Definition: It is a subconscious production of signs & symptoms to gain attention or to escape from a certain danger or threat (secondary gain), the symptoms usually have a symbolic meaning. Hysteria comes from the Latin word Hysteron meaning the uterus, it was previously thought that the condition occurs only in females due to certain uterine movements, but it occurs both in females &. males. Dissociative conversion disorders has replaced this previously used term, but many clinicians still prefer to retain hysteria as a diagnostic category. Etiology: 1. Heredity Genetic factors: may play a role especially in the personality disposition called hysterical personality. (see later). 2. Emotional stress conflict which may lead to conversion or dissociative reaction. 3 .Hysteria may occur in all social classes but it is commoner in noneducated people of below average intelligence. Clinical Picture: II- Conversion reaction: 1- Motor Disturbances: Paralysis: - In the form of monoplegia, hemiplegia, or paraplegia. - In comparison to organic hemiplegia propximal>distal, no clonus, no babiniski, or specific distribution. • Aphonia: the patient can not phonate words but continues to cough as the vocal cords are not affected. • Tics, tremors, coma. stupor with no abnormal signs. • Torticollis. • Fits: - No sequence of tonic then clonic movements. - 0ccur in presence of audience. - Never occur during sleep. - No cyanosis, incontinence or tongue biting. - There is resistance to interference. NB: All motor symptoms have a sympolic meaning e.g. Aphonia as she cannot express her feeling, torticollis as she does not want to look at her husband who sleeps beside her. 2- Sensory disturbances: • Anesthesia: frequently total with no specific distribution. • Blindness:: pupil reactive, patient Avoid object that would injure him • Pain bizarre: related to emotional conflicts. 3- Visceral disturbance: Vomiting, cough, hicough, pseudocyesis, globus hystericus. II- Dissociative Reactions: The personality is dissociated to escape from the suffering. 1. Amnesia: (usually circumscribed or patchy) e.g. forgetting a shameful situations. 2. Fugues: The patient may travel over long distance, the patient is unaware of his original life, he may forget everything that happened during the attack. 3. Sleep walking: The patient Awakes from sleep, performs certain activities then return to sleep with amnesia about this period. Common in children due to stresses e.g. (School-parents) 4. Double or multiple personalities: The patient acquires another personality through which he can behave in the way he likes then return back to his original personality with amnesia about the events that occurred. The acquired personality motivated by her subconscious desires. 5. Stupor & twilight: State of clouding of consciousness during which patient may stop all physical & mental activities. It may be an escape from psychological trauma. 6. Ganser’s syndrome (Hysterical pseudomentia): Occurs under severe stress as in prisoners; there is a childish, bizarre behavior; an educated patient may be unable to know the number of fingers.
