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Schematic conceptualization of psychiatric disorders historically classified as hysteria and phenomenologically related psychopathology.
Source publication
This article examines the history of the conceptualization of dissociative, conversion, and somatoform syndromes in relation to one another, chronicles efforts to classify these and other phenomenologically-related psychopathology in the American diagnostic system for mental disorders, and traces the subsequent divergence in opinions of dissenting...
Contexts in source publication
Context 1
... presenting with many psychiatric symptoms that suggest but are not part of several psychiatric disorders may well meet borderline personality disorder criteria. Figure 1 provides a schematic illustration of the relationships of these disorders based on the type of psychopathology exhibited. In this schematic diagram, "somatoform" syndromes include somatization and conversion disorders which present with physical symptoms of medical illnesses that the patient does not have: either throughout the body (somatization) or expressed in the sensory and motor peripheral nervous system (conversion). ...
Citations
... Subsequently, the psychotic manifestations of hysteria were investigated more and more rarely (shown in Fig. 1). The gradually decreasing interest toward HP over time could be related to the fact that international statistical diagnostic manuals such as ICD and DSM progressively abandoned the idea of hysteria as an autonomous syndrome [2,3], even less considering its psychotic features. The "International Classification of Diseases, 9th Revision" (ICD-9) of 1977 notes about Hysteria (300.1) that "behaviour may mimic psychosis or, rather, the patient's idea of psychosis". ...
b> Background: Hysteria in its most severe expression may reach psychotic manifestations. Such symptomatology has been occasionally described by various authors starting from the 19th century and defined as “hysterical psychosis” (HP) by Hollender and Hirsch in 1964. Currently, diagnostic psychiatric manuals such as DSM and ICD do not include the diagnosis of HP, although this term is commonly used in clinical practice. This raises a well-known problem with case definition due to an inconsistent use of terminology. Summary: Here, we propose a review of the literature that aims to highlight the clinical features of HP endorsed by the majority of authors, such as histrionic premorbid personality, acute reactive onset, short duration, altered state of consciousness, unstable delusions, typical hallucinations, labile mood, lack of flat affect. In the discussion, we focus on the differential diagnosis between HP and other diagnoses such as brief psychosis and schizophrenia, trying to point out aspects of distinction and continuity. Key Messages: The debate about this nosographic entity still remains a huge dilemma and needs further contributions.
... Based on his work with patients with hysteria, Pierre Janet developed the theory of dissociation, while Sigmund Freud developed the concept of hysterical conversion. In fact, P. Janet observed the dissociative aspects of hysteria, while S.Freud observed the conversion aspects(37). Dissociation and conversion were practically covered by the unique con-histerije dok je S. Freud sagledavao aspekte konverzije(37).Praktično su disocijacija i konverzija bile obuhvaćeni jedinstvenim koncep-in perspective-that is, a shift from a disorder-focused approach to a person-focused approach or "life history perspective" that seeks to "map the myriad complex pathways from early childhood to later adaptive or maladaptive development that may then form the basis for interventions for the prevention and treatment of disorders"(36). ...
... In fact, P. Janet observed the dissociative aspects of hysteria, while S.Freud observed the conversion aspects(37). Dissociation and conversion were practically covered by the unique con-histerije dok je S. Freud sagledavao aspekte konverzije(37).Praktično su disocijacija i konverzija bile obuhvaćeni jedinstvenim koncep-in perspective-that is, a shift from a disorder-focused approach to a person-focused approach or "life history perspective" that seeks to "map the myriad complex pathways from early childhood to later adaptive or maladaptive development that may then form the basis for interventions for the prevention and treatment of disorders"(36). ...
... Even though known for centuries as "hysteria" [15], modern medicine still understands very little about conversion disorders, especially psychogenic blindness, and a lot of physicians struggle with the diagnosis and treatment of non-organic vision loss. This is most probably due to the insufficient knowledge of medical professionals about the significant impact of psychological welfare on the visual system [16]. ...
