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| Hysteria (Conversion or Dissociative Disorders) |
Hysteria (Conversion or Dissociative Disorders)
Hysteria occupies a position at the top of the list of psychiatric diagnoses. There has been much controversy as to the relevance of its nosological status. The first 1,000 people who presented to the outpatient clinic of the Institute of Psychiatry, Ain Shams University in Cairo in 1990 were screened to determine those who fulfilled DSM-III-R criteria for either conversion or dissociation disorder, a replication of a study undertaken at an Egyptian University Hospital 23 years earlier. According to the findings, many disorders that would have been earlier diagnosed as hysteria would, at present, receive other diagnoses, mostly somatoform disorder. However, some disorders still require the category of hysteria to reflect the symptomatology and underlyingmechanisms (stress, primary gain, secondary gain, motor or sensory symptoms, etc., that are very culturally and symbolically specific for stress, etc.). The prevalence of 5% in that study is comparable with that of organic mental disorders (5.1%), personality disorders (4.9%) and anxiety disorders (7.9%), indicating that it is a diagnostic category whose prevalence cannot be ignored.
Factors that might contribute to a real decline in the incidence of hysteria could be related to the industrialization of our society and its increasing complexity, for which the primitive mechanism of defense against frustration is no longer strong enough to ward off unwanted anxieties. Hysterical spells were found to be related to sexual rivalry, jealousy and domestic quarrels in the setting of closed, fervently religious communities where a belief in possession by external agencies exists, or where people are easily excitable and emotional with a high level of acceptance for each other’s outbursts.Hysterical disorders also affect a large proportion of the patients who attend traditional healers in our region .
Hysteria occupies a position at the top of the list of psychiatric diagnoses. There has been much controversy as to the relevance of its nosological status. The first 1,000 people who presented to the outpatient clinic of the Institute of Psychiatry, Ain Shams University in Cairo in 1990 were screened to determine those who fulfilled DSM-III-R criteria for either conversion or dissociation disorder, a replication of a study undertaken at an Egyptian University Hospital 23 years earlier. According to the findings, many disorders that would have been earlier diagnosed as hysteria would, at present, receive other diagnoses, mostly somatoform disorder. However, some disorders still require the category of hysteria to reflect the symptomatology and underlyingmechanisms (stress, primary gain, secondary gain, motor or sensory symptoms, etc., that are very culturally and symbolically specific for stress, etc.). The prevalence of 5% in that study is comparable with that of organic mental disorders (5.1%), personality disorders (4.9%) and anxiety disorders (7.9%), indicating that it is a diagnostic category whose prevalence cannot be ignored.
Factors that might contribute to a real decline in the incidence of hysteria could be related to the industrialization of our society and its increasing complexity, for which the primitive mechanism of defense against frustration is no longer strong enough to ward off unwanted anxieties. Hysterical spells were found to be related to sexual rivalry, jealousy and domestic quarrels in the setting of closed, fervently religious communities where a belief in possession by external agencies exists, or where people are easily excitable and emotional with a high level of acceptance for each other’s outbursts.Hysterical disorders also affect a large proportion of the patients who attend traditional healers in our region .
In a study conducted by Okasha about the El Zar cult in Egypt (a musical, semi-religious dance in a group setting for exorcising evil spirits) it was found that 52% of Zar adherents had a hysterical personality and 40% of themhad, at the time of their attendance, a diagnosis of “hysteria,” with one or more of its presentations. The increasing complexity of our society and the intrusion of values that accompany the industrializedWestern example have led to a social context where competition and rivalry are gradually becoming hallmarks of everyday behavior,
with increasing stress on individuality and single personal achievements, especially in the work
sphere. People shut out of this sphere for one reason or another, or those who fail to cope with this new alien pattern, frequently resort to mental symptoms for defense.
with increasing stress on individuality and single personal achievements, especially in the work
sphere. People shut out of this sphere for one reason or another, or those who fail to cope with this new alien pattern, frequently resort to mental symptoms for defense.
The decline in the prevalence of hysteria over this time period from 11 % to 5% indicates that this primitivementalmechanism no longer suffices, with people tending more toward other behaviors that can be grouped under parasuicide, such as substance abuse. This transition is not unique and has been mentioned previously by Guinness, who stated that the profile of neurosis characterized by somatic and spiritual symptoms is a feature of a pre-industrial society that, with increases in industrialization and urbanization, tends to merge into another type of help-seeking behavior similar to parasuicide in industrialized societies.
