Hysteria(syn.: hysterical neurosis) - a form of general neurosis, manifested by a variety of functional motor, autonomic, sensitive and affective disorders, characterized by great suggestibility and self-hypnosis of patients, the desire to attract the attention of others in any way.
Hysteria as a disease has been known since ancient times. A lot of mythical and incomprehensible things were attributed to her, which reflected the development of medicine of that time, the prevailing ideas and beliefs in society. These data are now of a general educational nature only.
The term “hysteria” itself comes from the Greek. hystera - uterus, since ancient Greek doctors believed that this disease occurs only in women and is associated with dysfunction of the uterus. Wandering around the body in order to satisfy itself, it allegedly compresses itself, other organs or the vessels leading to them, which causes unusual symptoms of the disease.
The clinical manifestations of hysteria, according to the medical sources that have come down to us of that time, were also somewhat different and more pronounced. However, the leading symptom was and remains hysterical attacks with convulsions, insensitivity of certain areas of the skin and mucous membranes, a constricting headache (“hysterical helmet”) and pressure in the throat (“hysterical lump”).
Hysterical neurosis (hysteria) is manifested by demonstrative emotional reactions (tears, laughter, screaming). There may be convulsive hyperkinesis (violent movements), transient paralysis, loss of sensitivity, deafness, blindness, loss of consciousness, hallucinations, etc.
The main cause of hysterical neurosis is a mental experience that leads to a breakdown of the mechanisms of higher nervous activity. Nervous tension may be associated with some external moment or intrapersonal conflict. In such persons, hysteria can develop under the influence of an insignificant reason. The disease occurs either suddenly under the influence of severe mental trauma, or more often, under the influence of a long-term traumatic unfavorable situation.
Hysterical neurosis has the following symptoms
More often, the disease begins with the appearance of hysterical symptoms. Usually a seizure is provoked by unpleasant experiences, a quarrel, or emotional disturbance. A seizure begins with unpleasant sensations in the heart area, a feeling of a “lump” in the throat, palpitations, and a feeling of lack of air. The patient falls, convulsions appear, often tonic. The convulsions are in the nature of complex chaotic movements, like opisthotonus or, in other words, a “hysterical arc” (the patient stands on the back of his head and heels). During a seizure, the face either turns red or turns pale, but is never purplish-red or bluish, as with epilepsy. The eyes are closed; when trying to open them, the patient closes his eyelids even more. The reaction of the pupils to light is preserved. Often patients tear their clothes, hit their heads on the floor without causing significant damage to themselves, moan or mutter some words. A seizure is often preceded by crying or laughter. Seizures never occur in a sleeping person. There are no bruises or tongue bites, no involuntary urination, and no sleep after a seizure. Consciousness is partially preserved. The patient remembers the seizure.
One of the frequent phenomena of hysteria is a sensitivity disorder (anesthesia or hyperesthesia). This can be expressed in the form of a complete loss of sensitivity in one half of the body, strictly along the midline, from the head to the lower extremities, as well as increased sensitivity and hysterical pain. Headaches are common, and the classic symptom of hysteria is a feeling of being “driven in a nail.”
Disorders of the function of the sensory organs are observed, which manifest themselves in transient impairments of vision and hearing (transient deafness and blindness). There may be speech disorders: loss of voice sonority (aphonia), stuttering, pronunciation in syllables (chanted speech), silence (hysterical mutism).
Motor disorders are manifested by paralysis and paresis of muscles (mainly limbs), forced positioning of limbs, and the inability to perform complex movements.
Patients are characterized by character traits and behavioral characteristics: egocentrism, a constant desire to be in the center of attention, to take a leading role, mood swings, tearfulness, capriciousness, a tendency to exaggerate. The patient’s behavior is demonstrative, theatrical, and lacks simplicity and naturalness. It seems that the patient is happy with his illness.
Hysteria usually begins in adolescence and proceeds chronically with periodic exacerbations. With age, the symptoms smooth out, and during menopause they worsen. The prognosis is favorable once the situation that caused the aggravation is eliminated.
A little history
In the Middle Ages, hysteria was considered not a disease requiring treatment, but a form of obsession, transformation into animals. The patients were afraid of church rituals and objects of religious worship, under the influence of which they had convulsive seizures, they could bark like a dog, howl like a wolf, cackle, neigh, and croak. The presence of areas of skin insensitive to pain in patients, which is often found in hysteria, served as evidence of a person’s connection with the devil (“the seal of the devil”), and such patients were burned at the stake of the Inquisition. In Russia, such a state was considered as “hypocrisy.” Such patients could behave calmly at home, but it was believed that they were possessed by a demon, therefore, due to their great suggestibility, seizures with shouting - “calling out” – often occurred in the church.
In Western Europe in the 16th and 17th centuries. There were some kind of hysteria. The sick gathered in crowds, danced, wailed, and went to the chapel of St. Vitus in Zabern (France), where healing was considered possible. This disease was called “major chorea” (actually hysteria). This is where the term “St. Vitus’s Dance” came from.
In the 17th century French physician Charles Lepois observed hysteria in males, which refuted the role of the uterus in the occurrence of the disease. At the same time, the assumption arose that the reason lay not in the internal organs, but in the brain. But the nature of the brain damage, naturally, was unknown. At the beginning of the 19th century. Brickle considered hysteria a “cerebral neurosis” in the form of disturbances of “sensitive perceptions and passions.”
A deeply scientific study of hysteria was carried out by J. Charcot (1825-1893), the founder of the French school of neuropathologists. 3. Freud and the famous neuropathologist J. Babinsky worked with him on this problem. The role of suggestions in the origin of hysterical disorders was clearly established, and such manifestations of hysteria as convulsive seizures, paralysis, contractures, mutism (lack of verbal communication with others while the speech apparatus was intact), and blindness were studied in detail. It was noted that hysteria can copy (simulate) many organic diseases of the nervous system. Charcot called hysteria “a great simulator,” and even earlier, in 1680, the English physician Sydenham wrote that hysteria imitates all diseases and “is a chameleon that constantly changes its colors.”
Even today in neurology such terms as “Charcot minor hysteria” are used - hysteria with movement disorders in the form of tics, tremors, twitching of individual muscles: “Charcot major hysteria” - hysteria with severe movement disorders (hysterical seizures, paralysis or paresis ) and (or) dysfunction of the sensory organs, for example blindness, deafness; “Charcot hysterical arc” - an attack of generalized tonic convulsions in patients with hysteria, in which the body of the patient with hysteria arches with support on the back of the head and heels; “Charcot hysterogenic zones” are painful points on the body (for example, on the back of the head, arms, under the collarbone, under the mammary glands, on the lower abdomen, etc.), pressure on which can cause a hysterical attack in a patient with hysteria.
