Whilst "hysterical" blindness, paralysis,
anesthesia, dysphagia, and gait disturbance have been described for millennia, The 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 Goupings:
* 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." 1
Specify type of symptom or deficit:
* With Motor Symptom or Deficit
* With Seizures or Convulsions
* With Sensory Symptom or Deficit
* With Mixed Presentation
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
See our Somatoform Disorders Page for links