Introduction: Conversion disorders are characterized by the presence of motor or sensory dysfunction, resulting in significant discomfort or disability, the occurrence of which is not justified by any somatic disease. Psychogenic blindness, a specific manifestation of conversion disorders, refers to the loss or impairment of vision that cannot be attributed to any organic abnormalities in the eyes or visual system. The exact mechanisms underlying psychogenic blindness are not fully understood, but it is believed to involve complex interactions between the brain, visual pathways, and psychological processes. This systematic review aims to summarize reported cases of blindness in conversion disorders. Material and methods: A comprehensive search of the MEDLINE and Embase databases identified 13 relevant articles reporting a total of 17 patients with psychogenic blindness. Results: The risk and triggering factors for psychogenic blindness included acute stress (for example acute physical injury), chronic stressful situations (such as chronic health problems, disruptions in family relationships), and multiple factors including coexisting psychiatric conditions (like anxiety or other conversion disorders). The course of blindness varied among patients, with duration ranging from hours to years. Diagnostic methods involved thorough ophthalmic and neurological examinations, brain imaging, and psychiatric evaluations. Conclusions: This review provides valuable insights into managing patients with psychogenic blindness. The findings highlight the need for a multidisciplinary approach involving ophthalmologists, neurologists, and mental health specialists. Further research is required to elucidate the underlying mechanisms and develop effective treatment strategies for individuals with psychogenic blindness. Keywords: psychogenic blindness, conversion disorders, causes
... Conversion disorders, referred to as hysterical neurosis conversion type in earlier editions of the Diagnostic and Statistical Manual [1], were assigned the name of functional neurological symptom disorders in the latest (5th) edition, which classified them as part of the "Somatic symptom and related disorders." These all share a common feature: "the prominence of somatic symptoms associated with significant distress and impairment" [2]. ...
Introduction:
Functional neurological symptom disorder (FNSD) is a common diagnosis among adolescents. However, we feel it is a difficult diagnosis to assess because of the diversity of its clinical manifestations, the rapid changes in its nosography over the years, and its common imbrication with established somatic diagnoses. We would like to illustrate this hypothesis through a case presentation and the original diagnostic process that emerged from it.
Methods:
We chose to present our diagnosis approach through the case of an 11-year-old boy who showed a progressive loss of motor and sensory function to the point of total dependency, and then suddenly switched between this state and a "normal" physical presentation, while deliriously claiming to be an angel.
Results:
All possible infectious, autoimmune, metabolic, and toxic disorders were ruled out. After the successive therapeutic failures of antidepressants and neuroleptics, FNSD was diagnosed.
Conclusion:
The DSM-5-TR classification was insufficient to explain the full clinical picture and a complementary approach (biblical, psychoanalytical, and historical) was used to analyze the cause of this atypical presentation.
... For example, constructs and dimensions are constantly evolving, as represented by the 70-year history of dynamic shifts in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A cornerstone of Western medicine and psychiatric treatment, the DSM categories and descriptions are created through consensus and represent their time's prevailing socio-political, ideological, empirical, and medical knowledge (North, 2015). Changes in the conceptualization of a construct or dimension inevitably result in changes to what, why, and how it is measured. ...
The provision of quality healthcare relies on scales and measures with robust evidence of their psychometric properties. Using measurement instruments with poor reliability, validity, or feasibility, or those that are not appropriate for the target diagnostic group or construct/dimension under consideration, may be unfavorable for patients, unproductive, and hinder empirical advancement. Resources from the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) group can assist in identifying and developing psychometrically sound measures. The COSMIN initiative is the only international, research-based practice taxonomy and methodological guidelines for measurement in healthcare. This manuscript aims to provide an accessible introduction to theories, principles and practices of psychometrics, instrument properties, and scale development, with applied examples from the COSMIN recommendations. It describes why measurement in healthcare is critical to good practice, explains the concepts of the latent variable and hypothetical construct and their importance in healthcare assessments, explores issues of flawed measurement and briefly explains key theories relevant to psychometrics. The paper also outlines a ten-step process to develop and validate a new measurement instrument, with examples drawn from a recently developed visuoperceptual measure for analysis of disordered swallowing to demonstrate key concepts and provides a guide for understanding properties of and terminology related to measurement instruments. This manuscript serves as a resource for healthcare clinicians, educators, and researchers who seek to develop and validate new measurement instruments or improve the properties of existing ones. It highlights the importance of using psychometrically sound measurement instruments to ensure high-quality healthcare assessments.
