Skip to main content
SpringerLink
Log in

Hysteria in Neurological Practice

The Somatoform and Dissociative Disorders

  • Chapter
Psychiatry for Neurologists

Part of the book series: Current Clinical Neurology ((CCNEU))

  • 1415 Accesses

Abstract

The Somatoform and Dissociative Disorders* of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) are the current representation of a disease known of old, hysteria; they amount to “hysteria split asunder,” as one of the leaders of the nosological revolution in contemporary psychiatry put it (2). Although the current diagnostic formulation is arguably a pale reflection of previous conceptualizations (the argument is made below), the disorder is certainly still a clinical presence. It has, as Sir Aubrey Lewis said, “outlive [d] its obituarists” (3). In this chapter, I set the scene for understanding neurological presentations of Somatoform and Dissociative Disorders by pointing to a historical moment in the development of the understanding of hysteria; provide a review of the current diagnostic categories and describe the clinical features of patients fitting into those categories, with greatest emphasis on Conversion Disorder because of its importance in neurological practice; offer a summary of the known risk factors for somatization, as well as describing the limited information available on its neurobiology; and provide a set of recommendations for clinical management by the physician not specializing in psychological medicine.

The capitalization style is as given in the DSM and should be taken to mark the words as applying to those nosological categories. Readers skeptical of DSM-IV may want to see the capitals as equivalent to scare quotes. Individual citations for criteria or quotations are not provided in the text, but the reference should be clear from the context, because of the topical organization of the DSM.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Weir Mitchell S. Rest in nervous disease: its use and abuse. In: Seguin EC, ed. A Series of American Clinical Lectures. New York: G. P. Putnam’s Sons; 1876:83–102.

    Google Scholar 

  2. Hyler SE, Spitzer RL. Hysteria split asunder. Am J Psychiatry 1978;135:1500–1504.

    PubMed  CAS  Google Scholar 

  3. Lewis A. The survival of hysteria. Psychol Med 1975;5:9–12.

    PubMed  CAS  Google Scholar 

  4. King H. Once upon a text: hysteria from Hippocrates. In: Gilman SL, King H, Porter R, Rousseau GS, Showalter E, eds. Hysteria Beyond Freud. Berkeley: University of California Press; 1993:3–90.

    Google Scholar 

  5. Micale MS. Approaching Hysteria: Disease and its Interpretations. Princeton: Princeton University Press; 1995.

    Google Scholar 

  6. Shephard B. A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century. Cambridge: Harvard University Press; 2001.

    Google Scholar 

  7. Gelfand T. Charcot’s response to Freud’s rebellion. J Hist Ideas 1989;50:293–307.

    Article  PubMed  CAS  Google Scholar 

  8. Charcot JM, Harris R. Clinical Lectures on Diseases of the Nervous System. London, New York: Tavistock/Routledge; 1991.

    Google Scholar 

  9. Micale MS. On the “disappearance” of hysteria: a study in the clinical deconstruction of a diagnosis. Isis 1993;84:496–526.

    Article  PubMed  CAS  Google Scholar 

  10. Reynolds JR. Paralysis, and other disorders of motion and sensation, dependent on idea. Brit Med J 1869;ii:483–485.

    Google Scholar 

  11. Lenze EJ, Miller AR, Munir ZB, Pornnoppadol C, North CS. Psychiatric symptoms endorsed by somatization disorder patients in a psychiatric clinic. Ann Clin Psychiatry 1999;11:73–79.

    Article  PubMed  CAS  Google Scholar 

  12. Stone J, Zeman A, Sharpe M. Functional weakness and sensory disturbance. J Neurol Neurosurg Psychiatry 2002;73:241–245.

    Article  PubMed  CAS  Google Scholar 

  13. Gould R, Miller BL, Goldberg MA, Benson DF. The validity of hysterical signs and symptoms. J Nerv Ment Dis 1986;174:593–597.

    Article  PubMed  CAS  Google Scholar 

  14. Carson AJ, Ringbauer B, Stone J, McKenzie L, Warlow C, Sharpe M. Do medically unexplained symptoms matter? A prospective cohort study of 300 new referrals to neurology outpatient clinics. J Neurol Neurosurg Psychiatry 2000;68:207–210.

