Hysterical Neurosis: Psychiatric Significance Of Its Clinical Presentations, Diagnosis And Treatment
Motor Symptoms And Tremor
Hysteria can mimic any disease. Symptoms may be those of conversion reaction or dissociative reaction. The conversion reactions manifest as phenomena pertaining to the motor, sensory and visceral systems.
Conversion reaction: Symptoms of conversion reaction are as follows:
Motor symptoms: Various types of peresis and paralysis like hemiplegia, monoplegia and paraplegia, bizarre gait, termors, and mutism are common. It is usually a function (movement) and not a group of muscles or any nerve distribution that is affected. The proximal parts of the limbs are more affected than the distal parts. The paralysed muscles may be used in one movement but not in others. Efforts to produce a particular movement in a paralysed limb may produce spasm in the opposite group of muscles. Examination reveals generalized muscular rigidity with increased tendon reflexes and flexor plantar response. Disused atrophy may rarely supervene in long-standing cases.
Tremors: Coarse tremors occurring at rest and exaggerated when attention is drawn to them are suggestive of hysterical tremors.
Other Clinical Manifestations
Sensory symptoms: These include anaesthesia, paraesthesia and hyperaesthesia. These sensory disturbances do not correspond to any anatomical pattern. Unlike as in organic neurological lesions, the boundaries are sharply demarcated and the extent varies widely with repeated testing. Symmetrical anaesthesia affecting the extremities (glove and stocking type) may occur.
Special Senses: Hysterical blindness and deafness may occur. The patient can avoid obstacles in her path even when there is total blindness. Many patients complain of diplopia as well.
Visceral manifestations: Common symptoms of vomiting, retention of urine, constipation, loss of appetite, etc.
Dissociative reaction: In dissociative reactions, the symptoms are confined to the psychic field. Amnesia, fugue, somnambulism, multiple personality, hysterical trance, fits, etc, are the common manifestations.
Amnesia: In hysterical amnesia, the loss of memory is confined to a circumscribed event or connected events, which are agonizing to the patient. The amnesia occurs in situations of intolerable stress. The intellectual functions are unaffected unlike as in dementia.
Fugue: In hysterical fugue, the person may wander in the amnestic state with loss of identity. A different identity may be assumed by the patient and he may engage in a work quite dissimilar to the previous job. The original identity can be regained under hypnosis.
Somnabulism: It is a hysterical state where the individual walks around in sleep to attain certain motives. He avoids obstacles on his way. This symptom may also occur in depression, epilepsy etc.
Dual or multiple personality: The patient is possessed by a different personality, usually by a ‘spirit’. In dual personality, the second personality may dominate the activities of the patient and he may not be aware of his real personality.
Hysterical trance (Hysterical twilight state or hysterical stupor): In this disorder, the patient gets detached from reality and may become almost immobile and immersed in his own self or in some other “divine power”.
© 2014 Funom Theophilus Makama