HYSTERIA [Conversion Disorder, Dissociative Disorder]

In this disorder the patient's mental conflicts are expressed UNCONSCIOUSLY by converting the Mental stress into a Physical Disorder or Dissociating their Conscious from their Unconscious mind. It begins in Adolescence or Early Adulthood and is more common in Women than Men.

SIGNS and SYMPTOMS

A. CONVERSION SYMPTOMS 

Can present as any organic disease and will depend on the level of knowledge of the individual. Blindness. Deafness, Paralysis, Convulsions or the Inability to Feel Pain may all be presenting symptoms. 

B. DISSOCIATIVE SYMPTOMS

Amnesia is the commonest presenting symptom. In its severest form it presents as a FUGUE STATE where the individual loses ALL memory about himself and past life. He may wander off and make a new life for himself even to the extent of getting married and having children. Years later he may suddenly recover his memory for his past life and have total amnesia for the Fugue Period. The signs and symptoms produce a PRIMERY and SECONDARY GAIN. The Primary Gain is the relief from Stress and Tension: The Secondary Gain is the sympathy and help they receive for their illness.

TREATMENT

Physical causes for the presenting symptoms must be excluded before the disorder is classified as a psychiatric illness.

The nurse's observation may be very important in determining whether any Physical Conversion sign is part of a physical or mental illness. For example if the patient has Fits is it a true fit or not.

Remember that the patient is Not Aware that their Conversion signs and symptoms are caused by a psychiatric disorder. They need sympathy and help it does no good to tell them to "Stop Acting, and Grow up". These symptoms will disappear under Hypnosis or in Narco analysis, but it is dangerous to remove the symptoms with out dealing with the underlying cause. Cases have occurred where "Stage Hypnotists" have "Cured" patients of paralysis and the individual has walked out of the theater and killed themselves.

These patients need strong support from the nurses in order to gain Insight and develop other Coping Mechanisms.