Whilst "hysterical"
blindness, paralysis, anesthesia, dysphagia, and gait disturbance
have been described for many years, This patient confronts an acute
stressor that creates a psychic conflict, and the physical symptom(s)
serve as the resolution for the conflict. The patient may repress
the stressor or be unaware of its impact. Failure to recognize and
treat this early in the course may lead to symptoms which eventually
become harder or impossible to cure. This disorder may occur at any
age, either gender, any personality. A
conversion disorder is characterized by the loss of a bodily function,
for example blindness , paralysis, or the inability to speak . The
loss of physical function is involuntary, but diagnostic testing does
not show a physical cause for the dysfunction.
At least one symptom or deficit of sensory or voluntary motor function
suggests a neurological or general medical condition.
It is not limited to pain or sexual
dysfunction.
Appropriate investigation does not identify a neurological or general
medical condition or the direct effects of substance use that can
fully explain it.
Conflicts or other stressors that precede the onset or worsening of
this symptom suggest that psychological factors are related to it.
The patient doesn't consciously feign the symptoms for material gain
(Factitious Disorder) or to
occupy the sick role (Malingering).
It is not a culturally sanctioned behavior or experience.
It is serious enough to produce at least 1 of:
warrants medical
evaluation, or
causes distress that is clinically important, or
impairs social, occupational or personal functioning
It does not occur solely during
Somatization Disorder, and no other mental disorder better explains
it.
Symptom
Groupings:
Sensory Symptoms: These include anesthesia, excessive sensitivity
to strong simulation (hyperanesthesia), loss of sense of pain
(analgesia), and unusual symptoms such as tingling or crawling sensations.
Motor Symptoms: In motor symptoms, any of the body's muscle
groups may be involved: arms, legs, vocal chords. Included are tremors,
tics (involuntary twitches), and disorganized mobility or paralysis.
Visceral Symptoms: Examples are trouble swallowing, frequent
belching, spells of coughing or vomiting, all carried to an uncommon
extreme. In both sensory and motor symptoms, the areas affected may
not correspond at all to the nerve distribution in the area.
Specify type
of symptom or deficit:
With Motor Symptom
or Deficit.
With Seizures or Convulsions.
With Sensory Symptom or Deficit.
With Mixed Presentation.
Associated
Features:
Depressed
Mood.
Somatic
or Sexual Dysfunction.
Guilt or Obsession.
Anxious or Fearful or Dependent
Personality.
Differential
Diagnosis:
Some disorders have similar or even the same symptom. The clinician,
therefore, in his diagnostic attempt has to differentiate against
the following disorders which he needs to rule out to establish a
precise diagnosis.
Generalized
Anxiety Disorder.
Histrionic
Personality Disorder.
Dependent
personality Disorder.
Cause:
The symptom onset
of this disorder is usually very sudden and follows a stressful experience.
These disorders may be best thought of as disturbances of illness
perception or need. They are paradigms of mind-body interactions and
of the critical role of mental factors in the production of illness.
Though the role of the mind in creating and maintaining illness has
been known since antiquity, terms such as hysteria or psychosomatic
illness have lost their meaning over time. All illnesses are "psychosomatic:"
they occur in an individual at a particular psychological point in
his/her life.
Treatment:
A physical examination
is performed to rule out physical cause for loss of function. Specific
diagnostic testing related to the exhibited symptom may be warranted
to rule out a physical cause.
Counseling and Psychotherapy [ See
Therapy Section ]:
The loss of function
may symbolize the underlying conflict associated with it. Psychodynamic
theory interprets the cause of the symptoms as a defense mechanism
that absorbs and neutralizes the anxiety generated by an unacceptable
impulse or wish.
Psychiatric treatment
is recommended to help the person understand the underlying psychological
conflict. The person needs to know there is no organic cause for the
symptom. The integrity of the affected body part or function must
be maintained until the conflict is resolved and the symptoms usually
disappear.
Complications can result from disuse of a body part or system. Seizure-like
disorders referred to as pseudoseizures develop in some individuals.
Pharmacotherapy
[ See Psychopharmacology
Section ]
Anti Depressants.