... BPD is a contested and controversial diagnostic construct mainly due to its low specificity (Hudziak et al., 1996;Lewis & Appleby, 1988;Tyrer, 2009;Hartley et al., 2022;Harding, 2020;Hodges, 2003;WrenAves, 2020;WrenAves, 2022a;WrenAves, 2023). Concerns also exist regarding the BPD diagnostic construct as it a) was introduced in the DSM at the same time hysteria (North, 2015) and homosexuality-as-mental-illness (Spitzer, 1981) were discarded, b) is predominantly applied to women and members of the LGBTQIA+ community (two marginalised communities) (Shaw & Proctor, 2005;Nicki, 2016;Wolff, 2020;Vanvuren, 2017;VMIAC, 2020;Lawn & McMahon, 2015;Di Maggio, 2019;Jackson & Daffin, 2023;Zimmerman, Benjamin, & Seijas-Rodriguez, 2022;Rodriguez-Seijas, Morgan, & Zimmerman, 2021;Meybodi & Jolfaei, 2022;Lomani, 2022;Reich & Zanarini, 2008), and c) is coincidentally synonymous with character assassination as well as neglect, disdain, and discrimination from health professionals (Papathanasiou & Stylianidis, 2022;Sulzer, 2015;Ferguson, 2015;McKenzie, Gregory, & Hogg, 2022;Rivera et al., 2014;Nehls, 1998;Woollaston & Hixenbaugh, 2008;Koekkoek, van Meijel, & Hutschemaekerd, 2006;Charlie, 2019;Aviram, Brodsky, & Stanley, 2006;Sharda, Baker, & Cahill, 2022;Veysey, 2014;Harvey, 2020;WrenAves, 2022a;WrenAves, 2020;Hoppypelican, 2022;Wolff, 2020;de la Mare, 2023), including in Australia (Klein, Fairweather, & Lawn, 2022;Lawn & McMahon, 2015). ...
While eating disorders have been estimated to affect at least 4% of the Australian population, research demonstrates that feeding difficulties and eating disorders are overrepresented in neurodivergent people, including in autism, ADHD, intellectual disability, giftedness, and Tourette’s disorder. However, despite there being a substantial body of literature spanning decades evidencing links between neurodivergence and eating disorders, awareness among clinicians and researchers of this existing knowledge base is only emerging in Australia.
NEDC commissioned Eating Disorders Neurodiversity Australia (EDNA) to write a report, Eating Disorders and Neurodivergence: A Stepped Care Approach, that synthesizes research and lived experience evidence regarding the prevention, early identification and treatment of eating disorders and disordered eating for neurodivergent people.
This report aims to encourage collaboration among stakeholders to co-produce and co-design appropriate, effective, culturally valid, and safe neurodiversity-affirming support systems and care pathways. It is designed for the use of a wide range of stakeholders, especially health care professionals (e.g., psychiatrists, psychologists, dietitians, general practitioners, paediatricians, occupational therapists), researchers, academics, educators (e.g., teachers), service managers, and lived experience experts.
This report draws on fundamental constructs relating to human rights, bioethics, humanistic psychology, phenomenology, and social justice. It challenges traditional understandings of neurodivergence as pathological. It seeks to destigamtise neurodivergent body awareness and image, feeding, and eating experiences and behaviours. It is a call to action for all eating disorder stakeholders to engage in a radical rethink of how neuronormative feeding and eating practices, which influence research and clinical practice across all levels of eating disorder care, may prove harmful for neurodivergent people.
... Rather than follow Kellerman in using the outmoded term 'hysterical', which colloquially means unrestrained emotional excess, and which lacks any clear definition in medicine and psychiatry (Lipovetzky & Agrest, 2010;North, 2015), Plutchik (1995) used the term, 'histrionic' to describe an individual with a personality disorder in which selfesteem depends upon the approval of others rather than from a valid feeling of self-worth. The individual beset with histrionic personality disorder (HPD) has a problem of mental health that centrally involves the primary emotion acceptance. ...
