Conversion symptoms are most characteristic of hysteria. Conversion and dissociative disorders

The original meaning of the concept "" (Freud) reflected the idea that the psychic energy hidden in sexual desire is transformed into a physical symptom, that is, converted. In this understanding, repressed desires acquire symbolic expression through conversion symptoms.

Thus lost mental balance

is restored again with the help of the often observed discrepancy between the mental attitude and the severity of the symptom (the so-called “belle indifference”). With this interpretation, conversion symptoms are considered in close connection with hysteria. However, in recent years, the concept of conversion has been used not only as a psychoanalytic explanatory model, but also as a phenomenological-descriptive one.

Already in the 20s, hysterical symptomatic neurosis

(
conversion
) and
hysterical character
(
hysterical character neurosis
). However, this division can only be considered as a relative gradation or distinction associated with certain emphases, since conversion syndromes develop especially often in hysterical individuals.

Classification of conversion syndromes

In recent years, efforts have been made to further differentiate all symptoms

associated with hysteria. In ICD-10, the term “hysteria” is practically not used “due to its many different meanings.” Instead, the disorders in this category are divided into the following three groups: 1) dissociative and conversion disorders (F 44) (eg, psychogenic amnesia, psychogenic stupor, psychogenic seizures); 2) somatoform disorders (F 45) (for example, multiple somatization disorders, hypochondriacal syndrome, psychogenic autonomic functional disorder, psychogenic pain); 3) histrionic personality disorder (F 60.4); this refers to the classic “hysterical personality.”

Here we describe a number of conversion syndromes

or hysterical disorders occurring in children and adolescents. Since their clinical manifestations are different, individual syndromes will be distinguished from each other when described. But since the etiology and pathogenesis, as well as psychotherapeutic approaches for these types of pathology, are very similar, these aspects will be presented in general for all the described syndromes.

Conversion disorder presents as a loss or deformation of motor or sensory function, indicating physiological problems when in fact no physical problems are found.

Symptoms are the result of a psychological need or psychological conflict. As for the term “conversion” itself, it should be perceived as the cause of pathology, which expresses itself through somatic symptoms, being purely psychological.

A detailed study by science of this phenomenon, previously called hysteria, begins in the 19th century, while previously the disease was perceived as an ordinary simulation.

After the sensational conclusion of J.-M. Charcot everything changed when, after observing patients, he concluded that patients were actually experiencing the symptoms of a certain disease and were not pretending

Pathogenesis

Dissociative states are characterized by a sudden onset and end, and they can only be observed under the influence of hypnosis or specially developed methods of interaction.

The duration of such procedures can change or eliminate completely conversion states. Often considered pathologies can imitate the lack of sensitivity of certain parts of the body, loss of smell, deafness, blindness, and a sharp narrowing of the field of vision. No less typical for such situations are loss of motor functions, paralysis, inability to stand, walk, and loss of voice.

There is a coexistence of sensory disturbances and paralysis, for example, at the same time the patient may lose sensation in the arms and legs, as well as the ability to move them.

Behavioral manifestations of the pathology may be more severe, for example, fainting episodes, seizures similar to epileptics, and coordination problems.

Previously, conversion disorder was also defined as a symptom of pain, but modern psychiatric practice does not recognize this symptom as a symptom of a dissociative seizure. All types of phenomena in question remit after a few months or weeks, especially if the cause of their initial manifestation is a traumatic event in life.

Chronic disorders that develop gradually, characterized by amnesia and paralysis, often associated with disrupted interpersonal relationships and insoluble problems. Resistance of dissociative states in relation to therapy is detected if they manifested themselves for 1-2 years before contacting a specialist.

Conversion disorder (hysteria, hysterical neurosis)

Conversion disorder presents as a loss or deformation of motor or sensory function, indicating physiological problems when in fact no physical problems are found.

Symptoms are the result of a psychological need or psychological conflict. As for the term “conversion” itself, it should be perceived as the cause of pathology, which expresses itself through somatic symptoms, being purely psychological.

A detailed study by science of this phenomenon, previously called hysteria, begins in the 19th century, while previously the disease was perceived as an ordinary simulation.

After the sensational conclusion of J.-M. Charcot everything changed when, after observing patients, he concluded that patients were actually experiencing the symptoms of a certain disease and were not pretending

Then Z. Freud directed his efforts to study this phenomenon, being at that time a young trainee with Charcot.

Pathogenesis

Dissociative states are characterized by a sudden onset and end, and they can only be observed under the influence of hypnosis or specially developed methods of interaction.

The duration of such procedures can change or eliminate completely conversion states. Often considered pathologies can imitate the lack of sensitivity of certain parts of the body, loss of smell, deafness, blindness, and a sharp narrowing of the field of vision. No less typical for such situations are loss of motor functions, paralysis, inability to stand, walk, and loss of voice.

There is a coexistence of sensory disturbances and paralysis, for example, at the same time the patient may lose sensation in the arms and legs, as well as the ability to move them.

Behavioral manifestations of the pathology may be more severe, for example, fainting episodes, seizures similar to epileptics, and coordination problems.

Previously, conversion disorder was also defined as a symptom of pain, but modern psychiatric practice does not recognize this symptom as a symptom of a dissociative seizure. All types of phenomena in question remit after a few months or weeks, especially if the cause of their initial manifestation is a traumatic event in life.

Chronic disorders that develop gradually, characterized by amnesia and paralysis, often associated with disrupted interpersonal relationships and insoluble problems. Resistance of dissociative states in relation to therapy is detected if they manifested themselves for 1-2 years before contacting a specialist.

Types of conversion disorders

Conversion disorders manifest themselves in the following conditions.

1. Balance imbalance is presented as a permanent or short-term inability to control the position of one’s own body in space. Signs include incoordination, swaying, unexpected falls, and unsteady gait.
2. Convulsive seizures also occur, but they should be differentiated from true epilepsy. The duration of attacks can range from a couple of seconds to several minutes, and the reasons for their occurrence can be the following:

• unusual memories;
• violent movements;
• sudden feeling of fear;
• feeling a strange taste or smell;
• tingling or twitching in one or another part of the body.

• Weakness in the limbs is characterized by a decrease in muscle strength in a certain part of the body, in other words, paresis. Paraparesis is weakness in both legs, hemiparesis is weakness of one limb - arm or leg. This category also includes paralysis, the manifestations of which are represented by the loss of the ability to move due to disruption of connections between nerves and muscles or disorders of the nervous system. The frequency of paresis in medical practice is significantly higher than the frequency of paralysis.
• Impaired sensitivity of the limbs - tingling or numbness. The sensations in question are characteristic of the surface of the skin in a certain area and are most often accompanied by tightness, burning or chilliness.
• Amnesia is characterized by the inability to remember names, dates, and current events. With such a symptom, it is important not to forget about the possibility of diagnosing alcoholism, Alzheimer's disease or multiple sclerosis.

