Causes, symptoms and treatment of hysteria (hysterical neurosis). Hysterics. Seizures in children and adults, causes, symptoms, how to prevent, help during and after hysteria Symptoms of hysteria in adults

Hysteria is a mental disorder that manifests itself in the form of a variety of functional, autonomic, motor, sensory and affective disorders. Hysteria is characterized by great self-hypnosis and the desire to attract the attention of others. The individual is able to attach symbolic and psychological value to these violations. Hysteria refers to an outdated medical diagnosis that corresponds to a range of mental disorders of moderate to mild severity. This disease often develops in individuals with neurotic character traits. Previously, this term was used for a long time in describing specific disorders of behavior and well-being in women.

Hysteria causes

The causes of hysterical behavior include internal and external factors. The disease is based on behavioral and individual characteristics of personality development, which depend on the individual’s high suggestibility and emotionality.

Hysteria refers to psychogenic pathologies that arise due to neuropsychic stress, as well as conflicts. In this case, the moment experienced by the patient is of great importance. Risk factors include certain diseases, physical stress, injuries, dissatisfaction with the professional sphere, dysfunctional family environment, alcohol abuse, irrational use of sleeping pills and tranquilizers.

Symptoms and signs of hysteria

For a long time, the signs of the disease included emotional demonstrative reactions - screams, tears, laughter, as well as paralysis, convulsions, deafness, loss of sensitivity, blindness, increased sexual activity, clouding of consciousness.

The diagnosis of hysteria was popular in medicine in the late 19th and early 20th centuries. The diagnosis is not currently officially used in either the ICD-10 or DSM-IV. The diagnosis of hysteria was divided into multiple specific diagnoses:

- anxious hysteria;

- dissociative (conversion disorders);

- hysterical personality disorder;

- somatoform disorders.

At the moment, hysteria is understood as a hysterical personality disorder, which is characterized by superficial judgments, self-hypnosis, suggestibility, the desire to attract attention, a tendency to fantasize, mood swings, and theatrical behavior.

Studies of hysteria have shown that this disorder has hysterical, theatrical, stage, histrionic qualities.

The patient also has dissociative or conversion manifestations. With the conversion form, the following symptoms are noted: tremor, paralysis, blindness, seizures, deafness. The dissociative variant is characterized by a narrowing of the field of consciousness, accompanied by selective amnesia. Superficial, pronounced personality changes are also observed, which take the form of a hysterical fugue (flight). Often the patient's behavior resembles imitation.

Hysteria is diagnosed if three or more signs are observed:

- suggestibility, susceptibility to circumstances and the influence of others;

- self-dramatization, exaggerated expression of emotions;

- lability and superficiality of emotionality;

- preoccupation with physical attractiveness;

- the desire for excitement, the desire to be recognized and to be the center of attention;

- inadequate seductiveness in behavior and appearance.

Additional personality traits include self-centeredness, an insatiable desire to be recognized, self-indulgence, a tendency to be easily offended, and constant manipulative behavior to satisfy personal needs.

A hysterical personality is distinguished by a desire to always feel in the center of attention, a desire for provocative, seductive behavior; shallow, changing emotions; using your appearance to attract attention; changeable and fluid style of speech with insufficient attention to detail; display of self-dramatization and exaggerated, theatrical emotions; easy suggestibility.

Researchers attribute hysteria to one of the types of neuroses, which is associated with an excessive tendency to self-hypnosis and suggestion, as well as the inability to consciously control one’s own behavior.

A hysterical personality is characterized by various disorders of the motor sphere, psyche, and sensitivity. It is characterized by seizures, disturbances of consciousness and adequate functioning of internal organs.

Hysteria is determined by demonstrative behavior. Sick individuals are characterized by weak intensity of experiences, and their external expression is quite exaggerated - crying, screaming, fainting, which are aimed at attracting attention.

The duration of a hysterical attack depends on how much attention and time is given to the patient. More attention - the hysterical attack will last longer.

