Can I be an histeric?
“Çocukluğumuzdan beri keyifle izlediğimiz eski Türk filmlerinde başrol oyuncusunun aniden kör olup ve sonra bir anda görmeye başladığı, hepimizin zihinlerinde yer eden, çoğu zaman gülümsememize yol açan sahnelere sıkça rastlamışızdır. Peki gerçekten böyle bir olayın günlük hayatta da yaşanması mümkün müdür?”
Evet! Halk dilinde “Histeri” olarak bilinen psikiyatride ise “Konversiyon Bozukluğu” olarak adlandırdığımız bu olguya sıkça rastlanmaktadır. Genel olarak “Somatoform Bozukluklar” arasında yer alan Konversiyon Bozukluğu, altta yatan organik bir neden bulunmaksızın aniden meydana gelen, duyu ve görüş kaybı, bayılma veya felç olma gibi nörolojik belirtilerdir.
Somatoform Bozukluklar, bedensel belirtilerle ortaya çıkan ruhsal bozukluklardır. Beyinle beden arasındaki ilişki açık değildir ve beyinde meydana gelen bazı sorunlar bedensel hastalıklar olarak ifade edilmektedir. Bu grupta yer alan hastalarda ön planda olan bedensel belirti ve yakınmaların organik olarak teşhis edilebilen bir nedeni yoktur. Ancak, hastalar:
• Bedensel ağrılardan, yanmalardan, bulantılardan, adet ağrılarından (Somatizasyon Bozukluğu),
• Bir kısım beden bölgesinin şekil bozukluğundan (Vücut Dismorfik Bozukluğu),
• Uyuşma, hissizlik ve fe
Everyone remembers the scenes from old movies where the lead actor suddenly becomes blindbut can later see again. Is it possible to experience this in normal life?
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Yes! The phenomenon is known as "hysteria" in colloquialism and as "Conversion Disorder" in psychiatry and is frequently observed. Conversion Disorder is among "Somatoform Disorders" and has neurological symptoms such as sudden loss of sensory and vision, fainting or paralysis without any underlying organic causes.
SomatoformDisorders are psychological disorders that display physical symptoms. The brain-body relation is not clear and some problems with the brain are expressed as physical illnesses. The patients in this group don't have any organically diagnosable cause for their physical symptoms and complaints. However,the patients mention:
• Body aches, burns, nausea, period pain (Somatization Disorder),
• Deformity of body parts (Body Dysmorphic Disorder),
• Numbness and paralysis (Conversion Disorder) or
• A continuous state of being ill (Hypochondria).
History
The word “hysteria”comes from the Greek word for wandering uterus. The idea that this disorder is caused by sexual insatiationdates back to ancient Greek civilization era. Conversion Disorder has been known since the early ages. Symptoms of this disease were identified in Egyptians circa 400 B.C and were claimed to be caused by the uterus wandering in the body.Hippocrates mentioned that some of the patients with convulsions were not suffering from epilepsy,but were in fact cases of hysteria and talked about the difficulty of making a distinction between the two. This disorder was associated with possession in the Middle Ages and was accepted as an organic disease in 19th century. Freud was the first to coin the term "conversion". According to Freud, suppressed and disturbing thoughts cause this disease while conversion mechanism.
Who has this disorder, under what conditions and how often?
Despite being rare in western cultures, Conversion Disorder is very common in our country. The rate of observation in psychiatric clinics is 1 to 3% in the West and around 10% in developing countries. In our country, this rate ranges between 4.5 and 32% according to various studies.
Symptoms of conversion can be observed in all ages from childhood well into the 90s. The disorder often arises during teenage and early adulthood years, but can rarely be observed in children younger than 10 and adults over 35. The clinical research indicates the disorder's observation frequency increases again around ages 50 and 60.
In women, it is observed twice or 3 times more than in men. Beating and sexual harassment increase this rate for children. Children whose parents have severe physical diseases or complaints about pain have a higher risk of this disorder. People from low socio-economic backgrounds with limited education have increased rates of risk of Conversion Disorder.