Causes

It is generally accepted that the disease affects people with the most unstable emotional state - old people and teenagers. Statistics indicate that this phenomenon occurs much less frequently among men than among women.

The following are two key reasons:

1. First of all, it is necessary to mention the psychological conflict, which helps to increase a person’s demands on others; there is no critical assessment of the situation.
   One’s own personality is also underestimated, and therefore the individual seeks to attract attention to himself on a subconscious level at any cost. Even at the expense of his illness, he wants to be the center of attention.
2. The psychological need to avoid social stress or some kind of psychological conflict can also cause the use of physical illness as a shield.

The reasons under consideration belong to the category of unconscious ones, it is impossible to control them, therefore even the patient himself is completely convinced that he is susceptible to a physical illness. In his opinion, everything is logical - the symptoms being tested perfectly correspond to the real disease

The finding of conversion symptoms is often associated with other psychological conditions.

An example is Briquet syndrome or antisocial personality disorders. The first disorder is considered somatized and manifests itself in the form of constant complaints about certain problems with a pronounced need for psychological support and assistance.

Rarely is an isolated conversion disorder developed by a situation of extreme psychological stress. The stability of conversion symptoms can persist for many years and over time they turn into real physiological pathologies.

As an example, it is worth citing a situation where a patient suffers from hysterical paralysis of a leg or arm, and as a result he experiences contracture of the muscles held by the limb or severe atrophy of the muscles that are not used. However, in most cases, the conversion symptom goes away much faster than the real disease begins to develop.

Types of conversion disorders

Conversion disorders manifest themselves in the following conditions.

1. Balance imbalance is presented as a permanent or short-term inability to control the position of one’s own body in space. Signs include incoordination, swaying, unexpected falls, and unsteady gait.
2. Convulsive seizures also occur, but they should be differentiated from true epilepsy. The duration of attacks can range from a couple of seconds to several minutes, and the reasons for their occurrence can be the following:

• unusual memories;
• violent movements;
• sudden feeling of fear;
• feeling a strange taste or smell;
• tingling or twitching in one or another part of the body.

• Weakness in the limbs is characterized by a decrease in muscle strength in a certain part of the body, in other words, paresis. Paraparesis is weakness in both legs, hemiparesis is weakness of one limb - arm or leg. This category also includes paralysis, the manifestations of which are represented by the loss of the ability to move due to disruption of connections between nerves and muscles or disorders of the nervous system. The frequency of paresis in medical practice is significantly higher than the frequency of paralysis.
• Impaired sensitivity of the limbs - tingling or numbness. The sensations in question are characteristic of the surface of the skin in a certain area and are most often accompanied by tightness, burning or chilliness.
• Amnesia is characterized by the inability to remember names, dates, and current events. With such a symptom, it is important not to forget about the possibility of diagnosing alcoholism, Alzheimer's disease or multiple sclerosis.

Dissociative conversion disorders: clinic

Conversion disorders are among the most severe dissociative disorders. Whether the disease is mild or complex, each patient experiences characteristic manifestations due to:

• an innate tendency to quickly succumb to frustration;
• lack of moral support, both in close and distant surroundings;
• mental and physical violence in childhood;
• the presence in the family of a person with dissociative disorder.

Important: scientists are still debating the influence of a difficult childhood on the development of conversion disorders. Some believe that memorable information from early years of life is quickly erased and cannot influence the child’s psyche for a long time.

A difficult childhood may cause dissociative conversion disorder

Causes

It is generally accepted that the disease affects people with the most unstable emotional state - old people and teenagers. Statistics indicate that this phenomenon occurs much less frequently among men than among women. The following are two key reasons:

1. First of all, it is necessary to mention the psychological conflict, which helps to increase a person’s demands on others; there is no critical assessment of the situation. One’s own personality is also underestimated, and therefore the individual seeks to attract attention to himself on a subconscious level at any cost. Even at the expense of his illness, he wants to be the center of attention.
2. The psychological need to avoid social stress or some kind of psychological conflict can also cause the use of physical illness as a shield.

The reasons under consideration belong to the category of unconscious ones, it is impossible to control them, therefore even the patient himself is completely convinced that he is susceptible to a physical illness. In his opinion, everything is logical - the symptoms being tested perfectly correspond to the real disease

The finding of conversion symptoms is often associated with other psychological conditions.

An example is Briquet syndrome or antisocial personality disorders. The first disorder is considered somatized and manifests itself in the form of constant complaints about certain problems with a pronounced need for psychological support and assistance.

Rarely is an isolated conversion disorder developed by a situation of extreme psychological stress. The stability of conversion symptoms can persist for many years and over time they turn into real physiological pathologies.

As an example, it is worth citing a situation where a patient suffers from hysterical paralysis of a leg or arm, and as a result he experiences contracture of the muscles held by the limb or severe atrophy of the muscles that are not used. However, in most cases, the conversion symptom goes away much faster than the real disease begins to develop.

Hysterical neurosis Dissociative (conversion) disorders – according to ICD-10 – F44

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The term “hysteria” was used in ancient times, when the cause of hysterical manifestations was associated with sexual dysfunction. This term comes from the Greek word hystera - uterus.

Prevalence. Individual hysterical symptoms are observed in almost 1/3 of the population. Up to 15% of patients with such disorders are admitted to general hospitals. Women get sick 2 times more often than men.

Clinic. The clinic of hysterical neurosis is distinguished by a variety of symptoms - mental, neurological, somatic. Persons with hysterical neurosis are characterized by increased suggestibility, vivid and labile emotions. The peculiarity of hysterical disorders is their demonstrative nature, special variability, suddenness of appearance and disappearance. Symptoms of the disease often take on the nature of manipulating others, and when the traumatic situation is resolved, they weaken or completely disappear. These violations are of a protective nature.

In hysterical neurosis, somatic and neurological symptoms are often closely related to the content of mental trauma. Thus, the fear of contracting some disease can cause “symptoms” of this disease in patients. In this regard, hysteria is called the great imitator, the chameleon.

Hysterical neurosis often develops in individuals of the artistic type with signs of mental infantilism, emotional immaturity, impressionability, and spontaneity. In the clinical picture of hysterical neurosis, the following groups of symptoms are observed: affective, autonomic, motor, sensory.

Affective disorders are manifested by extreme lability of emotions, extreme mood instability, and violent emotional reactions. Patients can sob loudly, giving the impression of inconsolable grief, and after a few minutes laugh cheerfully.