Hysteria in women and children is quite common; the occurrence of a hysterical attack in men is rather an exception. Often this condition acts as a protest and provocation in order to attract attention and gain benefits. The attack is characterized by a manifestation during the daytime, which is preceded by an unpleasant, stormy experience.

Treatment of hysteria

Hysterical seizures can last quite a long time, so it is important to be able to provide proper first aid.

Firstly, it is necessary to be able to differentiate a hysterical attack from an epileptic seizure, since they have much in common, but require different first aid measures.

During an attack, falling, the patient creates an impression of suddenness around himself, but he does not get injured because he does it carefully and slowly. A hysterical personality exhibits convulsive movements of the limbs, which are characterized by an erratic nature and theatrical expressiveness, while consciousness is preserved. There is no foamy discharge from the mouth, there is no biting of the tongue, there is no involuntary urination or defecation. There is a reaction to light, no sweating, and normal breathing. After an attack, a hysterical person remembers everything and does not fall asleep. During an attack, the patient does not make specific demands, for example, to administer a specific drug. After the cessation of the hysterical attack, the patient is able to continue his activities, which is impossible with withdrawal syndrome or after an epileptic seizure.

Treatment of hysteria includes the following first aid measures:

- calming the patient;

- transferring the patient to a quiet place;

— removal of unauthorized persons;

- give ammonia a sniff;

- stay at some distance from the patient, thereby not paying much attention;

- you must not leave the patient unattended and try to hold him by the shoulders, arms or head.

Treatment of hysteria requires the help of a psychiatrist. The specialist will carefully analyze the current situation and select the necessary therapy. Those close to you will need an attentive, calm attitude towards the patient, since worry and anxiety can become an obstacle on the path to recovery. Often, the doctor uses an integrated approach to treatment, accompanied by an impact on various levels of innervation - somatic and autonomic. Medications used in treatment include psychotropic medications and restorative procedures. Great importance is given to autogenic training, suggestion, and methods of persuasion. To carry out effective treatment, it is necessary to establish the cause that provoked neuropsychic exhaustion and try to reduce or completely eliminate its significance.

Treatment of hysteria in women depends on the form of the condition. There are two groups of clinical symptoms of the disease.

The first includes hysterical behavior, and the second includes hysterical attacks, accompanied by impaired sensitivity, disorders of consciousness, functioning of internal organs and movements.

Hysterical behavior is marked by vivid mental experiences, predominance, as well as sensitivity to external stimuli and an incredible desire to be in the center of attention in order to show off. To achieve these goals, nothing will stop a woman: she will constantly pretend, deceive, flaunt unusual character traits, express other people’s thoughts and commit actions that do not correspond to her ethical and moral character. Often such a woman is a good theatergoer.

A woman’s hysteria can occur after a strong experience, and subsequent seizures occur when the patient remembers the experience. The first stage of a seizure begins with a sensation of constriction in the throat and is marked by sobbing, screaming, erratic movements, and scratching or bruising. Consciousness is preserved, and the patient will never cause herself great harm.

Some cases of such disorders persist in women throughout their lives, this indicates hysteria. The same picture is observed after concussion or other diseases.

Female hysteria can be successfully treated on an outpatient basis, but its severe forms require therapeutic treatment in a hospital setting.

Treatment of hysteria in children is successfully carried out with false injections using placebo, simple suggestions, as well as stay in a psychoneurological hospital. Raising hysterical children is a big problem; it often requires the involvement of a specialist. Efficiency in treating the disease largely depends on getting rid of the traumatic situation. Repeated and prolonged mental trauma often causes a protracted course of the disease, which is accompanied by frequent relapses.

We use the expression “throw a tantrum” quite often, but few people think about the fact that this is not simple behavioral promiscuity, but a real disease, with its own symptoms, clinic and treatment.

What is a hysterical attack?

