Hysterical neurosis
Hysterical neurosis is a psychogenic disorder based on a change in the patient’s behavior against the background of increased suggestibility and emotionality. The second name of this disease is hysteria. Hysterical neurosis is manifested by various vegetative, motor, affective and sensitive dysfunctions. In addition to increased suggestibility, a characteristic feature of a patient with hysteria will be a constant desire to attract attention to himself. Patients develop a conditional desirability of a painful symptom, called the mechanism of “flight into the disease”. The diagnosis of hysterical neurosis is based on the analysis of anamnestic information and the comparison of patient complaints with the real clinical picture. Often such patients voice complaints about diseases that they do not have and are prone to imitating various symptoms. Hysteria therapy consists in a complex of occupational and psychotherapeutic measures, as well as general strengthening of the patient’s health.
The content of the article:
Causes of hysterical neurosis
Symptoms of hysterical neurosis
Diagnosis of hysterical neurosis
Treatment of hysterical neurosis
Prognosis and prevention of hysterical neurosis
Hysterical neurosis
Often, children with a genetic predisposition and as a result of alcoholism of their parents fall into the risk group of this disease.
Causes of hysterical neurosis
The genesis of hysteria is represented by a combination of endogenous and exogenous factors. Of particular importance in the development of hysterical neurosis belongs to the specifics of personality formation, as well as the nature of behavior depending on suggestibility and increased emotionality.
One of the causes of hysteria will be pyhogenia, which is represented by the results of conflicts and neuropsychiatric overstrain. At the same time, the individual perception of the experience is important. Risk factors for the development of this neurological pathology include:
injuries of various localization;
somatic diseases;
physical overstrain;
family trouble;
abuse of alcoholic beverages;
professional dissatisfaction;
frequent use of sleeping pills and tranquilizers.
Even in persons who are not characterized by neurotic character traits, against the background of increased neuropsychiatric stress, neurotic dysfunction, vegetoneurosis or a reactive state may develop.
Symptoms of hysterical neurosis
With hysterical neurosis, various and variable symptoms develop. Hyperventilation of the patient contributes to the replacement of some symptoms with others.
The clinical picture of hysteria often implies such manifestations as:
hysterical pains;
hysterical contractures and paralysis;
hysterical vomiting;
mental disorders;
athonia;
deafness;
hysterical violation of tactility;
hysterical amaurosis.
Convulsive seizures with hysterical neurosis can be combined with screams, moans, a state of ecstasy, crying, pulling out hair on the head, but the presence of spectators will be a prerequisite for these phenomena.
As for the big hysterical fit, this is a whole performance consisting of several acts.
Initially, a patient with hysteria depicts an attack that looks like an epileptic one, he has convulsions, he can bend in an arc, focusing support on the back of his head and heels.
After that, the behavioral tactics of the hysterical patient goes into a phase of clownism and hyperactivity. Sweeping movements of the upper limbs are performed, and patients can also beat with their legs, arms, and head.
This is often followed by a phase with passionate poses and grimaces, in which the whole essence of the patient expresses horror, anger, ecstasy.
At the next stage of hysteria, hallucinatory delirious states arise in which patients cry and laugh, also at this stage they can listen to something, whisper something, see various “pictures”, etc. Patients often remember their visions, but when trying to explain what they saw, they may have difficulties. Such phenomena in some cases last several hours, their duration directly depends on the audience.
Basically, during seizures, patients with hysteria do not fall. As a rule, they express complaints of pain in the heart, tachycardia, palpitations, nausea, discomfort and difficulty during inhalation or exhalation. The skin on the face may acquire a pale or red hue. When palpating the wrist, the heartbeat is determined well, the pulse is full and rhythmic. Patients randomly wave their hands or freeze for a while. There are also attacks of lethargy, which imply hysterical hibernation, with a frequency of up to several times a day. In the case of a longer hibernation on the background of hysteria, there is a hysterical stupor.
The main distinguishing feature of hysterical seizures, in particular from epileptic seizures, is the mandatory presence of spectators, with epilepsy, patients develop seizures regardless of the presence of someone and, as a rule, have a more severe course. With hysterical feigned seizures, patients fall on a comfortable surface (sofa, armchair, bed) and do not cause significant injuries to themselves.
The specifics of damage
The lesion of body parts in hysterical paralysis and contractures can be localized in the upper, lower extremities, feet, etc., often the distinction between healthy and affected tissue is placed directly along the articular line. Among hysterical paralysis, paralysis of the musculature of the extremities is most often diagnosed. Pathological phenomena can be both unilateral (damage to one arm and leg on one side) and bilateral in nature. The cervical and lingual muscles are rarely affected.
Features of contractures
Contractures on the background of hysteria most often affect the cervical region (hysterical torticollis), sometimes the trunk. With such contractures, the body can be fixed in pretentious poses, in the case of organic lesions, such poses do not occur. Paralysis and contractures in hysteria differ from true paralysis and contractures in the absence of muscle hypotension and hyperreflection. Patients with motor dysfunction with hysteria lack the characteristic pose of a truly paralyzed person.
Pain and sensitivity
Patients with hysterical neurosis often experience a decrease or increase in pain sensitivity. Localization of areas with impaired sensitivity contradicts physiological norms, that is, it does not correspond to the characteristic innervation. The location of these sites depends on the subjective representation and is not based on the anatomical and physiological characteristics of the body. Often the sensitivity is disturbed by the type of “stockings”, “jackets”, “gloves”.
Pain in hysteria has a huge range of shades and has a fairly diverse localization. As an example, a point with limited edges located on the head, which in the patient causes associations with a driven nail. The pain of hysteria is quite difficult to differentiate from the pain of a physical nature. The symptoms of hysterical neurosis may include autonomic dysfunctions, represented by an extraordinary variety of manifestations. Quite often, patients may feel discomfort in the throat, especially when swallowing, which is called a “hysterical lump”.
The occurrence of vomiting
Hysterical vomiting is based on the motive of the profitability or “pleasantness” of the situation, and the presence of an audience is also a prerequisite. Sensory disorders, with hysterical neurosis, in the majority of cases, are expressed by visual and hearing impairment.
Loss of vision, hearing, voice
Absolute vision loss in hysteria (hysterical amaurosis) can be one- and two-sided. With complete unilateral hysterical amaurosis, binocular vision remains absolutely normal. With complete bilateral hysterical amaurosis, patients are absolutely confident in the absence of their vision, but in fact visual perception is preserved. One of the confirmations of this phenomenon is the exclusion of life-threatening situations by these people.
Hysterical hearing loss and complete lack of hearing are more common in relation to hysterical amaurosis, the majority of cases were diagnosed in wartime conditions. Deafness can develop together with speech dysfunction, often with hysterical deafness and hearing loss, the sensitivity of the skin covering the auricles decreases, which cannot be with a true hearing impairment. Patients with this symptom perfectly perceive the focus of attention and speech. This means that deafness is part of the presentation and all information concerning this person is well absorbed and processed.
Mutism (dumbness) and aphonia (loss of voice) in hysterical neurosis are also frequent phenomena. Mutism is based on spasm of the vocal cords. With hysterical aphonia, the cough remains sonorous (with organic aphonia, this does not happen). Hysterical mutism is accompanied by the patient’s ability to communicate through gestures and writing, they understand oral speech and read remarkably well.
Mental disorders in hysterical neurosis are very diverse. Patients may see short-term hallucinations, which are accompanied by theatrical and dramatic experiences and increased emotionality. Sometimes there are complaints of amnesia (memory loss).
Also, hysterical stupor, twilight states and other psychogenic disorders can act as clinical manifestations of hysteria.
Diagnosis of hysterical neurosis
The main element of diagnosis, in case of suspicion of hysterical neurosis, is the comparison of the patient’s complaints with the real clinical picture, since this condition proceeds with the absence of organic changes characteristic of those diseases that patients have suggested to themselves.
With hysteria, patients often turn to a therapist or pediatrician, who in turn establish suspicion of hysterical neurosis and refer the patient to a neurologist for consultation.
In order to confirm or refute organic changes in the patient’s organs and systems, a number of instrumental and laboratory studies are performed. If there are complaints of motor disorders, the patient may be prescribed an MRI of the brain and a CT of the spine. To exclude vascular pathology, patients are recommended to undergo angiographic examination and ultrasound. In addition, polysymptomicity in hysteria necessitates many other diagnostic methods that are prescribed individually for each patient.
Treatment of hysterical neurosis
The basic method of treatment of hysterical neurosis is represented by various methods of psychotherapy. From the very first days of the detection of this disease, it is necessary to direct efforts to strengthen the general health of the patient, to provide rest, rest and restorative therapy. With the duration of the excited state of the patient, sedatives, small doses of neuroleptics or tranquilizers are prescribed (depending on the level of excitement). With persistent insomnia, taking sleeping pills is recommended. It is very important to identify the factor that caused the injury to the patient, to try to eliminate this factor, to help the patient find the optimal way out of the existing situation. It is possible to achieve the desired result using the method of indirect suggestion. Physiotherapy and vitamin therapy are also advisable.
The actions of the psychotherapist in the treatment of hysteria are aimed at instilling in the patient that the pathological condition is provoked by “flight into the disease”, therefore it is necessary to change the living conditions that contributed to the development of pathology.
Competent planning of the labor and household regime and a rational approach to education (in the case of hysteria in a child) are also important.
With pronounced symptoms of hysteria, hospitalization of the patient is recommended. Many symptoms can be eliminated through the use of hypnosis. During treatment, the doctor ignores seizures, or stops them with the help of medical authority. Repressive methods of psychotherapy for hysterical neurosis are absolutely contraindicated.
Prognosis and prevention of hysterical neurosis
With hysteria, there is practically no threat to the patient’s life, so the prognosis is mostly favorable. A less favorable prognosis is in the case of a combination of hysteria with severe somatic pathologies, or organic lesions of the central nervous system.
Preventive measures for this disease are reduced to the exclusion or minimization of factors that have a traumatic effect on the psyche, the creation of satisfactory conditions in the work team and at home. One of the main roles in the healthy formation of personality is played by proper upbringing, which represents the prevention of hysteria from early childhood.
Diagnosis of hysterical neurosis
The main element of diagnosis, in case of suspicion of hysterical neurosis, is the comparison of the patient’s complaints with the real clinical picture, since this condition proceeds with the absence of organic changes characteristic of those diseases that patients have suggested to themselves.
With hysteria, patients often turn to a therapist or pediatrician, who in turn establish suspicion of hysterical neurosis and refer the patient to a neurologist for consultation.
In order to confirm or refute organic changes in the patient’s organs and systems, a number of instrumental and laboratory studies are performed. If there are complaints of motor disorders, the patient may be prescribed an MRI of the brain and a CT of the spine. To exclude vascular pathology, patients are recommended to undergo angiographic examination and ultrasound. In addition, polysymptomicity in hysteria necessitates many other diagnostic methods that are prescribed individually for each patient.
Treatment of hysterical neurosis
The basic method of treatment of hysterical neurosis is represented by various methods of psychotherapy. From the very first days of the detection of this disease, it is necessary to direct efforts to strengthen the general health of the patient, to provide rest, rest and restorative therapy. With the duration of the excited state of the patient, sedatives, small doses of neuroleptics or tranquilizers are prescribed (depending on the level of excitement). With persistent insomnia, taking sleeping pills is recommended. It is very important to identify the factor that caused the injury to the patient, to try to eliminate this factor, to help the patient find the optimal way out of the existing situation. It is possible to achieve the desired result using the method of indirect suggestion. Physiotherapy and vitamin therapy are also advisable.
The actions of the psychotherapist in the treatment of hysteria are aimed at instilling in the patient that the pathological condition is provoked by “flight into the disease”, therefore it is necessary to change the living conditions that contributed to the development of pathology.
Competent planning of the labor and household regime and a rational approach to education (in the case of hysteria in a child) are also important.
With pronounced symptoms of hysteria, hospitalization of the patient is recommended. Many symptoms can be eliminated through the use of hypnosis. During treatment, the doctor ignores seizures, or stops them with the help of medical authority. Repressive methods of psychotherapy for hysterical neurosis are absolutely contraindicated.
Prognosis and prevention of hysterical neurosis
With hysteria, there is practically no threat to the patient’s life, so the prognosis is mostly favorable. A less favorable prognosis is in the case of a combination of hysteria with severe somatic pathologies, or organic lesions of the central nervous system.
Preventive measures for this disease are reduced to the exclusion or minimization of factors that have a traumatic effect on the psyche, the creation of satisfactory conditions in the work team and at home. One of the main roles in the healthy formation of personality is played by proper upbringing, which represents the prevention of hysteria from early childhood.