Causes and mechanisms of development of hysterical neurosis
According to modern views, an important role in the occurrence of hysterical neurosis belongs to the presence of hysterical personality traits and mental infantilism as a factor of internal conditions (V.V. Kovalev, 1979), in which heredity undoubtedly plays a significant role. Among external factors, V.V. Kovalev and other authors attached importance to family upbringing of the “family idol” type and other types of psychotraumatic influence, which can be very different and to a certain extent depend on the age of the child. Thus, in younger children, hysterical disorders can arise in response to acute fear (more often this is a perceived threat to life and well-being). In preschool and primary school age, such conditions in some cases develop after physical punishment, when parents express dissatisfaction with the child’s actions or categorically refuse to fulfill his request. Such hysterical disorders are usually temporary; they may not recur in the future if the parents realize their mistake and treat the child more carefully. Consequently, we are not talking about the development of hysteria as a disease. This is just a basic hysterical reaction.
In children of middle and older (in fact, teenagers) school age, hysteria usually occurs as a result of long-term psychological trauma, which infringes on the child as an individual. It has long been noted that various clinical manifestations of hysteria are more often observed in pampered children with weak will and immunity to criticism, who are not accustomed to work, and who do not know the words “impossible” and “must”. They are dominated by the principle of “give” and “I want”; there is a contradiction between desire and reality, dissatisfaction with their position at home or in the children's group.
I. P. Pavlov explained the mechanism of occurrence of hysterical neurosis by the predominance of subcortical activity and the first signaling system over the second, which is clearly formulated in his works: “... the hysterical subject lives to a greater or lesser extent not a rational, but an emotional life, is not controlled by cortical activity , and subcortical...”
Clinical manifestations of hysterical neurosis
The clinic of hysteria is very diverse. As stated in the definition of this disease, it is manifested by motor autonomic, sensory and affective disorders. These disorders can occur in varying degrees of severity in the same patient, although sometimes only one of the above symptoms occurs.
Clinical signs of hysteria are most pronounced in adolescents and adults. In childhood, it is less demonstrative and often monosymptomatic.
A distant prototype of hysteria may be conditions often found in children of the first year of life; a child who does not yet consciously utter individual words, but can already sit up and down independently (at 6-7 months), stretches out his arms to his mother, thereby expressing the desire to be taken. If the mother for some reason does not fulfill this wordless request, the child begins to be capricious, cry, and often throws his head back and falls, screams, and trembles all over his body. Once you pick him up, he quickly calms down. This is nothing more than the most elementary manifestation of a hysterical attack. With age, the manifestation of hysteria becomes more and more complicated, but the goal remains the same - to achieve what I want. It can only be supplemented by the opposite desire, “I don’t want,” when the child is presented with demands or given instructions that he does not want to fulfill. And the more categorically these demands are presented, the more pronounced and diverse the protest reaction. The family, in the figurative expression of V. I. Garbuzov (1977), becomes a real “battlefield” for the child: the struggle for love, attention, care not shared with anyone, a central place in the family, reluctance to have a brother or sister, to let go of oneself parents.
With all the variety of hysterical manifestations in childhood, the most common are motor and autonomic disorders and relatively rare sensory disorders.
Motor disorders. It is possible to distinguish separate clinical forms of hysterical disorders accompanied by motor disorders: seizures, including respiratory affective ones, paralysis, astasia-abasia, hyperkinesis. They are usually combined with affective manifestations, but can also be without them.
Hysterical fits- the main, most striking manifestation of hysteria, which made it possible to distinguish this disease into a separate nosological form. It should be noted that at present, in both adults and children, hysterical attacks, which were described by J. Charcot and Z. Freud at the end of the 19th century, practically do not occur or are observed only rarely. This is the so-called pathomorphosis of hysteria (like many other diseases) - a persistent change in the clinical manifestations of the disease under the influence of environmental factors: social, cultural (customs, morality, culture, education), medical advances, preventive measures, etc. Pathomorphosis is not one of the hereditarily fixed changes, which does not exclude manifestations in their original form.
If we compare hysterical seizures, on the one hand, in adults and adolescents, and on the other, in childhood, then in children they are of a more elementary, simple, rudimentary (as if underdeveloped, remaining in an embryonic state) character.
For illustration, several typical observations will be given.
The grandmother brought three-year-old Vova to the appointment, who, according to her, “suffers from a nervous disease.” The boy often throws himself on the floor, kicks his legs, and cries. This state occurs when his desires are not fulfilled. After an attack, the child is put to bed, his parents sit next to him for hours, then they buy a lot of toys and immediately fulfill all his requests. A few days ago, Vova was with his grandmother in the store, asking her to buy a chocolate bear. Knowing the child’s character, the grandmother wanted to fulfill his request, but there was not enough money. The boy began to cry loudly, scream, then fell to the floor, banging his head on the counter. There were similar attacks at home until his wish was fulfilled.
Vova is the only child in the family. Parents spend most of their time at work, and raising the child is completely entrusted to the grandmother. She loves her only grandson very much, and her “heart breaks” when he cries, so the boy’s every whim is fulfilled.
Vova is a lively, active child, but very stubborn, and gives standard answers to any instructions: “I won’t,” “I don’t want.” Parents regard this behavior as greater independence.
When examining the nervous system, no signs of organic damage were found. Parents are advised not to pay attention to such attacks, to ignore them. The parents followed the doctors' advice. When Vova fell to the floor, the grandmother went into another room, and the attacks stopped.
The second example is a hysterical attack in an adult.
During my work as a neurologist in one of the regional hospitals in Belarus, the chief doctor once came into our department and said that we should go to the vegetable base the next day and sort out the potatoes. We all silently, but with enthusiasm (previously it was impossible to do otherwise) greeted his order, and one of the nurses, a woman about 40 years old, fell to the floor, arched over and then began to convulse. We knew that she had similar seizures and provided the help necessary in such cases: we sprinkled her with cold water, patted her on the cheeks, and gave her ammonia to smell. After 8-10 minutes everything passed, but the woman experienced great weakness and could not move on her own. She was taken home in a hospital car and, of course, she did not go to work at the vegetable base.