Autonomic disorders manifest themselves in the form of a variety of “somatic” symptoms: pain in the heart, palpitations, fainting, nausea, vomiting, abdominal pain, shortness of breath, “attacks” of suffocation, false pregnancy, etc.

Movement disorders during hysteria can be in the form of hyperkinesis or akinesia. Hyperkinesis has the character of tics, tremors of the head and limbs, blepharospasm, glossolabilic spasm, choreoform movements, and convulsive seizures. A hysterical seizure must be differentiated from an epileptic one.

Hysterical hyperkinesis, unlike organic ones, depends on the emotional state of the patients, is accompanied by unusual postures, vegetative symptoms (lump in the throat), they disappear or weaken after the elimination or deactualization of traumatic influences.

Hysterical akinesias occur as mono-, hemi- and paraplegia. Gait disturbances are characteristic: “astasia-abasia,” when patients cannot stand or walk in the absence of organic disorders. Some patients complain of weakness in the arms and legs, which occurs with excitement, when the legs become “wobbly”, “heavy”, “braided”.

Characteristic of hysterical movement disorders are their inconsistency with the topographical location of the nerve trunks or the localization of the focus in the central nervous system, the absence of pathological reflexes, and changes in tendon reflexes.

Recently, aphonia has become rare; patients often complain of stuttering and difficulty pronouncing certain words.

Sensory disorders are represented by a disorder of sensitivity and pain in various organs and parts of the body. Skin sensitivity disorders have different configurations and locations; most often they are localized in the area of ​​the extremities in the form of gloves, stockings, and socks.

It should be noted that due to the widespread popularization of medical knowledge, a pathomorphosis of hysterical manifestations occurred. So, instead of a complete loss of sensitivity, patients complain of numbness in the limbs, a crawling sensation, and a feeling of heat in the limbs. With hysterical neurosis, patients talk about their experiences with pathos, emphasizing their exceptional nature: the pain is “terrible,” “unbearable,” incomparable. At the same time, they are not burdened by these violations, as if they are indifferent to them.

In foreign literature, some hysterical disorders are called dissociative. Dissociation is a state when, for a time, some mental complexes acquire autonomy and control mental processes in isolation from the integrity of mental life. These are transient disturbances in the integration of mental functions. Hysterical disorders of the dissociative type include amnesia (F44.0), fugue (F44.1), stupor (F44.2), trances and states of obsession (F44.3), hysterical psychoses, a description of which will be given in the chapter “reactive psychoses” .

In the clinical sense, the term “conversion” (Latin conversio - transformation, replacement) means a special pathological mechanism that causes the transformation of psychological conflicts into somatoneurological symptoms. These are motor, sensory and autonomic symptoms of hysterical neurosis.

Course of hysterical disorders Hysterical psychogenic reactions are short-term and disappear without treatment. However, long-term (over several years) fixation of painful symptoms is also possible. In some cases, a wave-like course is observed: after hysterical disorders have subsided, there remains a tendency for them to arise in psychologically unfavorable situations. With a protracted course of hysterical disorders, conversion symptoms become fixed, characterological changes worsen, and persistent asthenia, hypochondriacal and dysthymic disorders develop. Underestimation of the clinical significance of the symptoms of hysteria, interpreted as the result of self-hypnosis or aggravation and simulation, can lead to incorrect diagnosis and the prescription of inadequate therapy.

Unlike conversion hysterical symptoms, during malingering, symptoms imitating a disease are under conscious control and can be interrupted by the malingerer at any time. With hysteria, somato-nerological disorders develop according to their clinical patterns, not in accordance with the wishes of the patient.

Obsessive-compulsive disorder

Obsessive-compulsive neuroses are the general name for neuroses manifested by obsessive fears (phobias), obsessive thoughts (obsessions), obsessive actions, and anxiety.

In ICD-10, various manifestations of obsessive-compulsive neurosis are coded with different signs: phobic and anxiety disorders -F 40; agoraphobia – F 40.0 (without panic disorders – F 40.00; with panic disorders – F 40.01); social phobias – F 40.1; specific (isolated) phobias – F 40.2; other anxiety disorders – F 41; obsessive-compulsive disorder – F 42.

In domestic psychiatry, these conditions are traditionally described as a separate form of neurosis, because they are connected by a common etiological factor (mental trauma), symptoms of the disease occur in people with similar personal characteristics, they rarely occur in isolation and are accompanied by autonomic disorders characteristic of all neuroses. Individual manifestations of this neurosis are often found in patients who are treated by general practitioners. Thus, the prevalence of anxiety-phobic disorders reaches 10-20% in the general medical network; in the population they occur in 5% of cases. Obsessive-compulsive disorders occur in 1.5-2% of cases in the population, and in psychiatrists' practice up to 1% of all patients.

The manifestation of symptoms of obsessive-compulsive neurosis is preceded by mental trauma, which determines the content of the leading disorder. Thus, a patient who found herself in a crowd of people when exiting the subway developed unpleasant sensations in her heart and fear that it might stop, and subsequently developed agorophobia.

In the initial stage of the disease, the most common is panic disorder, which determines the onset of the disease. These are unexpected and rapidly growing vegetative disorders (feelings of suffocation, tightness in the chest, dizziness, palpitations, sweating), accompanied by fear of loss of consciousness, madness, and death. This state can last up to 20-30 minutes. Following panic attacks, obsessive fear develops - phobia, the most common phenomena being agoraphobia, social phobia, and hypochondriacal phobias.

Agoraphobia – fear of open spaces, transport, crowds. The violation is provoked by a trip on the subway, being in a store, a crowd, in an elevator, on an airplane, in a theater, cinema, etc. Fear is accompanied by vegetative symptoms (dry mouth, tachycardia, profuse sweat, tremor), thoraco-abdominal symptoms (shortness of breath, suffocation, chest pain, nausea, discomfort in the gastrointestinal tract), mental symptoms (derealization, depersonalization, fear of losing over control). Patients try to avoid situations where they may be left unaccompanied by a loved one in places where it is difficult for them to leave on their own. Some patients do not leave the house, fearing repetitions of attacks of fear; this disrupts their life pattern and social adaptation; sometimes they refuse any activity outside the home.

Social phobias – fear of being the center of attention, embarrassment and shame in the presence of others. Social phobias usually manifest in adolescence and adolescence and are provoked by special situations at school - this is the answer at the blackboard, an exam; the need to perform on stage, as well as the need to communicate with teachers, educators, and people of the opposite sex. Communication with loved ones does not cause fear. Patients are afraid of situations when they need to perform some action in the presence of strangers; a negative assessment of these actions is assumed. They try not to attend parties, they are afraid to talk, eat, write, or use a public toilet in the presence of strangers. Patients fear that others will notice this fear and mock them. At the same time, the attitude towards fear is always critical, but they cannot get rid of it, which leads to low self-esteem. Social phobias are often accompanied by other mental disorders: anxiety, other phobias, affective pathology, alcoholism, eating disorders.