What are the causes and symptoms of Conversion Disorder?
Various theories present different approaches to the onset of the disorder:
• According to psychoanalytic theory, conversion emerges as a result of problems caused by subconscious conflicts. According to Freud, the pioneer of psychoanalysis, when sexual or violent urges are prevented from rising to the conscious level, they are symbolized with a physical function and are expressed in terms of a disruption or loss of that function.
• According to socio-cultural approach, conversion symptoms are shaped under the influence of society and culture. In societies where the verbal expression of feelings is restricted, these symptoms become a non-verbal tool of communication. The socially forbidden emotions and ideas are expressed as conversion symptoms. In societies where psychological complaints are not considered important and in fact seen as a sign of weakness, the probability of expressing emotions via physical complaints is increased. An individual who cannot establish verbal communication with his surroundings is trying to convey the message "I am in deep psychological trouble. See me, care about my condition and take care of me" via his complaints.
• Symptoms may emerge as a result of some physical diseases.For example, it is possible to see symptoms of conversion or somatization in patients who have survived severe physical diseases. Loss of a loved one, divorce of parents and such periods of grief that have no closure may also cause Conversion Disorder.
• Another theory suggests that with the onset of conversion symptoms, patients obtain primary and secondary gains. Primary gain is the patient being relieved of psychological trouble and the secondary gain is getting out of the dire straits thanks to the disease or getting some rights for being sick.
• The symptoms may often have symbolic significance. For example, a person who sees or hears things he shouldn't have may experience temporary blindness or deafness.
Paralysis, blindness and muteness are the most frequently observed symptoms with this disease. The symptoms can be separated into three groups; sensory, motor and attack.
Sensory: (Sensory loss in the arms and legs, numbness and tingling, sensory loss affecting a part of the body, deafness, blindness)
• No organic cause can be found during neurological exams of numbness. The numb area is different than neurological sensory loss.
• Visual impairment is often observed as loss of eyesight in one eye, blindness in both eyes or tubular vision in one eye. The eye exam of the patient comes up as normal.
• The patients may speak in a quiet tone. There is no organic reason to explain not being able to speak.
Motor: (Impaired walking, atony, paralysis)
• The patient complains about weakness in any part of his body. Atony is usually in arms and legs. Paralysis may go from one arm to the other.
• There may be tremors or involuntary movements. This is different than neurological movement disorders.
• The patients cannot stand or walk. Sometimes the stance and walk are normal and disrupted again.
Attacks: (fainting, seizures similar to epilepsy)
• Fainting and attacks are usually observed in crowds. Fainting usually lasts a long time but there is no loss of consciousness or injury. The patient claims he can hear what's happening but cannot respond, as if his entire body is paralyzed. Patients who experience these attacks usually come to crying and may try to rip off their hair or scratch their faces.
Diagnosis and Treatment of the Disorder:
In order to diagnose Conversion Disorder, the patient must go through physical exam and all necessary medical inspections following a detailed history of complaints. For example, a patient with complaints of fainting should have an EEG and blood works. A patient who cannot see should have an eye exam, tomography and even advanced inspections such as MRI if necessary. In short, the patient needs to be evaluated by doctors from various specialties such as neurology, optometry and otorhinolaryngology prior to diagnosis. In case no organic findings are present in the exams and inspections, a doctor of psychiatry must be consulted.
The main point in treatment is founded on removal of the secondary gain that has a significant role in the establishment and continuation of the disorder. This makes treatment extremely difficult. Following this, necessary medical inspections are done during the second stage and the patient's insight is increased via sessions. Afterwards, critical psychological problems may be discussed as allowed by the patient's psychological state. Finally, in case of accompanying symptoms, medication can be prescribed to remove these. In order to remove secondary gains that may come up during treatment, the patient can be given behavioral therapy. In some patients, hypnosis may be used to interpret and remove symptoms. Cooperation of the family with the doctor is essential to the entire treatment process.