From the patient’s story and the conversations of her friends (women always like to gossip), the following was revealed. She grew up in a village in a wealthy and hardworking family. I graduated from 7th grade and studied mediocrely. Her parents taught her early to do housework and raised her in harsh and demanding conditions. Many desires in adolescence were suppressed: it was forbidden to go to gatherings with peers, to be friends with the guys, to attend dances in village clubs. Any protests in this regard were met with a ban. The girl hated her parents, especially her father. At the age of 20, she married a divorced fellow villager, who was much older than her. This man was lazy and had a certain passion for drinking. They lived separately, there were no children, the household was neglected. A few years later they divorced. She often came into conflict with neighbors who tried to somehow infringe on the “lonely and defenseless woman.”
During conflicts, she experienced seizures. Her fellow villagers began to shun her, and she found a common language and mutual understanding with only a few friends. Soon she left to work as a nurse in a hospital.
She is very emotional in behavior, easily excitable, but tries to restrain and hide her emotions. Doesn't get into conflicts at work. She loves it very much when she is praised for good work, in such cases she works tirelessly. He likes to be fashionable in a “city manner”, flirt with male patients and talk about erotic topics.
As can be seen from the above data, there were more than enough reasons for neurosis: this included infringement of sexual desires in childhood and adolescence, unsuccessful family relationships, and financial difficulties.
As far as I know, this woman has not had hysterical attacks for 5 years, at least at work. Her condition was quite satisfactory.
If you analyze the nature of hysterical attacks, you may get the impression that this is a simple simulation (pretense, i.e. imitation of a disease that does not exist) or aggravation (exaggeration of signs of an existing disease). In reality, this is a disease, but it proceeds, as A. M. Svyadoshch figuratively writes (1971), according to the mechanism of “conditional desirability, pleasantness for the patient, or “flight into illness” (according to Z. Freud).
Hysteria is a way to protect yourself from difficult life situations or achieve a desired goal. With a hysterical attack, the patient seeks to evoke sympathy from those around him; they do not occur if there are no strangers.
In a hysterical attack, a certain artistry is often visible. Patients fall without receiving bruises or injuries; there is no biting of the tongue or oral mucosa, urinary or fecal incontinence, which is often found during an epileptic seizure. Yet it is not so easy to distinguish them. Although in some cases there may be induced disorders, including due to the doctor’s behavior during a patient’s seizure. Thus, J. Charcot, while demonstrating hysterical seizures to students, discussed their difference from epileptic seizures in front of patients, paying special attention to the absence of involuntary urination. The next time he demonstrated the same patient, he urinated during a seizure.
Respiratory affective seizures. This form of seizures is also known as spasmodic crying, crying-sobs, breath-holding attacks, affective-respiratory seizures, spasms of rage, crying of anger. The main thing in the definition is respiratory, i.e. relating to breathing. The seizure begins with crying caused by negative emotions or pain.
The crying (or screaming) becomes louder and breathing quickens. Suddenly, during inhalation, breathing is delayed due to spasm of the muscles of the larynx. The head usually tilts back, the veins in the neck swell, and the skin becomes blue. If this lasts no more than 1 minute, then only pallor and slight cyanosis of the face appear, most often only of the nasolabial triangle, the child takes a deep breath and that’s where everything stops. However, in some cases, holding the breath may last for several minutes (sometimes up to 15-20), the child falls, partially or completely loses consciousness, and there may be convulsions.
This type of seizure is observed in 4-5% of children aged 7-12 months and accounts for 13% of all seizures in children under 4 years of age. Respiratory affective seizures are described in detail by us in the “Medical Book for Parents” (1996), which indicates their connection with epilepsy (in 5-6% of cases).
In this section we only note the following. Respiratory affective seizures are more common in boys than in girls, they are psychogenic and are a common form of primitive hysterical reactions in young children, usually disappear by 4-5 years. In their occurrence, a certain role is played by hereditary burden with such conditions, which, according to our data, occurred in 8-10% of those examined.
What to do in such cases? If the child cries and becomes upset, then you can splash him with cold water, spank him or shake him, i.e. apply another pronounced irritant. Often this is enough and the seizure does not develop further. If a child falls and convulsions occur, he should be placed on the bed, his head and limbs should be supported (but not forcibly held) to avoid bruises and injuries, and a doctor should be called.
Hysterical paresis (paralysis). In terms of neurological terminology, paresis is a limitation, paralysis is the absence of movements in one or more limbs. Hysterical paresis or paralysis are corresponding disorders without signs of organic damage to the nervous system. They can involve one or more limbs, are most often found in the legs, and sometimes are limited to only part of the leg or arm. If one limb is partially affected, weakness may be limited to only the foot or foot and lower leg; in the hand it will be the hand or hand and forearm, respectively.
Hysterical paresis or paralysis occurs much less frequently than the above hysterical motor disorders.
As an example, I will give one of my personal observations.
Several years ago I was asked to consult a 5-year-old girl whose legs had become paralyzed a few days earlier. Some doctors even suggested polio. The consultation was urgent.
The girl was carried in her arms. Her legs did not move at all, she could not even move her toes.
From questioning the parents (historical history), it was possible to establish that 4 days ago the girl began to walk poorly for no apparent reason, and soon could not make the slightest movement with her feet. When lifting the child, the armpits of the legs dangled (dangled). When they put their feet to the floor, they buckled. She could not sit down, and when her parents sat her down, she immediately fell to the side and back. A neurological examination revealed no organic lesions of the nervous system. This, along with many assumptions that develop during the examination of the patient, suggested the possibility of hysterical paralysis. The rapid development of this condition made it necessary to clarify its connection with certain causes. However, their parents did not find them. He began to clarify what she was doing and what she had done several days before. The parents again noted that these were ordinary days, they worked, the girl was at home with her grandmother, played, ran, and was cheerful. And as if by the way, my mother noted that she bought her skates and had been taking her to learn how to skate for several days. At the same time, the girl’s expression changed, she seemed to perk up and turn pale. When asked if she liked skating, she shrugged her shoulders vaguely, and when asked if she wanted to go to the skating rink and become a figure skating champion, at first she did not answer anything, and then quietly said: “I don’t want to.”
It turned out that the skates were a little too big for her, she couldn’t stand on them, skating didn’t work, she constantly fell, and after skating her legs hurt. No traces of bruises were found on the legs; walking to the skating rink lasted several days with minimal movement. The next visit to the skating rink was scheduled for the day the illness began. By this time, the girl had developed a fear of the next skating, she began to hate skates, and was afraid to skate.