There are two groups of social phobias: isolated and generalized. Isolated social phobias are the fear of not performing usual actions in public and avoidance of specific situations. There are no communication difficulties outside of these situations. One of the forms of isolated social phobia is the fear of blushing, showing awkwardness, and confusion in communication (ereitophobia). Fearing that others will notice this, patients are shy and often embarrassed in public. With generalized social phobias, along with fear, ideas of low value and relationships appear. These disorders most often occur with scoptophobia syndrome - the fear of appearing funny, of revealing one’s inferiority in public. Patients experience a feeling of shame, which is not due to real facts, but determines their behavior (avoiding contact with people).

Hypochondriacal phobias (nosophobia) are an obsessive fear of a serious illness. Cardio-, cancer-, syphilo-, AIDS-, and stroke phobias are most often observed. These patients often turn to various doctors, demanding examination. The efforts of patients are aimed at eliminating the conditions for fear and panic attacks. They develop a set of protective and adaptive measures: moving to an ecologically clean area, changing jobs. Certain hypochondriacal attitudes are formed: limiting contacts, taking a gentle lifestyle, refusing certain types of activities.

Specific (isolated) phobias - phobias are limited to a strictly defined situation: being near some animal, heights, thunderstorms, nausea, dental procedures. Contact with an object of fear causes anxiety, so these patients are characterized by avoidance of phobic situations or objects.

In addition to obsessive fears, with obsessional neurosis, obsessions (obsessive thoughts) and impulses (obsessive actions) are observed.

Obsessive thoughts arise against the will of the patient, are perceived by him as alien, absurd, and he tries to resist them. Obsessions often take the form of doubts, contrasting obsessions, and obsessive fear of contamination.

With obsessive doubts, patients are haunted by thoughts about the correctness of the decisions and actions taken. Patients constantly try to remember whether they closed the door, turned off the gas or electricity, or turned off the water taps. These doubts haunt the patient while performing his official duties: whether he filled out the papers correctly, followed the orders of his boss, wrote down his phone number, etc. This uncertainty forces you to spend a lot of time on revisions. Obsessive slowness is a serious obstacle to any daily activity, stretching out the simplest actions for hours: dressing, eating, shaving. Obsessive counting, repetition, pedantry, increased thoroughness are often observed, various rituals of counting, “good” and “bad” numbers develop. Contrasting obsessions are extremely unpleasant when patients have an irresistible urge to perform an action or utter a phrase that contradicts their own attitudes and generally accepted morality. For example, uttering obscene words, injuring your loved ones and children. These thoughts cause fear of losing control over oneself and possibly committing actions that are dangerous to others and to oneself. Patients ask loved ones to hide knives, forks, and axes. Obsessive thoughts are accompanied by a feeling of alienation, a strong affective intensity; they are alien to the content of thoughts and are combined with obsessive desires and actions. Often patients have obsessive thoughts and fear of pollution - mysophobia. They are afraid of contamination by dust, urine, soil, sewage, as well as the penetration of toxic substances and microorganisms into the body. To avoid this, patients carefully observe personal hygiene: often wash their hands, change their linen, clean the apartment daily, and carefully handle food products. Patients resort to various methods of protection, some rarely leave their apartment, do not even allow relatives to visit them, for fear of contact with dirt or toxic substances. Obsessive doubts are accompanied by frequent checking of one’s actions.

Obsessive actions almost never occur in isolation. They sometimes occur in the form of isolated, monosymptomatic movement disorders, more often - tics. Patients shake their heads, move their arms, and blink their eyes. Depending on the structural features of the obsessive syndrome, categories are distinguished: F42.0 – obsessive thoughts, mental chewing gum; F42.1 – predominantly compulsive actions, obsessive rituals; F42.1 - mixed obsessive thoughts and actions.

Obsession neurosis is chronic. Recovery is rare. In cases of monomorphic manifestations, there may be long-term stabilization, with a gradual reduction of psychopathological symptoms and social readaptation.

The most resistant to therapy are phobias of infection, pollution, sharp objects, contrasting obsessions, and numerous rituals. These patients have frequent relapses of painful manifestations and are at risk of developing residual disorders.

ICD-10 identifies “other anxiety disorders” F41 as a separate group.

Panic disorder (episodic paroxysmal anxiety) – F41.0 Panic attacks occur in the same way as with agoraphobia. The fear of expecting repeated attacks quickly develops, which patients try to hide. Panic attacks often occur spontaneously without connection with dangerous or life-threatening situations. Anxiety appears suddenly, reaches a maximum within a few minutes, and is accompanied by autonomic disorders. If 4 attacks are observed within a month, then this is moderate panic disorder - F41.00, if up to 4 attacks per week, then this is severe panic disorder - F41.01

Generalized anxiety disorder F41.1 Often combined with other neurotic conditions. It is observed in 2-5% of the population, in women 2 times more often than in men.

Clinically, the disorder is manifested by persistent anxiety, often meaningless, accompanied by a feeling of internal tension and vegetative symptoms, the intensity of which is less than in panic disorder. Patients experience internal trembling, they are fearful, and in all matters they anticipate the worst outcome. Patients are impatient, irritable, and fussy. They usually do not regard painful symptoms as mental, so they rarely turn to a psychiatrist; most of them seek help from internists.

Mixed anxiety and depressive disorder F41.2. Conditions in which the depressive and anxiety components are not sufficiently expressed and none of them dominates the other. These disorders are accompanied by autonomic disorders and occur in psychogenic situations.

Neurotic depression

At the beginning of the 20th century, neurotic depression was first described as an independent nosological form. In ICD-10, these disorders are qualified as a prolonged depressive reaction, manifested by mild neurotic depressive disorders in response to a prolonged stressful situation - F 43.21.

In the domestic psychiatric literature, some authors consider neurotic depression as an independent form of neurosis, others - as disorders that accompany other neuroses.

Neurotic depression develops more often in individuals with rigidity, uncompromisingness, who try not to show their emotions outwardly, but experience troubles “in themselves.” The cause of this neurosis is usually a long-term, unresolved unfavorable situation, such as an incurable illness of a child, separation from loved ones, or the inability to share one’s experiences with someone. Patients try to suppress negative emotions within themselves and do not show them to others.

