Hysteria is a term derived from the Greek word for the uterus, hysterika. Throughout the ages, the term hysteria has been used to describe a range of illnesses and symptoms experienced by women, with the ancient Greeks and Romans attributing it as the cause of almost every female ailment.
In the 1800s, hysteria was considered to be a psychological problem. The French psychologist Charcot used hypnosis in the treatment of women suffering from hysteria and work on hysteria by Sigmund Freud and Josef Breuer led to the development of modern psychoanalytic therapy.
Whatever the history, the fact remains that modern day psychologists consider hysteria to be categorized as two distinctive types of disorders – dissociative disorders and somatoform disorders.
Psychological disorders are dissociative disorders that involve an interruption or splitting off (dissociation) in certain aspects of mental functions such as consciousness, memory and identity. Examples of these disorders include multiple personality disorder, dissociative amnesia, dissociative fugue, depersonalization disorder and culture-bound dissociative symptoms.
Somatoform disorders are psychological disorders involving physical symptoms that manifest without an underlying physical cause. Examples of somatoform disorders include hypochondriasis, body dysmorphic disorder, pain disorder and somatization disorder.
The treatment of these different disorders will depend on the underlying cause.
Dissociative amnesia and dissociative fugue usually occur for short spells that end suddenly. However, they recur persistently, often brought on by periods of anxiety or depression. Treatment in these cases will usually focus on managing the trigger factors such as anxiety and depression.
Treatment for dissociative identity disorder focuses on attempting to integrate the different personalities into one cohesive whole. The psychoanalyst attempts to get the affected person to identify and cope with early childhood trauma that may be at the root of the disorder. In order to do this, the therapist will attempt to draw out the different personalities, working with whichever dominant personality emerges during the session to relive their traumatic experience. It is assumed that alternate personalities have developed as a coping mechanism and working through the traumatic experiences will help the person cope better with anxiety. The need to escape into an alternate personality to avoid anxiety will not exist and the personality can be made whole again.
In treating somatoform disorders such as conversion disorder, the psychoanalyst attempts to get to the root of conflicts that originate in childhood. After the conflict has been revealed and worked through, the symptoms should disappear. However, the psychoanalytic technique for treating conversion disorders has not been validated by adequate research and many professionals prefer using the behavioral approach to dealing with these types of disorders.
The behavioral approach best exemplified by cognitive behavioral therapy (CBT) has achieved a good success rate in treating somatoform disorders such as hypochondriasis and body dysmorphic disorder. The focus in this treatment is on the removal of sources of secondary gain associated with physical complaints. This teaches the affected persons to take responsibility for their selves rather than being dependent on others and rewards such behavior.
In cases of hypochondriasis, CBT helps to restructure a person’s belief system that has been distorted by the disorder. This helps to replace the person’s exaggerated illness-related belief with more rational alternatives.
The modern day approach of dealing with dissociative and somatoform disorders is however fraught with uncertainties. The biggest problem with these therapies is the dropout rate, with many patients choosing to discontinue treatment once they have been told that their problem is psychological rather than physical.
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