Hysterical neurosis is a manifestation of mental discomfort directly related to the pathological transfer of internal conflict to somatic soil. Motor disorders (tremor, coordination problems, aphonia, convulsions, paresis or paralysis), sensory (impaired sensitivity) and somatic disorders (disruption of internal organs), as well as hysterical seizures are characteristic. The diagnosis is established on the basis of serious complaints that do not correspond to reality. Therapeutic measures include psycho- and occupational therapy, general health promotion and elimination of current clinical symptoms.
F44 Dissociative [conversion] disorders
Hysterical neurosis is one of the forms of mental disorders associated with the desire to attract attention. More often, hysterical disorders are manifested in persons with unstable mentality. These people are usually emotionally unstable, any change in the situation causes them a violent reaction. Immaturity of the psyche is manifested by increased suggestibility and impressionability. At the same time, patients have narcissistic qualities. They have a desire to attract attention to their own person by any means, which further results in manipulating others.
Hysteria is often observed in children whose parents suffer from mental disorders or alcoholism. Women get sick much more often than men. The share of hysterical neurosis accounts for about 30% among all types of neuroses. The character of the patient with hysteria is characterized by theatricality and demonstrativeness (89%), egocentrism (97%), the desire to focus attention on his person (84%), the desire to become a leader in the family or school, manipulate people (80%), excessive sociability and fantasy, reaching the point of deceit (86%), infantilism (58%), increased suggestibility (78%), overestimated self-esteem (88%), self-dramatization (77%).
The hysterical mentality is not the only psychopathy that can later take the form of seizures. Persons with schizoid and excitable personality disorder are prone to this condition. According to Freud’s theory, absolutely all causes of mental disorders should be sought in childhood. Along with the traumatized psyche, the underlying cause of hysteria lies in sexual complexes. This explains the fact that the first manifestations of hysterical neurosis are more often manifested in childhood or during puberty.
The immediate impetus for the manifestation of hysteria are suddenly developed stressful situations: a family quarrel, a conflict at work, a break with a loved one or a sudden threat to life. A person finds an outlet for his emotions in hysteria, while extracting his own benefit from others (attention, sympathy, participation).
Unlike psychopathy, manifestations of hysteria manifest themselves as vividly as possible with the participation of other people. It is characterized by demonstrativeness — an essential condition for the manifestation of hysterical neurosis. Patient complaints and manifestations of the disease are not based on organic changes. All the symptoms of mental pathology end as suddenly as they began.
The clinical picture of hysterical neurosis is characterized by variegation and polymorphism. Motor disorders are observed: tremor of the fingers, impaired coordination, loss of voice (aphonia). Muscle tics (hyperkinesis) and seizures are often demonstrated. At the same time, all symptoms are aggravated by a medical examination of a pediatrician, therapist, neurologist and other specialists.
Hysterical aphonia is distinguished by sonorous coughing against the background of the absence of a voice. When stuttering occurs against the background of hysteria, the patient does not experience discomfort and embarrassment. Paralysis in hysteria is never accompanied by tissue atrophy (the difference with ischemic stroke). The main difference of such paralysis is in its localization: the patient indicates weakness or insubordination of the muscles on the arm to the elbow or on the leg to the knee, which is incompatible with an organic neurological lesion.
A severe form of the disease can manifest itself as partial (paresis) or complete paralysis of the limbs and muscles of the tongue. There is no organic pathology at the heart of motor disorders, motor disorders are short-term and depend on the patient’s peace of mind. The desire to attract maximum attention to himself stimulates the patient to false fainting, demonstrative hand-wringing, shortness of breath and throwing. However, if it is possible to switch the patient’s attention from his person to another object, motor disorders will either greatly weaken or disappear altogether.
Sensory disturbances can manifest as a decrease or absence of sensitivity (hypesthesia, anesthesia), and its intensification (hyperesthesia). At the same time, the spread of such signs is characteristic: patients limit the numbness zone to the area of gloves, socks, vests, etc. Often there are specific pains — causeless soreness in any part of the body.
A frequent manifestation of a hysterical reaction is sudden deafness or blindness (one- or two-sided). Patients may show a perverted color perception and narrowing of the visual fields, but this does not prevent them from adequately navigating in space. Deafness is often combined with paresthesia/anesthesia of the auricle.
Vegetative manifestations are limited by the patient’s imagination. He can complain of pain in any internal organ, most often it is the gastrointestinal tract and heart. Sometimes patients refuse to eat because of a false esophageal spasm. Nausea, abdominal pain, urge to vomit, heart pain, shortness of breath, palpitation or heart sinking have no basis; pathological changes in these organs that can cause such symptoms, in most cases there are no.
The patient may complain of burning and itching of the skin, showing the doctor combs on his hands and feet as confirmation. Almost always, patients report dizziness and headache, explaining this by pathology in the brain. Sometimes patients imitate the symptoms of appendicitis and bronchial asthma.