At the onset of the disease, vegetative-dystonic symptoms appear: sleep disturbances, headache, pain in the heart. Subsequently (after a few weeks) asthenia appears with decreased mood and anxiety. Patients say that they have lost the joy of life and at the same time they do not assess their future as unpromising, they make plans for the future as if not taking into account the unresolved traumatic situation. Patients often try to drown out mental pain by being more active in performing professional and household duties, despite weakness and fatigue. Some patients become tearful for any reason. With a long course of depressive neurosis, a previously unusual volubility appears in patients, when they begin to “pour out their souls” even to unfamiliar people, talk about their experiences and troubles.

One of the features of this neurosis is that traumatic situations usually do not affect the experiences of patients; they, as a rule, do not associate their condition with it. As with other neuroses, the clinical picture of neurotic depression shows a significant severity of somato-vegetative disorders: fluctuations in blood pressure, gastrointestinal dysfunction, sleep disturbances in the form of difficulty falling asleep and waking up in the early morning hours with a feeling of anxiety and palpitations. Patients often turn to therapists for help, who either treat them symptomatically or diagnose some kind of somatic disease. It should be noted that despite the abundance of somatic complaints in patients, there is no hypochondriacal fixation on them. Neurotic depression occurs in waves and is often a stage of neurotic personality development.

Neuroses in children

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Risk group

Among adolescents and women, the largest number of cases with the disease in question was identified. Among the most relevant factors are the following:

Symptoms of the disorder

Previously, symptoms were represented exclusively by mental disorders, seizures, paralysis of varying severity and fainting, but with the help of subsequent studies it was possible to prove that there are no boundaries in this matter and manifestations can affect any human system or organ.

As a result, all symptoms are divided into four groups:

1. Motor symptoms, represented by the absence or impairment of motor function. Manifestations include pseudoparalysis, gait disturbances and much more. In the presence of other people, seizures often and suddenly occur, and they also disappear suddenly under the influence of some irritant. This could be the appearance of a new person or a loud sound. Seizures may include unnatural bending, rolling on the floor, screaming, or falling.
2. The second group includes sensory symptoms, represented by the absence or impairment of sensitivity to temperature or pain. Impaired sense of smell, taste, as well as blindness and deafness are the most pronounced symptoms. The range of sensations and duration may vary.
3. The third group is represented by autonomic symptoms, which involve the patient feeling spasms of blood vessels or smooth muscles of internal organs. In this case, imitation of almost any disease is possible.
4. Mental symptoms represent the fourth group. These may be lapses in memory, expressed by imaginary amnesia, hallucinations, delusions or harmless fantasies.

Diagnosis of the disease

Obtaining the most reliable diagnosis requires the following conditions:

• psychogenic conditioning must presuppose a clear connection between relationship disturbances, problems or stressful events over time, even if the patient denies the presence of such;
• there must be no neurological or physical impairment associated in any way with the identified symptoms;
• Clinical features should be outlined for individual disorders.

Problems that may be encountered during diagnosis:

1. Since the symptoms of a particular disease really exist, the initial stage of development of the pathology in question is quite difficult to detect. The doctor will not be able to completely exclude the present disease, so the only solution to the problem will be long-term observation, clinical studies and numerous tests.
2. The unconsciousness of symptoms characteristic of conversion disorder makes it difficult to differentiate them from intentional ones, that is, a person can deliberately pass them off as real. If the patient truly has conversion disorder, he may consciously exaggerate the significance of his unconscious symptoms.
3. Diagnosis can be complicated by the stereotype that a person in modern society does not have seizures and other obvious motor symptoms and is considered an anachronism. In any case, determining the disease requires careful and long-term observation and numerous examinations.

Treatment

As with any other psychological illness, treatment for conversion disorder must be as careful and carefully planned as possible. If the patient is told that all his symptoms are fiction, there is a high risk of worsening the situation.

Modern medicine recognizes complex treatment of dissociative seizures, which involves pharmacotherapy and psychotherapy.

These directions are equal in importance and are aimed at eliminating symptoms. Their character is rather pathogenetic, but clearly not etiotropic. The time factor can also have a therapeutic effect and drug improvement can contribute to stable remission.

1. Psychotherapy in this particular case should be aimed at correctly determining the situation in which the patient finds himself. This is done in order to quietly and carefully eliminate the factors that provoke the disease. It is equally important to determine the benefit that the patient receives from the disorder. Yes, hypnosis is considered to be the most effective.
2. Drug treatment is most important in severe cases of remission or relapses. Among the popular psychopharmacological agents are tranquilizers, neuroleptics, thymoleptics, nootropic drugs, as well as psychostimulants and antidepressants.

The main role in successful treatment is played by timely initiation, since the longer the disorder lasts, the more rapidly the chances of recovery decrease.

Conversion disorders (synonyms: dissociative conversion disorders, dissociative disorders) are one of the groups that combine mental disorders of the patient’s personality, against the background of disturbances of consciousness, memory and a sense of self-identification.

In some dissociative disorders (or multiple personality), there is a complete replacement of a person’s real personality with a new one, in others there is a partial replacement or loss of some memories associated with real life (psychogenic amnesia).

Dissociation is a phenomenon proposed in the 19th century by the famous French psychiatrist of that time, P. Janet, who determined the possibility of some ideas existing separately from human consciousness, memory and behavior.

In modern psychotherapy, conversion disorders are the four main dissociative deviations of a person, which until 2004 were considered a single pathological condition:

• multiple personality;
• dissociative fugue;
• psychogenic amnesia;
• depersonalization.

The unifying factor for all conversion disorders is etiological causation. Dissociation, in essence, is a protective-adaptive reaction to an individual’s aggressive state of the environment or serious psychological trauma he has previously received - physical or emotional violence, sexual bullying. The human psyche tries to remove obsessive, persistent, traumatic memories of the past from consciousness or prevent the harmful effects of the present, creating the fiction of an alternative personality that has not gone through or is not going through difficult emotional experiences.

Conversion disorders should never be put on a par with schizophrenic disorders.

Treatment of conversion disorders is also identical for all manifestations and boils down mainly to symptomatic treatment and psychological support, except in cases where the patient is capable of causing harm to himself or others.

Psychodynamic therapy, aimed at the patient’s emotional overcoming of psychological discomfort that forces personality dissociation, comes to the fore in psychotherapeutic assistance.

Conversion disorder in psychiatry: main symptoms, methods of treating the disease

Personality disorder
21.11.2017

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6 min.

Conversion disorder is a psychogenic disease that occurs mainly due to internal psychological conflicts.

Dissociative disorder can be treated if you consult a psychiatrist with complaints in a timely manner. Therapy uses medications, the help of a psychotherapist and a psychologist.

Complex treatment helps get rid of the disease, and maintenance therapy prevents relapses.