A hysterical attack is a type of neurosis, manifested by indicative emotional states (tears, screams, laughter, arching, wringing of hands), convulsive hyperkinesis, periodic paralysis, etc. The disease has been known since ancient times; Hippocrates described this disease, calling it “rabies of the uterus,” which has a very clear explanation. Hysterical fits are more typical for women, they are less likely to bother children and occur only as an exception in men.

Professor Jean-Martin Charcot shows students a woman in a hysterical fit

At the moment, the disease is associated with a certain personality type. People subject to attacks of hysteria are suggestible and self-hypnosis, prone to fantasizing, unstable in behavior and mood, love to attract attention with extravagant actions, and strive to be theatrical in public. Such people need spectators who will babysit and care for them, then they receive the necessary psychological release.

Often, hysterical attacks are associated with other psychosomatic deviations: phobias, dislike of colors, numbers, pictures, conviction of a conspiracy against oneself. Hysteria affects approximately 7-9% of the world's population. Among these people there are those who suffer from severe hysteria - hysterical psychopathy. The seizures of such people are not a performance, but a real disease that you need to know, and also be able to provide assistance to such patients. Often, the first signs of hysteria appear already in childhood, so parents of children who react violently to everything, bend over backwards, and scream angrily should be shown to a pediatric neurologist.

In cases where the problem has been growing for years and an adult is already suffering from severe hysterical neuroses, only a psychiatrist can help. An examination is carried out individually for each patient, an anamnesis is collected, tests are taken and, as a result, specific treatment is prescribed that is suitable only for this patient. As a rule, these are several groups of drugs (hypnotics, tranquilizers, anxolytics) and psychotherapy.

Psychotherapy in this case is prescribed to reveal those life circumstances that influenced the development of the disease. With its help, they try to level out their significance in a person’s life.

Symptoms of hysteria

A hysterical attack is characterized by an extreme variety of symptoms

A hysterical attack is characterized by an extreme variety of symptoms. This is explained by the self-hypnosis of patients, “thanks to” which patients can depict the clinic of almost any disease. Seizures occur in most cases after an emotional experience.

Hysteria is characterized by signs of “rationality”, i.e. the patient experiences only the symptom that he “needs” or is “beneficial” at the moment.

Hysterical attacks begin with hysterical paroxysm, which follows an unpleasant experience, a quarrel, or indifference on the part of loved ones. A seizure begins with the corresponding symptoms:

• Crying, laughing, screaming
• Pain in the heart area
• Tachycardia (rapid heartbeat)
• Feeling short of air
• Hysterical ball (feeling of a lump rolling up to the throat)
• The patient falls, convulsions may occur
• Hyperemia of the skin of the face, neck, chest
• Eyes are closed (when trying to open, the patient closes them again)
• Sometimes patients tear their clothes, hair, and hit their heads

It is worth noting features that are not characteristic of a hysterical attack: the patient has no bruises, no bitten tongue, the attack never develops in a sleeping person, there is no involuntary urination, the person answers questions, there is no sleep.

Sensitivity disorders are very common. The patient temporarily ceases to feel parts of the body, sometimes cannot move them, and sometimes experiences severe pain in the body. The affected areas are always varied, these can be the limbs, the abdomen, sometimes there is a feeling of a “driven nail” in a localized area of ​​the head. The intensity of the sensitivity disorder varies, from mild discomfort to severe pain.

Sensory organ disorder:

• Visual and hearing impairment
• Narrowing of visual fields
• Hysterical blindness (can be in one or both eyes)
• Hysterical deafness

Speech disorders:

• Hysterical aphonia (lack of sonority of voice)
• Muteness (cannot make sounds or words)
• Chant (syllable by syllable)
• Stuttering

A characteristic feature of speech disorders is the patient’s willingness to enter into written contact.