The cause of the paralysis has become clear, but how can it be helped? It turned out that she loves sleep and knows how to draw, she likes fairy tales about good animals, and the conversation turned to these topics. Skating and skating were immediately put to rest, and the parents firmly promised to give the skates to their nephew and not visit the skating rink again. The girl perked up and willingly talked to me on topics she liked. During the conversation, I stroked her legs, lightly massaging her. I also realized that the girl was suggestible. This gives hope for success. The first thing I managed to do was get her to rest her legs a little on my hands while lying down. It worked. She was then able to sit up and sit up on her own. When this was possible, he asked her, sitting on the sofa and lowering her legs, to press them to the floor. So gradually, stage by stage, she began to stand on her own, at first staggering and bending her knees. Then, with rest breaks, she began to walk a little, and eventually she could jump almost well on one leg or the other. The parents sat silently all this time, without uttering a word. After completing the entire procedure, he told her with a hint of a question, “Are you healthy?” She shrugged her shoulders at first, then said yes. Her father wanted to take her in his arms, but she refused and walked from the fourth floor. I watched them unnoticed. The child's gait was normal. They didn't contact me anymore.
Is it always so easy to cure hysterical paralysis? Of course not. The child and I were lucky in the following: early treatment, identification of the cause of the disease, the child’s suggestibility, correct response to a traumatic situation.
In this case, there was a clear interpersonal conflict without any sexual overlays. If her parents had stopped visiting the skating rink in time and bought her skates that were the right size, and not “for her growth,” perhaps there would not have been such a hysterical reaction. But, who knows, all's well that ends well.
Astasia-abasia literally translated means the inability to stand and walk independently (without support). At the same time, in a horizontal position in bed, active and passive movements in the limbs are not impaired, the strength in them is sufficient, and the coordination of movements is not changed. It occurs with hysteria mainly in females, more often in adolescence. We have observed similar cases in children, both boys and girls. A connection with acute fear is suspected, which may be accompanied by weakness in the legs. There may be other causes of this disorder.
Here are a few of our observations.
A 12-year-old boy was admitted to the pediatric neurological department with complaints of the inability to stand and walk independently. Ill for a month.
According to his parents, he stopped going to school 2 days after he went with his father for a long walk in the forest, where he was frightened by a suddenly flying bird. My legs immediately gave way, I sat down and everything went away. His father at home made fun of him that he was cowardly and physically weak. The same thing happened at school. He reacted painfully to the ridicule of his peers, was worried, tried to “pump up” his muscle strength with dumbbells, but after a week he lost interest in these activities. Initially, he was treated in the children's department of the district hospital, where the diagnosis of astasia-abasia of psychogenic origin was correctly made. Upon admission to our clinic: calm, somewhat slow, reluctant to make contact, answers questions in monosyllables. He treats his condition indifferently. No pathology was detected from the nervous system or internal organs; he sits up and sits independently in bed. When trying to put him on the floor, he does not resist, but his legs immediately bend as soon as they touch the floor. The whole thing sags and falls towards the accompanying staff.
At first, he relieved his natural needs in bed on the ship. However, soon after being ridiculed by his peers, he asked to be taken to the toilet. She was noted to be able to use her legs well on the way to the toilet, although bilateral support was required.
In the hospital, courses of psychotherapy were carried out, he took nootropic drugs (aminalon, then nootropil), rudotel, darsonvalization of the legs. He did not respond well to treatment. A month later he could walk around the department with one-sided assistance. Coordination problems decreased significantly, but severe weakness in the legs remained. Then he was treated several more times in the hospital of a psychoneurological dispensary. After 8 months from the onset of the disease, the gait was completely restored.
The second case is more peculiar and unusual.
A 13-year-old girl was admitted to our children's neurological clinic, who had previously been in the intensive care unit of one of the children's hospitals for 7 days, where she was taken by ambulance. And the background to this case was as follows.
The girl’s parents, residents of one of the union republics of the former USSR, often came to trade in Minsk. Recently they have been living here for about a year, running their business. Their only daughter (let's call her Galya - she really has a Russian name) lived with her grandmother and aunts in her homeland, went to the 7th grade. In the summer I came to my parents. Here she was met by a 28-year-old native of the same republic, and he really liked her.
It has long been a custom in their country to steal brides. This form of getting a wife has become more common nowadays. The young man met Galya and her parents, and soon, as Galina’s mother said, he stole her and took her to his apartment, where they stayed for three days. Then the parents were informed about what had happened and, according to the mother, allegedly according to the customs of Muslim countries, the girl stolen by the groom is considered his bride or even his wife. This custom was observed. The newlyweds (if you can call them that) began to live together in the groom's apartment. Exactly 12 days later, Galya felt bad in the morning: pain appeared in the lower left abdomen, she had a headache, could not get up, and soon stopped speaking. An ambulance was called and the patient was taken to one of the children's hospitals with suspected encephalitis (inflammation of the brain). Naturally, the ambulance doctor was not told a word about the previous events.
At the hospital, Galya was examined by many specialists. Data indicating an acute surgical disease have not been established. The gynecologist found pain in the area of the ovary on the left and assumed the presence of an inflammatory process. However, the girl did not make contact, could not stand or walk, and during a neurological examination she became tense all over, which did not allow us to judge the presence of organic changes in the nervous system.
A comprehensive clinical and instrumental examination of the internal organs and nervous system was carried out, including computer and magnetic resonance imaging of the brain, which did not reveal any organic disorders.
During the first days of the girl’s stay in the hospital, her “husband” managed to enter her room. Seeing him, she began to cry, shout something in her language (she knows Russian very poorly), shook all over and waved her hands. He was quickly taken out of the room. The girl calmed down, and the next morning she began to sit down on her own and talk with her mother. Soon she tolerated her “husband’s” visits calmly, but did not come into contact with him. The doctors suspected something was wrong, and the idea arose that the illness was mental. The mother had to tell some details of what happened, and a few days later the girl was transferred to us for treatment.
Upon examination, it was established that she was tall, slender, somewhat inclined to be overweight, with well-developed secondary sexual characteristics. He looks 17-18 years old. It is known that women in the East experience puberty earlier than in our climate zone. She is somewhat wary, neurotic, makes contact (through her mother as a translator), complains of compressive headaches, and periodic tingling in the heart area.
When walking, he drifts somewhat to the sides, staggers while standing with his arms outstretched forward (Romberg test). Eats well, especially spicy foods. The possibility of pregnancy has not been proven. In the ward he behaves adequately with others. While visiting the groom, they retire and talk for a long time about something. He asks his mother why he doesn’t come every day. But in general, the condition is noticeably improving.
In this case, a hysterical reaction is clearly visible in the form of astasia-abasia and hysterical mutism - the absence of verbal communication while the speech apparatus and its innervation are intact.