    Article  PubMed  CAS  Google Scholar 

  15. Lempert T, Dieterich M, Huppert D, Brandt T. Psychogenic disorders in neurology: frequency and clinical spectrum. Acta Neurol Scand 1990;82:335–340.

    Article  PubMed  CAS  Google Scholar 

  16. Reuber M, Pukrop R, Mitchell AJ, Bauer J, Elger CE. Clinical significance of recurrent psychogenic nonepileptic seizure status. J Neurol 2003;250:1355–1362.

    Article  PubMed  Google Scholar 

  17. Scott PA, Silbergleit R. Misdiagnosis of stroke in tissue plasminogen activator-treated patients: characteristics and outcomes. Ann Emerg Med 2003;42:611–618.

    Article  PubMed  Google Scholar 

  18. Allanson J, Bass C, Wade DT. Characteristics of patients with persistent severe disability and medically unexplained neurological symptoms: a pilot study. J Neurol Neurosurg Psychiatry 2002;73:307–309.

    Article  PubMed  CAS  Google Scholar 

  19. Slater ET, Glithero E. A follow-up of patients diagnosed as suffering from “hysteria”. J Psychosom Res 1965;9:9–13.

    Article  PubMed  CAS  Google Scholar 

  20. Crimlisk HL, Bhatia K, Cope H, David A, Marsden CD, Ron MA. Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms. Br Med J 1998;316:582–586.

    CAS  Google Scholar 

  21. Mace CJ, Trimble MR. Ten-year prognosis of conversion disorder. Br J Psychiatry 1996;169:282–288.

    Article  PubMed  CAS  Google Scholar 

  22. Moene FC, Landberg EH, Hoogduin KA, et al. Organic syndromes diagnosed as conversion disorder: identification and frequency in a study of 85 patients. J Psychosom Res 2000;49:7–12.

    Article  PubMed  CAS  Google Scholar 

  23. Stone J, Sharpe M, Rothwell PM, Warlow CP. The 12 year prognosis of unilateral functional weakness and sensory disturbance. J Neurol Neurosurg Psychiatry 2003;74:591–596.

    Article  PubMed  CAS  Google Scholar 

  24. Reuber M, Pukrop R, Bauer J, Helmstaedter C, Tessendorf N, Elger CE. Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients. Ann Neurol 2003;53:305–311.

    Article  PubMed  Google Scholar 

  25. Spitzer C, Spelsberg B, Grabe HJ, Mundt B, Freyberger HJ. Dissociative experiences and psychopathology in conversion disorders. J Psychosom Res 1999;46:291–294.

    Article  PubMed  CAS  Google Scholar 

  26. Grunau RV, Whitfield MF, Petrie JH, Fryer EL. Early pain experience, child and family factors, as precursors of somatization: a prospective study of extremely premature and fullterm children. Pain 1994;56:353–359.

    Article  PubMed  CAS  Google Scholar 

  27. Hotopf M, Mayou R, Wadsworth M, Wessely S. Childhood risk factors for adults with medically unexplained symptoms: results from a national birth cohort study. Am J Psychiatry 1999;156:1796–1800.

    PubMed  CAS  Google Scholar 

  28. Craig TK, Bialas I, Hodson S, Cox AD. Intergenerational transmission of somatization behaviour: 2. Observations of joint attention and bids for attention. Psychol Med 2004;34:199–209.

    Article  PubMed  CAS  Google Scholar 

  29. Fleisher W, Staley D, Krawetz P, Pillay N, Arnett JL, Maher J. Comparative study of trauma-related phenomena in subjects with pseudoseizures and subjects with epilepsy. Am J Psychiatry 2002;159:660–663.

    Article  PubMed  Google Scholar 

  30. Prueter C, Schultz-Venrath U, Rimpau W. Dissociative and associated psychopathological symptoms in patients with epilepsy, pseudoseizures, and both seizure forms. Epilepsia 2002;43:188–192.

    Article  PubMed  Google Scholar 

  31. Fergusson DM, Horwood LJ, Lynskey MT. Childhood sexual abuse and psychiatric disorder in young adulthood: II. Psychiatric outcomes of childhood sexual abuse. J Am Acad Child Adolesc Psychiatry 1996;35:1365–1374.