Conversion (dissociative) disorder is a psychogenic disease in which a person loses or partially disrupts sensory or motor function.

Because of this, the patient begins to experience some physiological disturbances.

This disease is more typical for women and for people of adolescence and adolescence, because it is their emotional sphere that is vulnerable and unstable.

Patients with this disease are people with low socioeconomic status and educational level.

According to statistics, in developing countries the prevalence of conversion disorders reaches 30%.

The main cause of conversion disorder is an internal psychological conflict, in which the patient begins to be biased towards people around him and makes excessive demands.

The reasons for the emergence and development of this illness include the desire to escape from internal or external conflict.

In this way, the body builds a protective reaction in the form of illness to avoid stressful situations. There may be an unconscious desire to obtain some benefit from the disease.

Other factors that influence the onset and progression of conversion disorder include:

• physical or sexual abuse, especially in children;
• economic difficulties, low socio-economic status;
• presence of family members with conversion disorder or chronic diseases (hereditary predisposition);
• presence of mental disorders (depression, anxiety and panic disorder);
• individual psychological characteristics of the personality.

Conversion symptoms include partial or complete amnesia for important past events and lack of control of body movements. The beginning and end of hysterical attacks are sudden. This syndrome manifests itself in the fact that its symptoms can fade away after some time if their appearance was associated with a traumatic event.

The diagnosis of “conversion disorder” is established in psychiatry in the presence of the main symptoms:

• amnesia;
• fugue;
• stupor;
• convulsions;
• disturbances of motor skills and sensations.

Memory loss is not caused by organic brain disorders (somatic diseases) and is too severe to be a cause of fatigue. Patients cannot remember and tell long moments from their lives. Sometimes they deny that they know anything about their life before. This type of violation manifests itself in several forms:

1. 1. Localized form of amnesia - forgetting short-term events (from several hours to several days).
2. 2. The generalized form of amnesia is manifested by memory loss for the entire period of the illness.
3. 3. Selective form - forgetting some events that are significant for the individual. The continuous type of amnesia is characterized by forgetting every event in the patient's life.

This is a disorder in which the patient, under the influence of stressful situations, abruptly moves from his previous and usual place of residence, while completely losing memories of his own personality. The fugue period is amnesic, i.e.

Memories of this period of life are forgotten by the patient. This condition lasts from several hours to several months (in some cases, years).

In this state, patients maintain personal hygiene rules and interact with society.

Dissociative fugue begins suddenly, usually after sleep at night. After waking up, the patient begins to prepare for departure and leaves. The return to the old personality occurs suddenly, usually after sleep. At the same time, anxiety is noted.

The patient becomes aware of his former personality. There is disorientation in space. With prolonged fugues, there is a gradual return to the previous personality. With short fugues, no radical changes occur.

This is a movement disorder that is characterized by decreased/absent voluntary movements. There is a disturbance in reactions to noise, light and touch. The patient lies and sits motionless for a long time.

This disorder is characterized by mutism - lack of speech. There is a narrowing of consciousness. Patients do not answer questions addressed to them or respond with a delay. This disorder is diagnosed in the absence of somatic and neurological symptoms and the presence of psychotrauma.

They are characterized by the presence of limb spasms. The difference from epileptic seizures is that there is no tongue biting and the patient does not suddenly fall to the floor. There is no loss of consciousness. When the doctor tries to open his eyes, the patient experiences resistance.

The duration of the attack ranges from several minutes to several hours. In such patients, tonic and clonic phases are not observed. The patient may arch, bang his arms or head on the floor, or bite or scratch himself. The reaction to light is preserved.

Seizures occur in the presence of other people and develop while paying attention to the patient. When you lose interest in it, the attacks disappear. In some cases, fainting, tears or laughter occur. In children, pseudo-seizures occur as a reaction to protest when adults refuse to comply with their demands.

These are disturbances of sensation or movement that occur in the absence of any physical symptom.

Movement disorders manifest themselves in the form of paresis (decreased muscle strength with limited range of voluntary movements), paralysis (complete inability to perform movements), trembling of the limbs.

There is a lack of coordination of movements (ataxia), loss of sonority of the voice while still speaking in a whisper (aphonia).

In such patients, speech impairment occurs due to limited mobility of the organs of the speech apparatus: soft palate, lips and tongue (dysarthria), sudden voluntary movements of various muscle groups (dyskinesia). There is a violation of the ability to sit and walk (astasia-abasia), involuntary contraction of the circular muscles of the eye (blepharospasm). Sometimes hysterical blindness, hysterical pain, tics and head tremors occur.

Conversion disorders must be distinguished from somatic diseases that have similar symptoms. Hysterical disorder must be distinguished from organic diseases. First, the exact form of symptoms and signs must be determined and carefully compared with those that occur with tumors and brain injuries.

It is necessary to distinguish hysterical seizures from seizures due to epilepsy. People with a hysterical personality type have similar symptoms. When reacting to stress, these people are prone to demonstrative reactions. They love to be paid attention to.

It is necessary to distinguish conversion disorders from malingering.

Malingering methods are especially common among prisoners, military personnel, military conscripts, and individuals who may deliberately feign illness in order to avoid negative consequences or in order to obtain monetary compensation.

The age of the patient and the cause of the pathology should be taken into account. Conversion disorder rarely occurs at age 40. Therefore, differentiation must be carried out, knowing the age limits at which this pathology occurs.

Treatment of hysteria is carried out on an outpatient basis. Conversion disorder must be treated with medication and psychotherapy. Only comprehensive treatment can get rid of this disease. Treatment with medications affects the manifestation of symptoms.

Drug treatment includes the use of antipsychotics, tranquilizers, antidepressants, psychostimulants and nootropic drugs.

The most widely used are antidepressants and tranquilizers. The type of drugs and their dosage depends on the symptoms and their severity, and the individual characteristics of the patient.

If outpatient treatment does not produce results, then he is hospitalized in a hospital.

At the same time as taking medications, it is necessary to undergo psychotherapeutic treatment. The psychotherapist helps the patient identify and eliminate the cause of the disease. The main direction of psychotherapy in this case is the psychodynamic approach.

This type of treatment is used with both adults, children and adolescents. In some cases, hypnosis is used. Family psychotherapy is used in cases where the cause of the disease is family problems.

Treatment of conversion disorder in children does not require medications. To get rid of this disease, it is recommended that parents change their style of behavior towards the child and methods of education. If this method does not help cure conversion disorder, then you need to seek help from a psychologist or psychotherapist.