The cause of the condition was the child's early sexual activity with an adult man. Perhaps there were some other circumstances in this regard, which the girl is unlikely to tell her mother, much less the doctor.
Hysterical hyperkinesis. Hyperkinesis is involuntary, excessive movements of various external manifestations in various parts of the body. With hysteria, they can be either simple - trembling, shuddering the whole body or twitching of various muscle groups, or very complex - peculiar pretentious, unusual movements and gestures. Hyperkinesis can be observed at the beginning or end of a hysterical attack, occur periodically and without an attack, especially in difficult life situations, or are observed constantly, especially in adults or adolescents.
As an example, I will give one personal observation, or my “first meeting” with hysterical hyperkinesis, which took place in the first year of my work as a district neurologist.
On the main street of our small urban village, in a small private house, lived with his mother one young man, 25-27 years old, who had an unusual and strange gait. He raised his leg, bending it at the hip and knee joints, moved it to the side, then forward, rotating his foot and lower leg, and then placed it on the ground with a stamping motion. The movements were the same on both the right and left sides. This man was often accompanied by a crowd of children, repeating his strange gait. The adults got used to it and didn’t pay any attention. This man was known throughout the area because of the strangeness of his walking. He was slender, tall and fit, always wore a military khaki jacket, riding breeches and boots that were polished to a shine. After observing him for several weeks, I approached him myself, introduced myself and asked him to come for an appointment. He was not particularly enthusiastic about this, but still showed up on time. All I learned from him was that this condition had been going on for several years and came on for no apparent reason.
A study of the nervous system did not reveal anything wrong. He answered each question briefly and thoughtfully, saying that he was very worried about his illness, which many tried to cure, but no one achieved even minimal improvement. I didn’t want to talk about my past life, not seeing anything special in it. However, it was clear from everything that he did not allow interference either in his illness or in his life; it was only noted that he artistically demonstrated to everyone his gait with some kind of pride and contempt for the opinions of others and the ridicule of children.
I learned from local residents that the patient’s parents have lived here for a long time; the father left the family when the child was 5 years old. They lived very poorly. The boy graduated from a construction college and worked at a construction site. He was self-centered, proud, could not stand other people's comments, and often entered into conflicts, especially in cases when it came to his personal qualities. He met a divorced woman of “easy” virtue and was older than him in age. They talked about marriage. However, suddenly everything became upset, allegedly on a sexual basis, his former acquaintance told one of her next gentlemen about this. After that, none of the girls and women wanted to deal with him, and the men laughed at the “weakling.”
He stopped going to work and didn’t leave the house for several weeks, and his mother didn’t let anyone into the house. Then he was seen in the yard with a strange and uncertain gait, which was fixed for many years. He received the second group of disability, while his mother received a pension for her years of service. So they lived together, growing something in their small garden.
I, like many doctors who treated and advised the patient, was interested in the biological meaning of such an unusual walk with a kind of hyperkinesis in the legs. He told the attending physician that when walking, the genitals “stick” to the thigh, and he cannot take the right step until “unsticking” occurs. Perhaps this was so, but subsequently he avoided discussing this issue.
What happened here and what is the mechanism of hysterical neurosis? Obviously, the disease arose in a person with hysterical personality traits (hysterical-type accentuation); a subacute conflict situation in the form of problems at work and in his personal life played a traumatic role. Man has been haunted everywhere by failures, creating a contradiction between what is desired and what is possible.
The patient was consulted by all the leading neurological luminaries of that time working in Belarus; he was repeatedly examined and treated, but there was no effect. Even hypnosis sessions did not have a positive effect, and no one was engaged in psychoanalysis at that time.
The psychological significance for a given person of his hysterical disorders is clear. In fact, this was the only way to obtain disability and the possibility of living without work.
If he lost this opportunity, everything would go to waste. But he didn’t want to work, and, apparently, he couldn’t do it anymore. Hence the deep fixation of this syndrome and a negative attitude towards treatment.
Autonomic disorders. Autonomic disorders in hysteria usually concern disruption of the activity of various internal organs, the innervation of which is carried out by the autonomic nervous system. This is most often pain in the heart, epigastric (epigastric) region, headaches, nausea and vomiting, a feeling of a lump in the throat with difficulty swallowing, difficulty urinating, bloating, constipation, etc. Children and adolescents especially often experience tingling in the heart, a burning sensation, lack of air and fear of death. At the slightest excitement and various situations requiring mental and physical stress, patients clutch their hearts and swallow medications. They describe their sensations as “excruciating, terrible, terrible, unbearable, terrible” pain. The main thing is to attract attention to yourself, evoke compassion from others, and avoid the need to carry out any errands. And, I repeat, this is not pretense or aggravation. This is a kind of illness for a certain type of personality.
Autonomic disorders can also occur in children of early and preschool age. If, for example, they try to force-feed a child, he will cry and complain of pain in the abdomen, and sometimes while crying from displeasure or unwillingness to carry out some assignment, the child begins to hiccup frequently, then the urge to vomit occurs. In such cases, parents usually change their anger to mercy.
Due to increased suggestibility, vegetative disorders can occur in children who see the illness of their parents or other persons. Cases have been described where a child, having seen urinary retention in an adult, stopped urinating himself, and even had to urinate with a catheter, which led to even greater fixation of this syndrome.
It is a general property of hysteria to take the form of other organic diseases, imitating these diseases.
Autonomic disorders often accompany other manifestations of hysteria, for example, they may occur in the intervals between hysterical attacks, but sometimes hysteria manifests itself only in the form of various or persistent autonomic disorders of the same type.
Sensory disorders. Isolated sensory disturbances in hysteria in childhood are extremely rare. They are pronounced in adolescents. However, in children, changes in sensitivity are possible, usually in the form of its absence in a certain part of the body on one or both sides. A unilateral decrease in sensitivity to pain or its increase always extends strictly along the midline of the body, which distinguishes these changes from changes in sensitivity in organic diseases of the nervous system, which usually do not have clearly defined boundaries. Such patients may not feel parts of a limb (arm or leg) on one or both sides. Hysterical blindness or deafness may occur, but is more common in adults than in children and adolescents.
Affective disorders. In terms of terminology, affect (from the Latin affectus - emotional excitement, passion) means a relatively short-term, pronounced and violently occurring emotional experience in the form of horror, despair, anxiety, rage and other external manifestations, which is accompanied by screaming, crying, unusual gestures or a depressed mood and decreased mental activity. The state of affect can be physiological in response to a sharply expressed and sudden feeling of anger or joy, which is usually adequate to the force of external influence. It is short-term, quickly passing, leaving no long-lasting experiences.