A sharp deterioration (seizure) in hysteria is very similar to the manifestation of epilepsy. Any situation that is psychologically difficult for the patient to perceive — a quarrel, unpleasant news, the refusal of others to fulfill the patient’s desire — ends with a theatrical seizure. This may be preceded by dizziness, nausea and other signs of pseudo-deterioration of the condition.
The patient falls, bending in an arc. At the same time, the patient will always fall “correctly”, trying to protect himself from injury as much as possible. Waving his arms and legs, banging his head on the floor, violently showing his emotions with tears or laughter, the patient depicts unbearable suffering. Unlike an epileptic, a hysterical person does not lose consciousness, the reaction of the pupils persists. A loud shout, irrigation of the face with cold water or a slap in the face will quickly bring the patient to his senses. Also, the patient is given a complexion: with an epileptic seizure, the face is purplish-cyanotic, and with hysteria — red or pale.
A hysterical seizure, unlike an epileptic one, never happens in a dream. The latter always happens in public. If the audience stops paying attention to the convulsions of hysteria or retires, the seizure will quickly end. After an attack, the patient may show amnesia, up to ignorance of his own name and surname. However, this manifestation is also short-term, memory recovery occurs quite quickly, as it is inconvenient for the patient himself.
Hysteria is a “great malingerer”. The patient vividly talks about his complaints, excessively demonstrating their confirmation, but at the same time shows emotional indifference. One might think that the patient enjoys a lot of his “sores”, while considering himself a complex nature that requires close all-round attention. If the patient learns about any manifestations of the disease that were previously absent from him, these symptoms are likely to appear.
Hysteria is the patient’s translation of his psychological problems into a physical channel. The absence of organic changes against the background of serious complaints is the main sign in the diagnosis of hysterical neurosis. Most often, patients turn to a pediatrician or therapist. However, if hysteria is suspected, the patient is referred to a neurologist. With all the variety of manifestations of hysterical neurosis, the doctor finds discrepancies between the symptoms and the real state of the body. Although the patient’s nervous tension may cause some strengthening of tendon reflexes and tremor of the fingers, the diagnosis of “hysterical neurosis” is usually not difficult.
Important! Seizures in children under 4 years old who want to achieve the fulfillment of their desire are a primitive hysterical reaction and are also caused by psychological discomfort. Usually affective seizures disappear on their own by the age of 5.
Instrumental studies are carried out to confirm the absence of any organic changes on the part of internal organs. CT of the spine and MRI of the spinal cord are prescribed for motor disorders. CT and MRI of the brain provide confirmation of the absence of organic pathology. Angiography of the cerebral vessels, rheoencephalography, ultrasound of the vessels of the head and neck are resorted to to exclude vascular pathology. EEG (electroencephalography) and EMG (electromyography) can confirm the diagnosis of hysteria.
In hysteria, the data of the above studies will refute the pathology of the structures of the brain and spinal cord. Depending on the complaints that the patient confirms with certain external manifestations, the neurologist decides to appoint a consultation with a neurosurgeon, an epileptologist and other specialists.
The essence of hysteria treatment is to correct the patient’s psyche. One of these techniques is psychotherapy. At the same time, the doctor does not pay excessive attention to the patient’s complaints. This will only provoke an increase in hysterical seizures. However, ignoring it completely can lead to the same results. Repeated courses of psychotherapy with the identification of the true cause of the condition are mandatory. A psychologist or psychotherapist, using suggestion, will help the patient to adequately assess himself and the events taking place. Occupational therapy is of great importance in hysteria. The involvement of the patient in work, the search for a new hobby distract the patient from the neurotic state.
Medical treatment is mainly reduced to the appointment of general tonic. With increased excitability, it is advisable to prescribe drugs based on medicinal herbs (valerian, motherwort), bromine. In some cases, the use of tranquilizers in small doses and short-term courses is justified. When insomnia (prolonged insomnia) is established, sleeping pills are prescribed.
Prognosis and prevention
The prognosis for the life of such patients is quite favorable. Patients with signs of anorexia, somnambulism and suicide attempts require longer follow-up. Longer and sometimes prolonged treatment is required for patients of an artistic type and with hysteria phenomena that originated in childhood. A more unfavorable outcome is observed when hysterical neurosis is combined with organic lesions of the nervous system or severe somatic diseases.
Prevention of hysterical neurosis includes measures to prevent mental disorders and nervous processes, as well as strengthening and preparing the nervous system for overstrain. These events are especially important in relation to people of an artistic type and children.
It is necessary to somewhat limit the imagination and fantasies of the child, try to create a calm environment for him, attract him to sports and stay with peers. You should not constantly indulge the whims and surround yourself with excessive care. An important role in preventing the development of hysterical neurosis is played by the proper upbringing of the baby and the formation of a full-fledged personality. The patient himself should not ignore his psychological problems, a quick solution to them will eliminate a stressful situation and will not allow psychopathy to take root.