Hysterical Neurosis And Anorexia Nervosa: Psychiatric Significance Of Their Clinical Manifestations

This neurotic disorder is characterized by psychogenic loss or disorder of function, manifested either as conversion reaction or as dissociative reaction. In conversion reaction, the symptoms pertain to the sensorimotor field. Psychic symptoms develop in dissociative reaction.

Etiology: Hysteria is a psychogenic disorder which develops as a result of environmental stress in subjects who possess defective personalities. Such individuals are often emotionally immature and sexually seductive. They are defensive, dramatic in appearance, demonstrative, and demanding. They show tendency to be untruthful. They are easily suggestible. Hysterical symptoms can be produced by suggestion and abolished by persuasion. Sigmond Freud suggested that in the conditioned individual, hysteria develops as a result of some wish which gives rise to mental conflict. The hysterical manifestation relieves the patient of the anxiety due to the conflict. This is the primary gain. The secondary gain is the material advantage obtained by the patient. Hysterical patients are unconcerned about their disability (la-belia indifference).

Diagnosis: The diagnosis of hysteria is made from the clinical picture. Personality tests are very helpful in confirming the diagnosis. It should be in mind that hysterical manifestations are not always confined to hysterical personality.

Hysterical fits: The hysterical fits occur in emotionally charged situations in the presence of onlookers. Fits do not occur when the patient is alone. Consciousness is not lost during the fits and the sequences as seen in epilepsy are not present. The movements are bizarre and may resemble scratching or other acts. Injuries are not sustained during these fits.

Differential diagnosis: The somatic symptoms of hysteria may resemble those of physical diseases. Psychiatric disorders like schizophrenia, depression, dementia and mania have to be differentiated.

Treatment: Hysteria is best treated by hypnosis. The success of treatment depends on the identification of the secondary gain and resolution of the mental conflict. It is not uncommon to find a fresh symptom cropping up when the existing symptom is removed. Drug therapy is less successful. Drugs are given mainly for their placebo effect.

Anorexia nervosa is considered as a condition similar to hysterical neurosis. This clinical state is commonly observed in young females who become very obese. The symptom may start as amenorrhea, loss of appetite and loss of body weight. The loss of appetite is gradual and leads to total refusal to eat. Though, considerable loss of weight develops, such subjects appear to be energetic and active. They may not complain of any symptom. Management consists of hospitalization and correction of the nutritional status. Drugs, such as chlorpromazine in small doses may be of benefit. The condition is likely to recur.