We all periodically rejoice in good things, and experience sorrows and adversities that often occur in life. For example, a child accidentally broke an expensive and beloved vase, plate, or spoiled some thing. Parents may yell at him, scold him, put him in a corner, or show an indifferent attitude for a while. This is a common phenomenon, a way of instilling in a child the prohibitions (“don’ts”) that are necessary in life.
Hysterical affects are of an inadequate nature, i.e. do not correspond to the content of the experience or the situation that has arisen. They are usually sharply expressed, outwardly brightly decorated, theatrical and can be accompanied by peculiar poses, sobs, wringing of hands, deep sighs, etc. Similar conditions can occur on the eve of a hysterical attack, accompany it, or occur in the interval between attacks. In most cases, they are accompanied by vegetative, sensitive and other disorders. Often, at a certain stage of development, hysteria can manifest itself exclusively as emotional-affective disorders, which in most cases are accompanied by other disorders.
Other disorders. Among other hysterical disorders it should be noted aphonia and mutism.
Aphonia- lack of sonority of the voice while maintaining whispered speech. It is predominantly laryngeal or true in nature, occurs in organic, including inflammatory, diseases (laryngitis), with organic lesions of the nervous system with impaired innervation of the vocal cords, although it can be psychogenically caused (functional), which in some cases occurs with hysteria . Such children speak in a whisper, sometimes straining their faces to create the impression that normal verbal communication is impossible. In some cases, psychogenic aphonia occurs only in a certain situation, for example, in kindergarten when communicating with a teacher or during lessons at school, while when talking with peers, speech is louder, and at home it is not impaired. Consequently, a speech defect occurs only in response to a certain situation, something displeasing to the child, in the form of a unique form of protest.
A more pronounced form of speech pathology is mutism- complete absence of speech while the speech apparatus is intact. It can occur in organic diseases of the brain (usually in combination with paresis or paralysis of the limbs), severe mental illnesses (for example, schizophrenia), and also in hysteria (hysterical mutism). The latter can be total, i.e. is observed constantly in various conditions, or selective (elective) - occurs only in a certain situation, for example, when talking about certain topics or in relation to specific individuals. Total psychogenically caused mutism is often accompanied by expressive facial expressions and (or) accompanying movements of the head, torso, and limbs (pantomime).
Total hysterical mutism in childhood is extremely rare. Some casuistic cases of it in adults are described. The mechanism of occurrence of this syndrome is unknown. The previously generally accepted position that hysterical mutism is caused by inhibition of the speech-motor apparatus does not contain any specification. According to V.V. Kovalev (1979), selective mutism usually develops in children with speech and intellectual disabilities and traits of increased inhibition in character with increased demands on speech and intellectual activity while attending kindergarten (less often) or school (more often). This can occur in children at the beginning of their stay in a psychiatric hospital, when they are silent in class, but enter into verbal contact with other children. The mechanism of occurrence of this syndrome is explained by the “conditional desirability of silence,” which protects the individual from a traumatic situation, for example, coming into contact with a teacher you don’t like, responding in class, etc.
If a child has total mutism, a thorough neurological examination should always be performed to exclude an organic disease of the nervous system.
Hysterical paralysis, contractures and hyperkinesis
Paralysis and contractures cover a group of muscles involved in performing some purposeful motor act, for example, chewing, sucking, closing your eyes, etc., regardless of whether this group is innervated by one or more nerves. Paralysis of the facial muscles and especially the tongue is uncommon.
Hysterical blepharospasm manifested by spasm of the orbicularis oculi muscle. Usually occurs after significant neuropsychic stress. The orbital and zygomatic reflexes do not change. When reflexes are evoked, deliberate shudders of the whole body or demonstrative strengthening of the reflex are often observed. It can also be observed when, after several evocations of the reflex, they only make a striking gesture (holding the hammer) without touching the patient. During sleep and in a state of passion, the spasm of the orbicularis oculi muscle disappears.
If the patient has hysterical hemiplegia, then the paralysis does not extend to the muscles of the face and tongue. Such patients do not have speech disorders, synkinesis, protective reflexes, etc.
Hysterical facial paralysis manifested by immobility of one of the halves of the face. Occurs if it is “conditionally pleasant or desirable” for the patient. In its development, either hysterical fixation or self-hypnosis or suggestion is important.
Hysterical hyperkinesis. Among functional hyperkinesis, tics occupy an important place. These are short-term, monotonous, stereotypical violent clonic twitches of a certain group of muscles, often having a deliberate appearance: various grimaces, protruding the tip of the tongue, involuntary blinking of both eyes or simultaneous winking, frowning of the eyebrows, wrinkling of the forehead, repeated movements of the head to the sides and stretching of the neck, reminiscent of gestures , as if the patient is trying to free himself from a tight collar, thumb sucking, the tip of the tongue, lips, convulsive stretching of the lips with the trunk, biting nails (onychophagia), puffing out the cheeks, moving the tongue to remove a lump of food from the gums, chewing, tic spitting, snorting, snorting, sniffing, snoring, forced coughing, etc.
They arise in connection with negative emotion, mental trauma, and also as imitation.
The disease is chronic, periodically worsening, in rare cases it occurs as an episodic manifestation.
Hysterical glossoplegia occurs under the influence of negative emotions, manifested by a violation of active movements of the tongue. Patients have difficulty speaking and moving food in the mouth. However, more often voluntary movements of the tongue are possible. The patient moves his tongue in his mouth very slowly, but cannot stick it out of the mouth. There is hypoesthesia of the tongue, pharynx and skin in the tracheal area, which does not correspond to the zone of innervation of nerves or nerve roots, i.e. hysterical type hypoesthesia. The cough of patients is loud. Patients prefer to explain themselves in writing.
The prognosis is usually favorable, movements can be restored immediately, or recovery is slow, leading to hysterical stuttering.
Hysterical aphonia develops under the influence of mental trauma. In patients, the sonority of the voice disappears, and in contrast to aphonia caused by organic lesions of the nervous system, the cough in patients remains sonorous.
During the examination, hysterical hypoesthesia of the tongue and pharynx may be noted; the glottis remains open with significant tension on the vocal cords. Hysterical aphonia is very difficult to treat and can develop into hysterical stuttering.
Emergency and specialized assistance. Typically, hysterical symptom complexes arise acutely, and in cases where medical assistance is not provided in a timely manner, they can persist for many years. The main treatment method is psychotherapy in combination with medications. In very severe cases, hypnosis with explanation is used. The method of self-hypnosis and autogenic training are important.