Movement disorders:

• Paralysis (paresis)
• Inability to perform movements
• Unilateral paresis of the arm
• Paralysis of the muscles of the tongue, face, neck
• Trembling of the whole body or individual parts
• Nervous tics of facial muscles
• Arching the body

It should be noted that hysterical seizures do not mean real paralysis, but an elementary inability to make voluntary movements. Often, hysterical paralysis, paresis, and hyperkinesis disappear during sleep.

Disorder of internal organs:

• Lack of appetite
• Swallowing disorder
• Psychogenic vomiting
• Nausea, belching, yawning, cough, hiccups
• Pseudoappendicitis, flatulence
• Shortness of breath, imitation of an attack of bronchial asthma

The basis of mental disorders is the desire to always be the center of attention, excessive emotionality, inhibition, psychotic stupor, tearfulness, a tendency to exaggerate and the desire to play a leading role among others. All the patient’s behavior is characterized by theatricality, demonstrativeness, and to some extent infantilism; one gets the impression that the person is “glad about his illness.”

Hysterical seizures in children

Symptomatic manifestations of mental seizures in children depend on the nature of the psychological trauma and on the personal characteristics of the patient (suspiciousness, anxiety, hysteria).

The child is characterized by increased sensitivity, impressionability, suggestibility, selfishness, mood instability, and egocentrism. One of the main features is recognition among parents, peers, society, the so-called “family idol”.

For young children, it is common to hold their breath when crying, provoked by the child’s dissatisfaction or anger when his requests are not satisfied. At older ages, the symptoms are more varied, sometimes similar to attacks of epilepsy, bronchial asthma, and suffocation. The seizure is characterized by theatricality and lasts until the child gets what he wants.

Less commonly observed are stuttering, neurotic tics, blinking tics, whining, and tongue-tiedness. All these symptoms arise (or intensify) in the presence of persons towards whom the hysterical reaction is directed.

A more common symptom is enuresis (bedwetting), which often occurs due to changes in the environment (a new kindergarten, school, home, the appearance of a second child in the family). Temporarily removing the baby from a traumatic environment can lead to a decrease in diuresis attacks.

Diagnosis of the disease

The diagnosis can be made by a neurologist or psychiatrist after the necessary examination, during which an increase in tendon reflexes and tremor of the fingers are noted. During the examination, patients often behave unbalanced, may groan, scream, demonstrate increased motor reflexes, spontaneously shudder, and cry.

One of the methods for diagnosing hysterical seizures is color diagnostics. The method represents the rejection of a certain color during the development of a particular condition.

For example, a person dislikes the color orange; this may indicate low self-esteem, problems with socialization and communication. Such people usually do not like to appear in crowded places; it is difficult for them to find a common language with others and make new acquaintances. Rejection of the color blue and its shades indicates excessive anxiety, irritability, and agitation. Dislike for the color red indicates disturbances in the sexual sphere or psychological discomfort that arose against this background. Color diagnostics is currently not very common in medical institutions, but the technique is accurate and in demand.

First aid

It is often difficult to understand whether the person in front of you is sick or an actor. But despite this, it is worth knowing the mandatory first aid recommendations in this situation.

Do not persuade the person to calm down, do not feel sorry for him, do not be like the patient and do not fall into panic yourself, this will only encourage the hysteroid even more. Be indifferent, in some cases you can go to another room or room. If the symptoms are violent and the patient does not want to calm down, try to splash cold water on his face, bring him to inhale the vapor of ammonia, give a gentle slap in the face, press on the painful point in the elbow fossa. Do not indulge the patient under any circumstances; if possible, remove strangers or take the patient to another room. After this, call the attending physician; do not leave the person alone until the medical worker arrives. After an attack, give the patient a glass of cold water.

During an attack, you should not hold the patient’s arms, head, neck or leave him unattended.

To prevent attacks, you can take courses of tinctures of valerian, motherwort, and use sleeping pills. The patient’s attention should not be focused on his illness and its symptoms.

Hysterical seizures first appear in childhood or adolescence. With age, clinical manifestations smooth out, but in the menopause they can again appear and worsen. But with systematic observation and treatment, exacerbations pass, patients begin to feel much better, without seeking help from a doctor for years. The prognosis of the disease is favorable if the disease is detected and treated in childhood or adolescence. We should not forget that hysterical fits may not always be a disease, but only a personality trait. Therefore, it is always worth consulting with a specialist.

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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 itself hysteria" 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.

Clinical manifestations hysteria, according to the medical sources of that time that have come down to us, 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.

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 seizures are 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 early accustomed her to 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 in 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), where their connection with epilepsy is indicated (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 the skating rink 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 layers. 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 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, and 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. Other hysterical disorders include aphonia and mutism. Aphonia is the absence 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 - a 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.

Hysteria is a mental disorder belonging to the general group of neuroses. Hysterical neurosis is considered the second most common among all existing neurotic disorders. This disease is known from antiquity, the clinical picture of which was described by doctors of ancient Greece. And the very concept of “hysteria” is of Greek linguistic origin, which translated from Greek means “womb”. Because at that time it was believed (and until the beginning of the twentieth century) that this disorder occurs only in women.

Hysterical neurosis is a very complex and unusual disease, over which a halo of mythicality and mystery hung for a very long time. In addition, this disorder, like no other, is not characterized by such pronounced and varied pathomorphism. That is, the variability of symptoms. The clinical picture of this disease often changes, and some signs disappear altogether. This is mainly due to changes in the social structure of society, global changes in values. The symptoms of modern patients are becoming less demonstrative and stage-like, and the most severe symptoms do not appear at all or appear mildly. However, the main features that distinguish this mental illness from others remain unchanged.

Hysterical neurosis: characteristics of the disease

Hysterical neurosis is a set of neurotic conditions and disorders caused by a psychogenic nature. It is characterized by somatic, mental, autonomic, sensory and motor disorders. Such a diagnosis is made only on the basis that all of the above disorders that may be observed in the patient are not caused by organic disorders of the body.

This disorder is interesting from a medical point of view because it often disguises itself as other, very diverse neurological diseases. For which it received the metaphorical name in medical circles “the great malingerer.” Because the main sign of the disease are symptoms that always have only a psychogenic nature.

Hysteria should not be confused with hysterical syndrome. Because it is one of the symptoms of other mental or neurological diseases and disorders.

Hysterical neurosis occurs much more often in women than in the opposite sex. This disease most often begins to develop at a young age. It is chronic in nature with periodic exacerbations and relapses. With age, in female representatives, the symptoms and signs of the disease practically disappear, and during menopause they can reappear. They can also suffer from hysteria in adolescence and adolescence under the influence of a pronounced traumatic factor in the form of systematic oppression of the individual or, conversely, in a situation of overprotection and spoiling of the child - the “idol of the family.”

Causes of the disease

Hysterical neurosis most often occurs in persons with a hysterical type of character, which is characterized by such manifestations as infantilism, egocentrism, selfishness, and excessive impressiveness. A person with a hysterical character is inclined to blame others for his troubles and misfortunes, mistakes and defeats, while completely abdicating responsibility. A sharp change in mood, intense sadness or joy for no apparent reason, a certain theatricality and artificiality of experiences, an uncontrollable desire to attract attention to oneself in any way, a desire for recognition are also very characteristic of the hysterical personality type.

However, this disease can develop in almost any person, regardless of his psychotype. And the main reasons for this are an acute traumatic factor that led to a breakdown of mental mechanisms, or a conflict situation that is long-term in nature.

Symptoms of hysterical neurosis

This disease is characterized by a large number of symptoms, which tend to change from time to time. In most cases, certain signs of the disease appear according to the principle of self-hypnosis. And very often the symptoms that appear reflect the patient’s ideas about this disease.