Love is defined and examined as an emotion, using the psychoevolutionary theory of emotions developed by Robert Plutchik and extended to social psychiatry by Henry Kellerman. This theory posits a fourfold ethogram, representing the valanced adaptive reactions to problems of life which define the eight primary emotions. The problem of identity is addressed by acceptance and disgust; temporality, by joy-happiness and sadness. Using a hierarchical classification system, love is defined as a secondary-level emotion, a mixture of joy and acceptance. Examination of the brain infrastructure of these emotions supports their interpretation as basic emotions. In romantic and other forms of love, there is a global acceptance-incorporation, of the other, together with the joy of sexual pair-bonding. This can rise to the level of a clinical disposition that is both histrionic and manic, akin to a Durkheimian collective effervescence. The emotions of acceptance and joy are in everyday life constrained by ego-defense mechanisms: acceptance is constrained by a more critical, less idealised, view of a potential love object; uninhibited joy of sexuality is defended against by sublimation, in which libidinal energy is deflected into an emphasis on correct and proper behaviour, and purposive and productive activities.
... The term hysteria has undergone several name changes over the years. Dissociation, conversion and somatization are some of these names (3). The French philosopher and psychiatrist Pierre Janet introduced the concept of dissociation in relation to multiple personality disorder (4). ...
Hysteria has been described from biblical times. It has changed its name many times over the years. Possession states and pseudoseizures are subtypes of hysteria. With the two major diagnostic classifications, the DSM 5 and the ICD 10 separating hysteria into different subcategories with dissimilar names, the confusion for clinicians has compounded. Fortunately, the upcoming ICD 11 has taken a sensible approach describing all types of hysteria under one term; dissociative disorder. This term describes its underlying psychodynamic aetiology and will most likely be widely accepted. The editorial discusses some of the historical roots of the term hysteria and its different names, definitions and clinical features, and their classification with guidelines for management.
... While apnea describes the cessation of inhalation, hysteria has more complicated origin and meaning. As a medical term, hysteria used to encompass a wide range of dissociative, somatoform, and conversion disorders in the Diagnostic and Statistical Manual of Mental Disorders until the 1990's [5]. Although it is obsolete as a medical term, it is still used in a variety of lay contexts to describe loss of sentimental control oftentimes accompanied by marked vocal and physical symptoms. ...
Objective:
The aim: To presents clinical, epidemiological and pathophysiological aspects of the disease described by Galenos of Pergamon during the 2nd century AD and discusses its implications on contemporary discourse on gender equity and gender - based discrimination.
Patients and methods:
Materials and methods: The authors searched original medical texts written in Greek language and attributed to Galenos for records related to hysterical apnea.
Conclusion:
Conclusions: Galen attempted to interpret hysterical apnea by combining clinical and epidemiological observations with anatomical and functional lesions. His approach denounced the anatomically unsound notion of the wandering womb and availed the knowledge of his period in a rational manner. Investigating gender - related aspects of contemporary psychosomatic conditions related to fertility and pregnancy can help address gender - based discrimination in modern societies.
... Dissociation is a serious psychological condition that is known to cause severe disability, require extensive treatment, and burden individuals and society with substantial costs. 1,2 It is widely believed that trauma and posttraumatic stress can lead to dissociative disorders, and associations between these entities and dissociation are well established. [3][4][5][6][7] However, at least some of the association between trauma-related experience and dissociation in the dissociation literature may represent confounding based on sampling bias inherent in the selection of patient samples from treatment settings, and thus causal assumptions may be unwarranted. ...
Background:
Dissociation is a serious psychological condition that is characterized as a pathological outcome of trauma-related experience. Thus, dissociation could be expected to develop in survivors of disaster trauma and to be associated with trauma exposure and psychopathology.
Methods:
A sample of 278 disaster-affected Kenyans was assessed 8 to 10 months after the 1998 terrorist bombing of the US Embassy in Nairobi for a study of trauma-related psychopathology and dissociation in the context of personality and culture. Instruments of assessment were the Diagnostic Interview Schedule, the Dissociative Experiences Scale, and the Temperament and Character Inventory.
Results:
Dissociation appeared to represent a largely nonpathological response to the disaster experience that reflected personality variables and a cultural context.
Conclusions:
These findings suggest that dissociation encountered in disaster-exposed groups in this cultural setting does not necessarily represent psychopathology, but attention to dissociative responses might help clinicians identify and provide interventions for individuals experiencing distressing intrusive and hyperarousal symptoms.