    Article  PubMed  CAS  Google Scholar 

  32. Molnar BE, Buka SL, Kessler RC. Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. Am J Public Health 2001;91:753–760.

    PubMed  CAS  Google Scholar 

  33. Mulder RT, Beautrais AL, Joyce PR, Fergusson DM. Relationship between dissociation, childhood sexual abuse, childhood physical abuse, and mental illness in a general population sample. Am J Psychiatry 1998;155:806–811.

    PubMed  CAS  Google Scholar 

  34. De Bellis MD. Developmental traumatology: the psychobiological development of maltreated children and its implications for research, treatment, and policy. Dev Psychopathol 2001;13:539–564.

    Article  PubMed  Google Scholar 

  35. De Bellis MD, Keshavan MS, Shifflett H, et al. Brain structures in pediatric maltreatment-related posttraumatic stress disorder: a sociodemographically matched study. Biol Psychiatry 2002;52:1066–1078.

    Article  PubMed  Google Scholar 

  36. Reuber M, House AO, Pukrop R, Bauer J, Elger CE. Somatization, dissociation and general psychopathology in patients with psychogenic non-epileptic seizures. Epilepsy Res 2003;57:159–167.

    Article  PubMed  Google Scholar 

  37. Reuber M, Fernandez G, Helmstaedter C, Qurishi A, Elger CE. Evidence of brain abnormality in patients with psychogenic nonepileptic seizures. Epilepsy Behav 2002;3:249–254.

    Article  PubMed  Google Scholar 

  38. Marshall JC, Halligan PW, Fink GR, Wade DT, Frackowiak RS. The functional anatomy of a hysterical paralysis. Cognition 1997;64:B1–B8.

    Article  PubMed  CAS  Google Scholar 

  39. Vuilleumier P, Chicherio C, Assal F, Schwartz S, Slosman D, Landis T. Functional neuroanatomical correlates of hysterical sensorimotor loss. Brain 2001;124(Pt 6):1077–1090.

    Article  PubMed  CAS  Google Scholar 

  40. Mailis-Gagnon A, Giannoylis I, Downar J, et al. Altered central somatosensory processing in chronic pain patients with “hysterical” anesthesia. Neurology 2003;60:1501–1507.

    PubMed  CAS  Google Scholar 

  41. Stone J, Sharpe M, Carson A, et al. Are functional motor and sensory symptoms really more frequent on the left? A systematic review. J Neurol Neurosurg Psychiatry 2002;73:578–581.

    Article  PubMed  CAS  Google Scholar 

  42. Wessely S, White PD. There is only one functional somatic syndrome. Br J Psychiatry 2004;185:95–96.

    Article  PubMed  Google Scholar 

  43. Meares R. Towards a psyche for psychiatry. Aust N Z J Psychiatry 2003;37:689–695.

    Article  PubMed  Google Scholar 

  44. North CS, Hansen K, Wetzel RD, Compton W, Napier M, Spitznagel EL. Nonpsychotic thought disorder: objective clinical identification of somatization and antisocial personality in language patterns. Compr Psychiatry 1997;38:171–178.

    Article  PubMed  CAS  Google Scholar 

  45. Ovsiew F. Psychogenic movement disorders: an overview of the psychiatric approach to conversion disorder. In: Hallett M, ed. Psychogenic Movement Disorders; in press.

    Google Scholar 

  46. Karvonen JT, Veijola J, Jokelainen J, Laksy K, Jarvelin MR, Joukamaa M. Somatization disorder in young adult population. Gen Hosp Psychiatry 2004;26:9–12.

    Article  PubMed  Google Scholar 

  47. Fink P, Hansen MS, Oxhoj ML. The prevalence of somatoform disorders among internal medical inpatients. J Psychosom Res 2004;56:413–418.

    Article  PubMed  Google Scholar 

  48. Feder A, Olfson M, Gameroff M, et al. Medically unexplained symptoms in an urban general medicine practice. Psychosomatics 2001;42:261–268.

    Article  PubMed  CAS  Google Scholar 

  49. Breslau N, Lipton RB, Stewart WF, Schultz LR, Welch KM. Comorbidity of migraine and depression: investigating potential etiology and prognosis. Neurology 2003;60:1308–1312.