The symptoms and clinical manifestations of the disease are very specific and individual, since they are based on the principles of “conditional desirability”. And the reasons for the appearance of certain symptoms are determined by how “beneficial” and “needed” it is for the patient in specific conditions.

Symptoms of the disease can be not only mental, but often somatic. With hysteria, disturbances may occur:

• motor (paralysis, numbness of the limbs, mutism, astasia-abasia, and many others);
• sensory (vision loss, hearing loss, auditory hallucinations);
• vegetative (arrhythmia, increased sweating, breathing and gastrointestinal problems, sexual dysfunction).

In fact, all vegetative-somatic and other symptoms are a kind of conversion response, subordinated to the displacement of mental conflict or trauma to the physiological level, the desire to “benefit” from one’s own illness.

Possible disorders in hysterical neurosis

Paroxysm or hysterical attack

Basically, this disorder begins to manifest itself as a hysterical attack, which is characterized by a number of distinctive features. A seizure usually occurs as a result of an experience of an unpleasant and conflicting nature. A hysterical attack almost always begins with autonomic disorders (difficulty breathing, redness of the skin, rapid pulse, slight tingling in the heart area). The patient may begin to cry sharply or cry and laugh at the same time. He falls to the floor and convulsions begin, usually tonic. When falling in a seizure, the patient never hits or bites his tongue. The face always turns red, the eyes are closed, and the pupils react to light. The seizure never begins in a state of sleep, consciousness is fully or partially preserved. During a seizure, the patient may scream or moan, bang his head on the floor or walls. The movements are often theatrical. Sometimes the clinical picture of paroxysm is less pronounced.

A hysterical seizure differs from an epileptic seizure in a number of features: the patient never bites his tongue, voluntary urination does not occur, in epileptics the face turns blue or purple during an attack, in hysterics it turns red.

Sensory (sensitive) disorders

Sensory disturbances are also the most common symptoms of this disease. These include hysterical pain, hypoesthesia (numbness of the limbs), anesthesia (complete or partial loss of sensitivity to pain), hyperesthesia (increased sensitivity at the level of the entire sensory system).

Most often, patients experience pain, which can be of a different nature and concentrated in different parts of the body. Such pain can be either mild or severe. Moreover, their causes always have a purely psychogenic basis.

This also includes visual and auditory impairments (“hysterical” blindness or deafness). At the same time, no organic disorders of these organs are observed. And even with bilateral blindness, the patient retains visual perception.

Speech disorders

Speech disorders manifest themselves in the form of aphonia (speech switching to a whisper), stuttering, mutism, scanning (communication in syllables).

Hysterical mutism is manifested by the inability to pronounce not only words, but also sounds; the pharynx or tongue may become numb. The cough with mutism is always loud, and patients willingly make contact with others through writing or gestures. Mutism can be interrupted abruptly or gradually, flowing into aphonia or stuttering. Stuttering during hysteria is not accompanied by contraction of the facial muscles or convulsive movements.

Motor disorders

Motor or motor disorders are manifested by paralysis of the face, arms or legs, less often the neck and tongue suffer. Contracture may also be observed - a violation of movement in a joint, in which it is impossible to fully bend or straighten the limbs in one or several joints at once. Other types of movement disorders include weakening of the muscles of the neck or spine, hysterical torticollis, inability to stand or walk, trembling in the body or in certain parts of it, tics and other hyper- and hypokinesis may be observed. With hysteria, all manifestations of motor disorders disappear during sleep.

Somatic disorders

Patients with hysterical neurosis may experience symptoms of disorders of the gastrointestinal tract: lack of appetite, psychogenic vomiting, flatulence, difficulty swallowing. Coughing, hiccups, pain in the heart area, a sharp decrease in libido, headaches, and attacks of pseudobronchial asthma may also appear.

Mental disorders

Since the basis of the disease is the hysterical character of the individual, all its manifestations can be classified as mental disorders. These are capriciousness, infantilism, excessive sensitivity, sudden mood swings, egocentrism, tearfulness, exaggeration of the importance of many insignificant events.