Source: https://neurofob.com/mental-behavioural/personality-disorder/konversionnoe-rasstrojstvo.html

Multiple personality

More often, this diagnosis can be heard under the name “split personality” or “”. Any of these definitions very eloquently emphasizes the main symptoms of this conversion disorder - in the body of one person two or more personalities can simultaneously exist, who can speak different languages, be of different gender, age, intelligence, temperament and belong to different religious denominations. Split personality disorder is the only one of the set of conversion disorders that occurs in a chronic form for many years.

The change of personalities occurs alternately, spontaneously and unpredictably, with one personality remembering nothing about the activities of the previous one.

Most specialists in the field of psychiatry do not consider the formulation of the diagnosis “dissociative identity disorder” to be correct, because in fact there is no other, or third, or fifth real personality in the patient - there is only one real personality, and everything else is only a psychological disorder. However, for lack of a better definition, the manifestation of “other persons in the patient’s body” is conventionally considered “persons.”

A diagnosis of dissociative identity disorder is only made if:

• the patient exhibits two or more different personal states, when each of them has a stable perception of the world around them, and also has its own worldview;
• control over cognitive and biological states is alternately captured by two or more personal states;
• being in a state of actual personality, the patient experiences amnestic phenomena about other identities;
• the disorder did not arise under the influence of psychotropic substances, chronic alcoholism, drugs, and is not a simulation or fantasies of the patient.

In dissociative identity disorder, a core, actual identity is necessarily present.

The number of “other” personal states tends to steadily increase during the course of the disease - in a few years their number can increase from 2 to 12; science knows of cases when a patient has been identified with more than a hundred different identities.

Dissociative fugue

Dissociative fugue, or “flight from oneself,” is characterized by a short-lived, non-repeating dissociative phenomenon in which consciousness, for a period of several hours to several days, loses its basic identity, “switching” the patient’s state to another personal state.

The transition of personal states from one to another occurs without any visible reasons that could have their effect immediately before the onset of the disorder. Most often, the change of identities occurs after a night's sleep.

The patient does not experience any external manifestations of the disorder - changes occur at such a deep level of the subconscious that the person does not even suspect that he is currently in some other personal state.

A characteristic and distinguishing feature of a dissociative fugue is a person’s irresistible desire to change his location. This happens absolutely consciously, without haste or emotional confusion. How a person learns about his destination remains a mystery that no specialist can solve at the moment. But it is known for certain that there is always a specific city and a specific address, and also a clearly defined algorithm of actions.

The moment of return of the basic personality also occurs unpredictably - at the moment of awakening. In this situation, a person is in a state of deep confusion about the meaning of his presence in an unfamiliar place, and his last memory will be the evening on the eve of the fugitive manifestation.

Psychogenic amnesia

Psychogenic amnesia is perhaps the easiest and safest dissociative identity disorder for human life and health, which is much more common than other disorders and is characterized by memory loss for certain blocks of information that have a traumatic effect on the patient’s psycho-emotional state.

The amnestic range can vary greatly - from individual events to entire time periods - years or decades, cases of complete amnesia are much less common.

One of the characteristic symptoms of psychogenic amnesia is the patient’s loss of orientation in time and space - a person can wander in circles in different directions without any purpose.

Unlike other conversion disorders, psychogenic amnesia is characterized by the absence of an alternative personality. Like dissociative fugue, the disorder disappears suddenly and without consequences.

Hysteria, dissociative disorder - what is it?

This mental pathology has been known to people since the times of Ancient Greece.

Hysteria (hysterical neurosis, conversion or dissociative disorder according to the modern classification of ICD 10) is a personality disorder that is characterized by the patient’s pronounced demonstrativeness, his increased need for self-attention, inflated self-esteem, egocentrism, as well as a variety of conversion symptoms that arise when a given personality is decompensated .

Netrusova Svetlana Grigorievna – candidate of medical sciences, associate professor, psychiatrist of the highest category, psychotherapist. You can watch other videos on this topic on our YouTube channel.

History of the study of hysteria (dissociative disorder)

The word "hysteria" comes from the term "hystera" (Greek for "uterus"). In Ancient Greece, they were confident in the possibility of this disease occurring only in representatives of the “fair sex” and its connection with disruption of the woman’s uterus.

They believed that “an unsatisfied uterus walks throughout the patient’s body, compressing both itself and other organs and vessels,” and this in turn leads to various disorders in the body. It was believed that where the uterus “stopped”, a “symptom” would arise in that part of the body or organ.

Today it has been proven that the occurrence of hysteria has nothing to do with gender, however, it manifests itself much less frequently in men than in women. These features are associated with higher emotional lability of women.

Hysteria (dissociative disorder) – a good actress

Hysteria is characterized by extremely diverse symptoms. Obviously, this is why she was nicknamed “the pretender,” because she can take the form of almost all somatic diseases, and is capable of manifesting bodily symptoms in the absence of real disorders.

Quite often, it disguises itself as an unknown disease that does not respond to conventional medical therapy. Almost any behavior of a hysteric is focused on the public - in its absence, all emotional manifestations simply do not make sense. Such people care about the impression they make.

They want to be loved, admired, and want to attract everyone's attention.

Hysterical neurosis or conversion, dissociative disorder according to the modern classification (ICD 10) is accompanied by rather unusual symptoms that convert mental stress into somatic (bodily) symptoms. These conversion symptoms often appear during psychological trauma and are considered as personality decompensation.

These symptoms include: disorders of sensitivity, vision, hearing, voice, movement disorders, somatic (bodily) disorders. A person with hysterical neurosis wants to be considered unhealthy. Her need for illness is so actualized that one can even talk about addiction.

Organic disease, naturally, is excluded with these symptoms.

The mechanism for the formation of hysterical (conversion, dissociative) symptoms is as follows: various unpleasant psychological disturbances, thanks to a protective mechanism called “repression,” are transformed into disorders used by the patient (often unconsciously) to attract the attention of people around. As a result, the painful state acquires the character of not only pleasant, but even desirable for the patient. This makes the treatment process more difficult.

Netrusova Svetlana Grigorievna – candidate of medical sciences, associate professor, psychiatrist of the highest category, psychotherapist. You can watch other videos on this topic on our YouTube channel.

Decompensation of hysteria (dissociative personality) in the form of conversion symptoms

A major hysterical attack can be called a kind of “performance”, which consists of several “acts” (phases). Sometimes hospital staff can see the induced conditions of patients who are in the same room.

The seizure of one patient is “picked up” by other patients in the ward, and each at the same time shows his “best sides”.

During such seizures, a person may perform a variety of chaotic movements with his hands, or, on the contrary, may be in an immobilized state for some time. Sometimes there are attacks of hysterical hibernation (lethargic attacks), repeated several times a day.

In this condition, it is not possible to wake up a person using the usual methods. With a long duration of such states, they are classified as hysterical stupor.