    PubMed  CAS  Google Scholar 

  50. Veale D. Body dysmorphic disorder. Postgrad Med J 2004;80:67–71.

    Article  PubMed  CAS  Google Scholar 

  51. Aouizerate B, Pujol H, Grabot D, et al. Body dysmorphic disorder in a sample of cosmetic surgery applicants. Eur Psychiatry 2003;18:365–368.

    Article  PubMed  CAS  Google Scholar 

  52. Phillips KA. Psychosis in body dysmorphic disorder. J Psychiatr Res 2004;38:63–72.

    Article  PubMed  Google Scholar 

  53. Barsky AJ, Ahern DK. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA 2004;291:1464–1470.

    Article  PubMed  CAS  Google Scholar 

  54. Allen LA, Escobar JI, Lehrer PM, Gara MA, Woolfolk RL. Psychosocial treatments for multiple unexplained physical symptoms: a review of the literature. Psychosom Med 2002;64:939–950.

    Article  PubMed  Google Scholar 

  55. Becker-Blease KA, Deater-Deckard K, Eley T, Freyd JJ, Stevenson J, Plomin R. A genetic analysis of individual differences in dissociative behaviors in childhood and adolescence. J Child Psychol Psychiatry 2004;45:522–532.

    Article  PubMed  Google Scholar 

  56. Kopelman MD. Disorders of memory. Brain 2002;125(Pt 10):2152–2190.

    Article  PubMed  Google Scholar 

  57. Cima M, Nijman H, Merckelbach H, Kremer K, Hollnack S. Claims of crime-related amnesia in forensic patients. Int J Law Psychiatry 2004;27:215–221.

    Article  PubMed  CAS  Google Scholar 

  58. Symonds C. Hysteria. In: Merskey H, ed. The Analysis of Hysteria. London: Balliere Tindall; 1979:258–265.

    Google Scholar 

  59. Hacking I. Mad Travelers: Reflections on the Reality of Transient Mental Illnesses. Charlottesville: University Press of Virginia; 1998.

    Google Scholar 

  60. Lambert MV, Sierra M, Phillips ML, David AS. The spectrum of organic depersonalization: a review plus four new cases. J Neuropsychiatry Clin Neurosci 2002;14:141–154.

    PubMed  Google Scholar 

  61. Baker D, Hunter E, Lawrence E, et al. Depersonalisation disorder: clinical features of 204 cases. Br J Psychiatry 2003;182:428–433.

    Article  PubMed  Google Scholar 

  62. Blanke O, Landis T, Spinelli L, Seeck M. Out-of-body experience and autoscopy of neurological origin. Brain 2004;127(Pt 2):243–258.

    Article  PubMed  Google Scholar 

  63. Maillard L, Vignal JP, Anxionnat R, TaillandierVespignani L. Semiologic value of ictal autoscopy. Epilepsia 2004;45:391–394.

    Article  PubMed  Google Scholar 

  64. Schrag A, Brown RJ, Trimble MR. Reliability of self-reported diagnoses in patients with neurologically unexplained symptoms. J Neurol Neurosurg Psychiatry 2004;75:608–611.

    Article  PubMed  CAS  Google Scholar 

  65. Dickinson WP, Dickinson LM, de Gruy FV, Main DS, Candib LM, Rost K. A randomized clinical trial of a care recommendation letter intervention for somatization in primary care. Ann Fam Med 2003;1:228–235.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of Chicago Hospitals, University of Chicago School Pritzker School of Medicine, Chicago, IL

    Fred Ovsiew MD

Authors
  1. Fred Ovsiew MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Psychiatry and Neurosciences, University of California, San Diego

    Dilip V. Jests MD

  2. Department of Psychiatry and Neurosciences, VA San Diego Healthcare System, San Diego, CA

    Dilip V. Jests MD

  3. Parkinson’s Disease and Movement Disorders Center, NeuroHealth, Warwick, RI

    Joseph H. Friedman MD

  4. University Medical School, Providence, RI

    Joseph H. Friedman MD

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Ovsiew, F. (2006). Hysteria in Neurological Practice. In: Jests, D.V., Friedman, J.H. (eds) Psychiatry for Neurologists. Current Clinical Neurology. Humana Press. https://doi.org/10.1007/978-1-59259-960-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-960-8_7

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-483-8

  • Online ISBN: 978-1-59259-960-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation