Hysteria

The term "hysteria" has been in use for more 2000 years and its definition has become broader and more diffuse over time. In modern psychology and psychiatry, hysteria is a feature of hysterical disorders in which a patient experiences physical symptoms that have a psychological, rather than an organic, cause; and histrionic personality disorder characterized by excessive emotions, dramatics, and attention-seeking behavior.

Patients with hysterical disorders experience physical symptoms that have no organic cause. These patients are not "faking" their ailments, as the symptoms are very real to them. Disorders with hysteric features typically begin in adolescence or early adulthood.

Histrionic personality disorder is found in approximately 2-3% of the general population. It begins in early adulthood and has been diagnosed more frequently in women than in men. Histrionic personalities are typically self-centered and attention seeking. They operate on emotion rather than fact or logic, and their conversation is full of generalizations and dramatic appeals. While the patient's enthusiasm, flirtatious behavior, and trusting nature may make them appear charming, their need for immediate gratification, mercurial displays of emotion, and constant demand for attention often alienates them from others.

Hysteria may be a defense mechanism to avoid painful emotions by unconsciously transferring this distress to the body. Symptoms may mimic a number of physical and neurological disorders which must be ruled out before a diagnosis of hysteria is made.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), individuals with histrionic personality possess at least five of the following symptoms or personality features:

• A need to be the center of attention
• Inappropriate, sexually seductive, or provocative behavior while interacting with others
• Rapidly changing emotions and superficial expression of emotions
• Vague and impressionistic speech (gives opinions without any supporting details)
• Easily influenced by others
• Believes relationships are more intimate than they are.

Hysterical disorders frequently prove to be actual medical or neurological disorders, which makes it important to rule these disorders out before diagnosing a patient with hysterical disorders. In addition to a patient interview, several clinical inventories may be used to assess the patient for hysterical tendencies, such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) or the Millon Clinical Multiaxial Inventory-III (MCMI-III). These tests may be administered in an outpatient or hospital setting by a psychiatrist or psychologist.

For people with hysterical disorders, a supportive healthcare environment is critical. Regular appointments with a physician who acknowledges the patient's physical discomfort are important. Psychotherapy may be attempted to help the patient gain insight into the cause of their distress. Use of behavioral therapy can help to avoid re-enforcing symptoms.

Psychotherapy is generally the treatment of choice for histrionic personality disorder. It focuses on supporting the patient and on helping them develop the skills needed to create meaningful relationships with others.

The outcome for hysterical disorders varies by type. Some may last a lifetime, others for only a few months. Symptoms of hysterical disorders may suddenly disappear, only to reappear in another form later.

Individuals with histrionic personality disorder may be at a higher risk for suicidal gestures, attempts, or threats in an effort to gain attention. Providing a supportive environment for patients with both hysterical disorders and histrionic personality disorder is key to helping these patients.