Hysteria is a common problem which a physician confronts very frequently in his day to day practice. Symptoms are represented by the patient for the sake of getting some attention or advantage and he/she is fully aware of it. A hysterical reaction is an unconscious effort on the part of the sufferer to draw attention towards him/her.
Hysteria is most psychogenic of all illnesses and its recognition is doubly important since before labeling a patient as hysteric, genuine illness must be excluded and an adequate motivating factor be recognized.
A number of factors have been incriminated to explain why some people show hysteria features. Heredity is an important factor. There is higher incidence of hysteria in family members of those who suffer from mental ailments. There is probably a combination of heredity and environment which may be operative.
Hysterical personality is a split personality where certain psycho physiological elements get separated from the conscious life. Most sufferers almost unwittingly manufacture situation according to their needs and make a scene. Some use illness or well acted fantasies to satisfy their hardly conscious needs.
A hysteria or hysterical personality suffers from features of mental dissociation. If due attention is paid to the behavior of a young girl at adolescence one would be able to appreciate abnormal behavior with unusual fantasies.
The precipitating factor for the onset of symptoms is usually a emotionally changed situation where patients symptoms will bring him/her more or less overt gain which a person may not acknowledge.
This may be done to gain attention in the family in case of young married girls, to claim for pension or compensation. They flourish in such situations.
They are bizarre and do not fit into any specific pattern. The precise nature is determined by suggestion which operates through the patient’s acceptance on irrational grounds of the idea that he/she is suffering from certain symptoms.
The purposive character of the hysterical symptoms is relevant as these may express unconscious solution of a mental conflict. The individual suffering from hysteria is confronted with a mental difficulty which is a conflict between two opposing wishes.
They are like those any conceivable affection of which the patient has a notion.
The perceptional symptoms of hysteria include globes hysterics, blindness and deafness. Hysterical blindness may be unilateral or bilateral and may be complete. It comes suddenly. There are no physical abnormalities in eyes. Optic discs are normal and papillary reactions are normal.
Motor symptoms are in the form of paralysis, paresis, spasms and tremors. Hysterical paralysis may affect any part of the body. It does not affect muscles but always movements. If the limb is flaccid there is no loss of tone or reflex responses.
While performing passive movements to overcome any spasticity, he/she moves the antagonistic muscles as well as the prime muscles. Patient often gives wrong impression about the paralysis of limbs and keeps his/her paretic limbs stiff.
Sensory loss does not fit any segmental loss. Very often the patient complains of complete sensory loss of one half of the body.
Hysterical fists occur commonly in young girls. There may be little more than a fainting attack. There is often a dramatic performance appropriately staged to draw attention. These fits do not occur when the person is alone.
The patient falls on the ground in such a manner that he/she does not injure himself / herself. There is no biting of tongue or voiding of urine in clothes as happens in a true epileptic fit. Many bring out the attack by over breathing. Crying out often occurs; Fits are well coordinated and purposive.
Other symptoms of a hysteria include excessive air swallowing, loud belching, Hysterical vomiting palpitations, Tachycardia etc. Hysterical hyperpnoea may follow sudden fright. Sexual disturbances (impotence in men, vaginismus in women) are of common occurrence. Some may go to great lengths to perpetuate their imaginary illnesses. Suicidal attempts are threatened but not executed.
The bizarre presentation of various physical signs should make one suspicious of the diagnosis. Before one considers hysteria, organic ailments must be excluded by proper investigations.
Diagnosis can be arrived at by observing the patient unawares and seeing if the symptoms persist.
Patient of Hysteria must be treated sympathetically. Due attention should be paid to the social and family history of the patient. It is essential that the cause of conflict should be discovered. The whole aim of treatment is aimed at making the patient return to ordinary conditions of life as soon as possible. Auto suggestion, hypnosis and psychotherapy should be employed.
Generally no drugs are required but some sedatives or anti anxiety drugs (Diazepam / Aiprazolam) in small does are helpful.
A case of hysteria requires sympathy and not derision.