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.
