“It’s not like I planned it. I never woke up from some rosy dream and said, “Okay, world, today I’m gonna spaz.” Shannon Celebi
A few years ago a female patient was brought in unresponsive. She was a high school student who had passed out during the second term final examination. According to the teachers, she just saw the examination paper and fainted. First aid was done but there was no response hence the teachers thought it best to bring her to the hospital for further evaluation. Our initial physical assessment was unremarkable. Her vital signs were all within normal ranges and when one tried to assess her pupils she would forcefully shut her eyes. Our immediate conclusion was hysteria. Was it an appropriate diagnosis? I will let you be the judge. After about an hour of observation, she immediately got up. You must be wondering what worked? Well, a cotton wasp laden with chlorhexidine was brought to her nostrils and immediately she got up. This response assured us that she was in good health and hence she was discharged back to school with a prescription for better exam preparations. However, this marked the beginning of her frequent ER visits and it always coincided with the exam period.
The fourth visit prompted the need for a psychiatric consult and after assessment, she was taken in for psychotherapy and commenced treatment. According to her records, she is yet to turn up at the ER again and her final diagnosis was documented as Conversion disorder.
So what is /hysteria?
Hysteria broadly refers to a patient responding disproportionately emotionally to the situation at hand. It was scraped from the DSM and in its place terms like dissociative and somatic disorders were introduced. Dissociative and somatoform disorders have been linked to patients who have experienced or witnessed trauma in some way eg physical, emotional, or sexual abuse (Verywellmind, 2022,Williams et al., 2020)
1. Dissociative disorders are further divided into;
- Dissociative amnesia, which involves forgetting personal information or not being able to recall certain events
- Dissociative fugue, which involves forgetting personal information combined with changing physical locations, sometimes creating a new identity in the process
- Dissociative identity disorder, which involves having two or more distinct personalities, each with no memory of what the other has done
2. Somatic symptom disorders - involves having a significant focus on physical symptoms such as weakness, pain, or shortness of breath. This preoccupation with symptoms results in significant distress and difficulties with normal functioning. This includes:
- Conversion disorder (functional neurological symptom disorder)
- Factitious disorder (Munchausen syndrome imposed on one's self)
- Illness anxiety disorder (formerly hypochondriasis)
How do such patients present? They may present with one or a combination of the following symptoms (Verywellmind, 2022)
- Blindness
- Emotional outbursts
- Hallucinations
- Histrionic behaviour
- Increased suggestibility
- Loss of sensation
- Being in a sort of trance
- Developing amnesia
- Experiencing paralysis
- Fainting or passing out (syncope)
- Having epileptic-like seizures
- Increased pain sensations
- Rigid or spasming muscles
Handling such patients requires patience and an acute sense of awareness of the possibility that there's more than what meets the eye (Levenson., 2023). Their symptoms may be very different from what is stated above. Presently there is an advent of many traumatic events. There are ranging from gender-based violence, civil unrest in different regions, deaths from emerging and emerging diseases, natural disasters etc It is our role to recognize and refer where we can. Often we act as a gateway to the quality of life our patients will get and hence we should choose the best. For most people, it is not a choice for them to present as the above patients. So be kind and keep your biases aside. It doesn't hurt to have several differential diagnoses, remember "there is a crack in everything, that’s how the light gets in." Leonard Cohen.
References
Best Documentary. (1946). Let
there be light. https://youtu.be/lW4E-MxFI_w
Levenson., J. L. (2023). Somatic symptom disorder: Assessment and diagnosis. https://www.uptodate.com/contents/somatic-symptom-disorder-assessment-and-diagnosis
Verywellmind. (2022). What Is Hysteria? https://www.verywellmind.com/what-is-hysteria-2795232#toc-what-is-hysteria
Williams, S.
E., Zahka, N. E., & Kullgren, K. A. (2020). Somatic symptom and related
disorders. Clinical Handbook of
Psychological Consultation in Pediatric Medical Settings, 169-181.