During psychotherapy, patients with hysterical prosopalgia are prescribed tranquilizers: diazepam (Seduxen), chlordiazepoxide (Elenium), trioxazine, meprotan (Andaxin), etc., among which diazepam is the most effective. It is prescribed 0.005 g 2-3 times a day. It is advisable to select the dose individually, starting with the minimum and gradually increasing it. Valerian root, bromine preparations, barbital sodium (medinal) and motherwort tincture in combination with small doses of caffeine are also used.
Treatment of hysterical paralysis, paresis and sensitivity disorders can also be successful only if psychotherapy is combined with drug therapy and electrical procedures.
Patients with hysterical trismus and hysterical glossoplegia (glossoparesis) are prescribed a course of treatment with caffeine and barbamyl: 1 ml of a 20% caffeine solution is injected subcutaneously and then 5-10 minutes later very slowly - 3-5 ml of a 5% barbamyl solution. The patient is told that his existing disorders will gradually smooth out. The course of treatment is 6-10 sessions.
Patients with mild and moderate forms of the disease are recommended to do daily morning exercises. Physical therapy followed by warm baths is indicated, preferably in a sanatorium (change of environment).
Psychogenic (hysterical) paralysis, occurring under the influence of psychotraumatic influences (see Neuroses), may outwardly resemble both central and peripheral paralysis. However, there are no changes in muscle tone, tendon-periosteal and skin reflexes, no pathological reflexes, trophic disorders, changes in electrical excitability of nerves and muscles.
P.'s diagnosis does not present great difficulties and is based on the results of a clinical examination. In the differential diagnosis of spastic and flaccid P., along with clinical data, a significant role is played by the study of electrical excitability of nerves and muscles, as well as the bioelectrical activity of muscles (see Electromyography). Hysterical P. is differentiated from similar conditions of organic origin. An essential role is played by the absence of signs of organic damage to the nervous system in hysterical P., as well as the presence of emotional and behavioral characterological disorders.
For the diagnosis of hemiparesis, comparison of muscle strength on both sides is of great importance. This is achieved by comparing the scores of symmetrical movements, as well as using various additional techniques. The essence of the latter is to perform voluntary movements in a physiologically uncomfortable position. The following techniques and functional tests can be used.
Venderovich's motor ulnar defect is a technique that reveals the strength of the adductor muscles of the IV-V fingers. Determination method: with the hands in an extended position, the subject presses the fingers together with maximum force, the doctor withdraws the little finger, taking it by the first interphalangeal joint. If ulnar nerve function is impaired or the pyramidal tract is mildly affected, less force is required to abduct the little finger.
Rusetsky's symptom. Make maximum extension of the hands, which are at the same level; on the P. side, extension is limited.
Babinski's symptom of automatic pronation. The patient extends his arms forward in a state of supination; there is a tendency to pronate on the affected side.
Mingazzini's sign - lowering of the outstretched arm on the P side.
Panchenko's technique (Buddha phenomenon). The subject raises his arms up and brings his hands together above his head, palms turned upward, almost until the fingers touch. On the P. side, pronation of the hand is observed, and the hand drops down.
Mingazzini-Barre sample. In the prone position, the patient bends his legs at the knee joints at an angle of 90° and holds them for 1-2 minutes. If there is mild weakness in one of the lower limbs, it begins to droop. The test is more demonstrative if the shin is bent at an angle of 30-45° (leg drop test). You can offer the patient in a prone position to bend his legs as much as possible: on the P. side, the flexion is less pronounced (Vitek’s symptom).
Early signs of mild P.: muscle weakness, impaired tempo of movements. If there is even slight weakness of the hand, it is difficult for the patient to perform fine movements, the hand becomes tired (tired) while writing, and handwriting may change. Weakness of the hand is also determined by studying the strength of spreading or bringing together the fingers, contrasting the first finger with the others. A very early sign of hand weakness is the inability to touch the tip of the first finger to the fifth finger on the palmar surface of the hand. To study the pace of movement, it can be recommended to quickly perform maximum flexion - extension of the feet, opposing the first finger of the hand to the rest.
In newborns and infants, attention should be paid to the presence of asymmetries of movements, for which, in addition to simple observation, it is recommended to use special diagnostic techniques carried out with the child lying on his back.
Traction test. The doctor takes the child's wrists with one hand and slowly pulls him towards himself. In healthy children, uniform resistance to extension is determined.
Withdrawal reflex. Alternate tingling of the soles causes uniform flexion of the hips, legs and feet.
Cross extensor reflex. The child’s leg is extended and fixed, then several injections are made into the sole of the fixed limb. In response, extension and slight adduction of the other leg occur.
Lower limb abduction test. With a quick movement, the child’s bent legs are moved to the sides, while moderate resistance to abduction is felt.
P. must be differentiated from movement disorders that arise from damage to the muscles, osteoarticular system, ligamentous apparatus, as well as from limitation of movements due to ataxia, apraxia, and sensitivity disorders (including severe pain syndrome).
P.'s treatment depends on the location and nature of the damage to the nervous system. Prescribed medications, physiotherapeutic agents, exercise therapy, massage. Orthopedic measures and, if necessary, neurosurgical operations are carried out (see Obstetric paralysis, cerebral palsy, stroke, neuritis, polyneuritis).
The manifestation of mental discomfort, directly related to the pathological transfer of internal conflict to somatic grounds. Characterized by motor (tremor, coordination problems, aphonia, convulsions, paresis or paralysis), sensory (impaired sensitivity) and somatic disorders (impaired functioning of internal organs), as well as hysterical seizures. The diagnosis is made on the basis of serious complaints that do not correspond to reality. Therapeutic measures include psycho- and occupational therapy, general health promotion and elimination of current clinical symptoms.
General information
A sharp deterioration in condition (seizure) during hysteria is very similar to the manifestation of epilepsy. Any situation that is psychologically difficult for the patient to perceive - a quarrel, unpleasant news, the refusal of others to fulfill the patient's wishes - ends in a theatrical seizure. This may be preceded by dizziness, nausea and other signs of pseudo-deterioration.
The patient falls, bending into an arc. In this case, the patient will always fall “correctly”, trying to protect himself as much as possible from injury. Waving his arms and legs, hitting his head on the floor, violently expressing his emotions with tears or laughter, the patient portrays unbearable suffering. Unlike an epileptic, a hysteric does not lose consciousness; the reaction of the pupils is preserved. A loud shout, sprinkling cold water on the face or a slap in the face will quickly bring the patient to his senses. The patient’s complexion also gives away his complexion: during an epileptic seizure, the face is purple-bluish, and during hysteria, it is red or pale.