The behavior of patients is characterized by pretense, “playing for the public”; there seems to be nothing natural, simple and natural in it.

It may seem that a person suffering from manifestations of this disease is very happy about his illness. The patient almost always demonstratively emphasizes the severity of his disorder, complaining of his unbearable suffering and terrible pain. And at the same time, he does not try to get rid of this condition. Because for the patient this is an opportunity for psychological protection through illness - “escape into illness.” Thus, the patient does not need to accept the problem, fight it and take responsibility for its solution.

A person suffering from this neurosis strives for recognition and the constant attention of others to his person.

All of the above symptoms may be less or more pronounced, but they are always aggravated in an unfavorable situation for the patient. Behavior becomes as theatrical as possible, disposition becomes even more one-personal, the patient concentrates on himself and his own illness. Disorders of a hysterical nature can be long-term or short-term, chronic with sudden relapses. The intensity of symptoms depends on how quickly and how much the patient can achieve through his behavior. But in practice this does not happen. Even if it is possible to achieve the realization of short-term goals and desires, in the long term the opposite is true. Family and professional relationships inevitably collapse, and one’s own life gradually turns into one continuous disease.

Manifestations of incontinence and excessive emotionality, nervous attacks, tears and screams are sometimes not just a manifestation of an absurd character and whims. These symptoms are nothing more than signs of a hysterical disorder, which affects people of any age and both sexes.

What is hysteria?

A mental disorder of mild to moderate severity is hysteria. It is an outdated medical diagnosis, which corresponds to a number of mental abnormalities of behavior and well-being. For a long time, hysteria was considered a female disease, and its cause was seen in the “untying” and “wandering” of the uterus, which, of course, is not true. But this is where the popular name for the disease comes from - “uterine rabies”.

Hysteria in psychology

The diagnosis of hysteria was first described by Hippocrates, then Plato spoke about it, characterizing it as “rabies” into which the uterus falls, unable to conceive. It was believed that the manifestation of the syndrome in men was impossible. Nowadays, the term refers to neurosis that occurs in an individual with hysterical personality traits. His actions are determined by emotions, often exaggerated and dramatized, rather than by reason. Hysterical individuals strive to emphasize their exclusivity and demonstrate openly provocative behavior.

This neurotic disease hysteria has a variety of clinical manifestations. The nature of the disease is a disorder of motor and visual functions, mental states of the patient. Hysterical personalities are self-centered, easily suggestible, demonstrative and flirtatious, and prone to fiction. They show increased demands and claims towards others, but not towards themselves.

Hysteria according to Freud

Hysteria was considered and analyzed in psychoanalysis by Sigmund Freud, who classified it among neuroses and distinguished it from phobia. He made a great contribution to the study of the disease and proved the possibility of its development in men. According to Freud, hysteria occurs due to the fact that a person represses an unbearable memory from consciousness, but it does not disappear. An affect is formed that becomes the cause of excitement. You can get rid of hysterical syndrome with the help of psychoanalysis.

Hysteria - reasons

Not only external, but also internal factors can cause pathology, but the basis of hysteria is always the individual behavioral characteristics of a person. The weaker an individual is emotionally, the more likely he is to develop the disease. Pathology occurs after conflicts and neuropsychic stress. An attack of hysteria can be caused by factors such as:

• injuries;
• physical overload;
• some somatic diseases;
• job dissatisfaction;
• dysfunctional family situation;
• alcohol or drug abuse;
• uncontrolled use of tranquilizers and sleeping pills.

Types of hysteria

Sigmund Freud, in his analytical works, distinguished what kinds of hysteria there are. He identified two types of this pathology: hysteria of fear and conversion hysteria. In the first case, the patient does not overcome his phobia (today this diagnosis is called phobic neurosis). Obsessions arise against a person's will. Conversion hysteria is characterized by the patient’s attempt to cope with his problem by translating mental conflict into physical symptoms. In both cases, the main feature of the development of the disease is protection from internal experiences and conflicts through repression.