It is necessary to distinguish between hysterical seizures and grand mal seizures in epilepsy. During an epileptic attack, a person has no need for an audience (“spectators”) and there is a disturbance of consciousness (coma), which is not observed in hysterics.

The state of coma can be detected by such signs, in particular, as suppression of reflexes, dilation of the pupils, lack of their reaction to light, absence of corneal reflexes (there is no blinking when touching the cornea of ​​the eye), abdominal reflexes.

After a seizure, patients with epilepsy experience amnesia, when they do not remember what happened. This cannot be said about patients with hysteria who are in excellent condition after a seizure.

Conversion manifestations

Movement disorders can appear in the form of conversion symptoms : paralysis, paresis, hyperkinesis, etc. Such “lesions” usually affect the limbs. It is curious that in such cases the legs are affected more often (astasia - inability to stand, abasia - inability to walk) than the arms.

This is due to the fact that people use their hands to eat and serve themselves. Also, in people with conversion, dissociative disorder (hysterical neurosis), the muscles of the face, neck or tongue are quite rarely affected (as opposed to true paralysis).

This fact is also not surprising, since hysterics without the above body parts simply will not be able to “perform performances.” The patient can sometimes take truly bizarre poses that are absolutely uncharacteristic of people with organic lesions.

With true paralysis, there is extinction of reflexes and a significant decrease in muscle tone, but in the course of conversion, dissociative (hysterical) disorders this is not the case. All reflexes are preserved, and muscle tone is normal.

Another type of conversion is sensitivity disorders , manifested by changes in the pain threshold and hysterical pain (algia).

But the distribution of areas of disturbance does not at all correspond to those areas that are innervated by sensory nerves, but corresponds only to the patient’s subjective ideas about how functions are distributed.

If the patient learns which areas should be innervated in the “correct way,” the existing areas of sensitivity loss change their location. Algia during hysteria can be of different nature, origin and localization.

Often pain appears in places where the patient previously had some kind of injury or damage. Algia of hysterical (conversion) genesis is quite difficult to distinguish from physical pain. Doctors use a special method in this case using a placebo.

If, when taking an analgesic without the knowledge of the patient, physical pain becomes less pronounced, then hysterical pain does not disappear with pharmacotherapy. But if the patient is convinced that the pain is reduced as a result of the action of some “medicinal agent,” drinking even ordinary water alleviates the condition. This is a characteristic feature of psychogenic pain, allowing the doctor to distinguish it from physical pain.

Often, patients with hysteria (dissociative disorder) suffer from conversion disorders of internal organs .

For example, there is a spasm of the esophageal muscles, reminiscent of a “lump in the throat” sensation, difficulty moving food through the esophagus, hysterical vomiting, cases of pseudoappendicitis, shortness of breath and bloating, the so-called.

bronchial asthma with pseudoasthmatic attacks, hysterical angina, pseudoinfarction, tachycardia and cardiovascular disorders.

The mentioned pseudo-manifestations are distinguished from real diseases by the fact that they are based on a mechanism of benefit or conditional pleasantness for the patient, often subconscious. Such disorders are beneficial to the patient (for example, they can save him from being in an unpleasant situation, give him the opportunity not to work, create a certain “position” at home among relatives).

With hysterical conversion visual disorders, the so-called narrowing of visual fields . Such a disorder does not in any way impair orientation in space and terrain.

When hysterical blindness of one eye occurs, binocular vision remains unchanged - patients in such cases make excellent use of their “unseeing” eye.

In the case of complete hysterical blindness of both eyes, patients are completely confident in their own complete inability to see, but during examination there is no pathology of the visual analyzer.

Manifestations of hysterical deafness are more common.

Usually, with hysterical deafness, a decrease or complete absence of sensitivity of the ears themselves is manifested, which in itself is not possible.

In other words, hysterical (conversion) deafness is selective in nature, therefore all information relating to the patient’s personality is perfectly perceived.

Complete mutism ( loss of sonority of the voice ) is also a common occurrence among hysterics. Speaking about muteness, which is based on a pronounced spasm of the ligaments, it is important to note that the cough in patients is sonorous, which is not typical for a cough with organic muteness.

Hysterical disorder can often be accompanied by a variety of short-term mental disorders , with strong affective overtones and theatricality. Often, such mental disorders are a reflection of an exciting event or topic for a person.

This kind of disorder often manifests itself in the form of amnesia , which is also selective or conditionally beneficial. Hysterical amnesia can cover a time period tightly associated by the patient with an unpleasant event in his life.

When amnesia is no longer relevant and no longer beneficial, the “lost memory” returns. Sometimes hysterics seem to act out scenes and, in the course of them, express delusional ideas and experience vivid scene-like hallucinations.

Due to various self-induced ideas, some individuals are susceptible to attacks of hysterical glossolalia (involuntary speech in a non-existent language).

Speaking about twilight states of consciousness in hysteria, it is worth mentioning qualitative differences with similar ones in epilepsy and organic disorders. Hysterical (dissociative) “twilight” is characterized by theatricality and pretense.

If during the “performance” patients are asked something, they may well give an answer, albeit stupidly, but still on the topic of the question asked. With other organic or mental disorders, the answer is given completely out of place and in itself is quite absurd.

Hysteria can take on a wide variety of masks, and it can last from several hours to several years (provided the individual is in traumatic circumstances all this time).

When the influence of former triggers is suspended or completely stopped, we can talk about the elimination of factors that threaten the well-being of the patient, and the reality of getting rid of conversion symptoms.

Sometimes getting rid of dissociative symptoms occurs in a state of passion.

An integrated approach is required in the treatment of hysteria

In the treatment of hysterical neurosis (conversion or dissociative disorder), psychotherapy (individual, group) and occupational therapy play a more significant role. Therapy is often supplemented with medications (tranquilizers, small doses of sedative neuroleptics) or symptomatic therapy is carried out for increased anxiety, depression, panic attacks, and phobias.

Psychocorrection may reveal childhood psychological trauma, or “overprotection syndrome.” In adult life, decompensation of dissociative (conversion) disorder occurs after or against the background of a traumatic situation, frequent conflicts, dissatisfaction with any area of ​​one’s life (primarily personal), social maladaptation, and lack of fulfillment in something.

A timely visit to a specialist will help to quickly cope with psychotrauma in these patients, and this will lead to improvement (compensation) of the mental state, and will also establish harmonious relationships with others. Therefore, if you or your loved ones experience the symptoms described above, do not delay going to the doctor, but solve psychological problems as soon as possible and enjoy life!

Source: https://psyhosoma.com/isteriya-dissociativnoe-rasstrojstvo-chto-eto/