogle ScholarPubMed
61.Slater, E.Diagnosis of hysteria. Br Med J 1965; 1: 1395–1399.CrossRefGoogle ScholarPubMed
62.Merskey, H., Burich, N.Hysteria and organic brain disease. Br J Med Psychol 1975; 48: 359–366.CrossRefGoogle ScholarPubMed
63.Roy, A.Hysteria: A case note study. Can J Psychiatr 1979; 24: 157–160.CrossRefGoogle ScholarPubMed
64.Ludwig, A.Hysteria: A neurological theory. Arch Gen Psychiatr 1972;27: 771–777.CrossRefGoogle Scholar
65.Flor-Henry, P., Fromm-Anch, D., et al. A neuropsychosocial study of the stable syndrome of hysteria. Biol Psychiatr 1981; 16: 601–626.Google Scholar
66.Meyer, B-U., Britton, T., Beneke, R., et al. Motor responses evoked by magnetic brain stimulation in psychogenic limb weakness: diagnostic valve and limitations. J Neurol 1992; 239: 251–255.CrossRefGoogle Scholar
67.Guze, S.Studies in hysteria. Can J Psychiatr 1983; 28: 434–437.CrossRefGoogle ScholarPubMed
68.Torgersen, S.Genetics of somatoform disorders. Arch Gen Psychiatr 1986; 43: 502–505.CrossRefGoogle ScholarPubMed
69.Ljungberg, L.Hysteria: a clinical prognostic and genetic study. Acta Psychiat Neurol Scand 1957; 32: Suppl 112.Google Scholar
70.Shields, J.Genetical studies of hysterical disordersIn: Roy, A., ed. Hysteria. New York: John Wiley & Sons Ltd, 1982: 41–56.Google Scholar
71.Slater, E.The thirty-fifth Maudsley lecture: Hysteria 311. J Ment Sci 1961; 107: 359–381.CrossRefGoogle Scholar
72.Guze, S., Woodruff, R., Clayton, P.Sex, age and the diagnosis of hysteria (Briquet’s Syndrome). Am J Psychiatr 1972; 129: 745–748.CrossRefGoogle ScholarPubMed
73.Guze, S., Woodruff, R., Clayton, P.A Study of conversion symptoms in psychiatric outpatients. Am J Psychiatr 1971; 128: 643–646.CrossRefGoogle ScholarPubMed
74.Guze, S., Woodruff, R., Clayton, P.Hysteria and antisocial behaviour: further evidence of an association. Am J Psychiatr 1971; 127: 957–960.CrossRefGoogle Scholar
75.Simon, GE., Vonkorff, M.Somatisation and psychiatric disorder in the NIMH epidemiologic catchment area study. Am J Psychiatr 1991; 148: 1494–1500.Google ScholarPubMed
76.Tomasson, K., Kent, D., Coryell, W.Somatisation and conversion disorder: comorbidity and demographics at presentation. Acta Psychiat Scand 1991; 84: 288–293.CrossRefGoogle ScholarPubMed
77.Murphy, G.The clinical management of hysteria. JAMA 1982; 247: 2559–2564.CrossRefGoogle ScholarPubMed
78.Folks, DG., Hawck, CA.Somatoform disorders, factitious disorders and malingering. In: Stoudemire, A., Fogel, BS., eds. Psychiatric Care of the Medical Patient. New York: University Press, 1993; 267–287.Google Scholar
79.Adams, RD., Victor, M.Principles of Neurology (4th ed). McGraw-Hill, N.Y. 1989; 1197–1198.Google Scholar
80.Sargant, W., Slater, E.An Introduction to Physical Methods of Treatment in Psychiatry. 5th ed. London: Churchill Livingstone, 1972; 145–149.Google Scholar
81.Goldberg, D., Gask, L., O’Dowd, T.The treatment of somatisation: teaching techniques of reattribution. J Psychosom Res 1989; 33: 689–695.CrossRefGoogle ScholarPubMed
82.Sternbach, R.Pain Patients: Traits and Treatments. NY: Academic Press, 1974: Ch IX.Google Scholar
83.Miller, H.Accident neurosis. Br Med J 1961; 1: 919–925; 992–998.CrossRefGoogle ScholarPubMed
84.Tarsh, M., Royston, C.A follow-up study of accident neurosis. Br J Psychiatr 1985; 146: 18–25.CrossRefGoogle ScholarPubMed
85.Binder, RL., Trimble, MR., McNeil, DE.The course of psychologic symptoms after resolution of lawsuits. Am J Psychiatr 1991; 148: 1073–1075.Google ScholarPubMed
86.Benson, H., Beary, J., Carol, M.The relaxation response. Psychiatry 1974; 37: 37–46.CrossRefGoogle ScholarPubMed
87.Kiloh, L., Smith, J., Johnson, G.Physical Treatments in Psychiatry. Boston: Blackwell Scientific Pubs, 1988: 117–160.Google Scholar
88.Potter, WZ., Rudorfer, MV., Manji, H.The pharmacologic treatment of depression. N Engl J Med 1991; 325: 633–642.Google ScholarPubMed
89.Sharav, Y., Singer, E., et al. The analgesic effect of amitryptiline on chronic facial pain. Pain 1987; 31: 199–209.CrossRefGoogle Scholar