Hysteria - symptoms and signs

There are many signs of this disease - for many centuries the cause was considered to be the “wandering” of the uterus in the woman’s body. The symptoms are still not clear, and recognizing the syndrome is not easy. The main signs of hysteria are considered to be:

The diagnosis is confirmed if three or more symptoms are observed. Although previously all abnormal over-emotional behavior was characterized as demonstrative hysteria. Screaming, laughter and tears, paralysis, deafness, convulsions, increased sexual activity - all these were signs of a developing disease. Only later did the diagnosis break down into types with great specificity: those identified by Freud, somatoform and personality disorders.

Hysteria in women - symptoms

The weaker sex is more emotional; suspicious individuals are especially susceptible to neuroses and mood swings. There is also such a diagnosis as hysteria before menstruation, when women become depressed and become whiny and irritable. But the disorder depends on the state of the body, not. The female hysteria in question is a form of neurosis and manifests itself in unconscious behavior and the inability to control one’s thoughts and actions.

The main signs of hysteria are: self-centeredness, touchiness, desire to manipulate, suggestibility, superficial emotionality. Disorders can be observed throughout life. The duration of the attack depends on how much attention is paid to the patient. Hysterical personalities are dependent on the opinions of others and play to the public.

Hysteria in men - symptoms

Approximately the same symptoms and course of the disease are observed in representatives of the stronger sex. The patient tries to attract maximum attention to himself, but there is also a strong change in behavior. Actions in familiar situations are non-standard. Hysteria in men has the following interesting symptoms:

• frequent mood swings from laughing to crying;
• unsure gait “with unsteadiness”;
• complaints of lack of air and pain in the heart;
• headache;
• lack of sensation in some parts of the body.

Hysteria in children - symptoms

As a type of neurosis, childhood hysteria is a fairly common occurrence. It is observed in children of different ages, often accompanied by outbursts of anger and astasia-abasia syndrome, when the child refuses to walk and randomly moves his legs and arms. Seizures can result in convulsions, paralysis, auditory and visual impairment. Older children exhibit theatrical behavior. Young patients are very vulnerable, require increased attention, love to fantasize and lie. When surrounded by other people, a child may demonstrate unexpected and unnatural behavior.

How to cure hysteria?

The main factor in successful treatment is identifying the main cause that gave impetus to the development of neuropsychic exhaustion. Then you need to completely eliminate it or reduce its significance as much as possible. It is important to understand what the doctors’ efforts will initially be aimed at: relieving acute symptoms or solving an internal conflict.

Mental imbalance should not be ignored, and at the first signs of the syndrome, treatment should be applied so that the neurosis does not become chronic. Hysteria is treated by psychotherapists. After doctors have studied the nature of the pathology and symptoms, conversations with the patient and relatives, the patient is prescribed psychotherapeutic sessions, and sometimes hypnosis. Psychoanalytic therapy can change the patient's worldview. Medication treatment is also possible - taking sedatives - but they are ineffective for personality disorder.

Hysteria - treatment with folk remedies

Since the disease hysteria has been known since ancient times, there are many folk methods for getting rid of it. Until now, they are useful, effective and can be an addition to the main course of treatment. At home, the patient's condition can be significantly alleviated by the use of medicinal herbs: valerian, mint, chamomile, lemon balm, infusion of hop cones. Herbal infusions and decoctions can be added to baths. Royal jelly has a positive effect on the nervous system. It must be taken in a course, eating a teaspoon every day for 10 days.

Hysterical syndrome is a serious illness, and its treatment should be treated very responsibly. It is important to take only proven medications and high-quality ingredients, and to maintain contact with a psychotherapist. An integrated approach to eliminating the problem will help get rid of hysteria or significantly reduce its manifestations and alleviate the patient’s condition.