A hysterical attack, unlike an epileptic one, never occurs in a dream. The latter always happens in public. If the audience stops paying attention to the hysterical's convulsions or moves away, the seizure will quickly end. After an attack, the patient may exhibit amnesia, even to the point of not knowing his own first and last name. However, this manifestation is short-term; memory restoration occurs quite quickly, since it is inconvenient for the patient himself.
Hysteria is the “great simulator.” The patient speaks vividly about his complaints, excessively demonstrating their confirmation, but at the same time shows emotional indifference. One might think that the patient enjoys his many “illnesses”, while considering himself a complex person who requires close and comprehensive attention. If the patient learns about any manifestations of the disease that were previously absent, these symptoms are likely to appear.
Diagnosis of hysterical neurosis
Hysteria is the patient’s translation of his psychological problems into a physical channel. The absence of organic changes against the background of serious complaints is the main sign in the diagnosis of hysterical neurosis. Most often, patients turn to a pediatrician or therapist. However, if hysteria is suspected, the patient is referred to a neurologist. With all the variety of manifestations of hysterical neurosis, the doctor finds discrepancies between the symptoms and the real state of the body. Although the patient's nervous tension may cause some increase in tendon reflexes and tremor of the fingers, making a diagnosis of hysterical neurosis is usually not difficult.
Important! Seizures in children under 4 years of age who want to achieve their desire are a primitive hysterical reaction and are also caused by psychological discomfort. Usually, affective seizures disappear on their own by the age of 5 years.
Instrumental studies are carried out to confirm the absence of any organic changes in the internal organs. CT scan of the spine and MRI of the spinal cord are prescribed for movement disorders. CT and MRI of the brain confirm the absence of organic pathology. Angiography of cerebral vessels, rheoencephalography, and ultrasound scanning of the vessels of the head and neck are used to exclude vascular pathology. EEG (electroencephalography) and EMG (electromyography) can confirm the diagnosis of hysteria.
In case of hysteria, the data from the above studies will refute the pathology of the structures of the brain and spinal cord. Depending on the complaints that the patient confirms with certain external manifestations, the neurologist decides to schedule a consultation with a neurosurgeon, epileptologist and other specialists.
Treatment of hysterical neurosis
The essence of treating hysteria is to correct the patient’s psyche. One such technique is psychotherapy. At the same time, the doctor does not pay excessive attention to the patient’s complaints. This will only provoke an increase in hysterical attacks. However, ignoring it completely can lead to the same results. Repeated courses of psychotherapy are required to identify the true cause of the condition. A psychologist or psychotherapist, using suggestion, will help the patient to adequately assess himself and the events taking place. Occupational therapy is of great importance in hysteria. Involving the patient in work and searching for a new hobby distracts the patient from his neurotic state.
Basically it comes down to the prescription of general strengthening agents. In case of increased excitability, it is advisable to prescribe medications based on medicinal herbs (valerian, motherwort), bromine. In some cases, the use of tranquilizers in small doses and short-term courses is justified. When insomnia (prolonged insomnia) is established, sleeping pills are prescribed.
Forecast and prevention of hysterical neurosis
The prognosis for the life of such patients is quite favorable. Longer observation is required for patients with signs of anorexia, somnambulism and suicide attempts. Longer, and sometimes protracted, treatment is required for patients of the artistic type and with symptoms of hysteria that began in childhood. A more unfavorable outcome is observed when hysterical neurosis is combined with organic lesions of the nervous system or severe somatic diseases.
Prevention of hysterical neurosis includes measures to prevent mental disorders and nervous processes, as well as strengthening and preparing the nervous system for overstrain. These activities are especially important for artistic people and children.
It is necessary to somewhat limit the child’s imagination and fantasies, try to create a calm environment for him, involve him in sports and being with peers. You should not constantly indulge your whims and be surrounded by excessive care. An important role in preventing the development of hysterical neurosis is played by the correct upbringing of the child and the formation of a full-fledged personality. The patient himself should not ignore his psychological problems; a quick solution to them will eliminate the stressful situation and will not allow psychopathy to take root.
Hysterical neurosis- a group of psychogenically caused neurotic conditions with somatovegetative, sensory and motor disorders, more often at a young age, in women.
Patients are characterized by increased sensitivity, impressionability, suggestibility and self-hypnosis, mood instability and a tendency to attract the attention of others.
Clinical manifestations: 1. mental disorders– emotional and affective disorders in the form of fears, asthenia, hypochondriacal manifestations, depressed mood. Psychogenically arising amnesia is observed; under the influence of a psychotraumatic situation, everything connected with it “falls out”, is “repressed” from memory.
movement disorders
sensory disturbances
vegetative-somatic disorders: breathing disorders, cardiac activity, gastrointestinal tract.
Hysterical motor dysfunction.
Inhibition of motor function :
Hysterical paralysis and paresis (monoplegia, monoparesis), (hemiplegia, hemiparesis), (paraplegia and paraparesis), (tetraplegia, tetraparesis).
General signs of hysterical paralysis.
Before the onset of paresis or paralysis, pain or a feeling of weakness of the limb is noted.
Tendon reflexes do not change. When examining the tendon reflex, a deliberate flinch of the whole body or a demonstrative strengthening of the reflex is noted (you can make several blows with a hammer, and then just swing your hand without touching the limb, the movement of the limb will be observed, as if a blow was made with a hammer).
There are no pathological reflexes.
Muscle tone is reduced or normal.
There is no muscle atrophy.
By diverting the patient's attention from the symptoms, the function of the paralyzed limb is restored.
The patient actively resists during passive movements (all affected muscles are involved).
The localization of paralysis does not correspond to physiology. For example, with paralysis of the flexors and extensors of the hands, the full range of movement of the shoulder is preserved.
Paralysis, appearing in one situation, suddenly disappears in another. A “paralyzed” muscle may suddenly contract in a friendly manner while maintaining balance. If you take a “paralyzed” limb and let it go, it falls smoothly, and not like a whip, which is typical for organic paralysis.
When attempting active movements of a paralyzed limb, there is a demonstration of efforts to do this (exaggerated grimaces, redness of the face, muscle tension in the unaffected area).
Combination with other hysterical disorders (anesthesia, seizures, etc.).
The sudden appearance or disappearance of symptoms under the influence of strong emotional experiences.
To detect the hysterical nature of paralysis or paresis, it is necessary to observe the patient during sleep.