Conversion hysteria - A concept from psychoanalysis – the transformation of repressed mental conflict into somatic symptoms.

In psychoanalysis, it is generally accepted that conversion symptoms symbolically reflect internal conflict, while there is some benefit from the imaginary illness. Here, with conversion hysteria, the concept of “disease” is the broadest, including not only somatic disorders. This could be all the patient’s conceivable or unimaginable ideas about psychological health.

Conversion hysteria manifests itself in motor, sensory and sensory symptoms, as well as in seizure states, paralysis of the limbs, and even complete immobility. In the latter case, the triggering innate animal instinct to “pretend to be dead” finds its manifestation. And in general, hysteria in general, including conversion hysteria, is characterized by strong emotional arousal and imbalance, which triggers first one or another instinct hidden until that time.

Conversion hysteria, of course, can manifest itself not only in immobility, but also in a state of strong excitement: increased motor activity, raging, screaming, various kinds of emotional demonstrations. In common parlance, it is these active forms of hysteria that are called hysteria.

On the part of the patient, as already mentioned, a variety of complaints and “complaints” are possible, for example:

- paralysis of limbs,

– loss of sensitivity in certain areas of the skin, including anesthesia,

– deafness or blindness,

– vomiting, hiccups,

- lost appetite

– fainting,

– convulsive seizures,

– specific cough,

– pain in internal organs,

– loss of some ability (for example, writing or counting), etc. and so on.

Physical and mental “illnesses” during conversion hysteria can cause considerable suffering in their owners. Doctors and relatives often accuse such patients of malingering. The disrespectful attitude of others towards complaints often increases the torment of hysterical patients. However, understanding the cause-and-effect relationships in conversion hysteria is often very difficult. IN pure form conversion hysteria “invents” illnesses, but it should not be ruled out that there may be not only simulation, but also aggravation (exaggeration).

Often a hysterical patient is betrayed by the fact that he has little understanding of medicine, and the naivety of his symptoms is obvious to the doctor.

Often hysterical attacks are expressed in complex fantasy stories that can be analyzed in the same way as elements of dreams. In psychoanalysis, both phenomena are believed to be products of distortions arising from mechanisms in which the primary mental process is involved.

Domestic psychology and psychiatry is wary of psychoanalytic theory and practice. In any case, when treating or psychological correction, you must first carefully examine the essence of the problem. It is obvious that in many cases, behind hysteria and its “illnesses” there is not only and not so much internal conflicts as overexcitation nervous system, which may be of organic origin or be a consequence of psychosis (for example, schizophrenia).

Conversion disorder presents as a loss or deformation of motor or sensory function, indicating physiological problems when in fact no physical problems are found.

Symptoms are the result psychological needs or psychological conflict. As for the term “conversion” itself, it should be perceived as the cause of pathology, which expresses itself through somatic symptoms, being purely psychological.

A detailed study by science of this phenomenon, previously called hysteria, begins in the 19th century, while previously the disease was perceived as an ordinary simulation.

After the sensational conclusion of J.-M. Charcot everything changed when, after observing patients, he concluded that patients were actually experiencing the symptoms of a certain disease and were not pretending

Pathogenesis

Dissociative states are characterized by a sudden onset and end, and they can only be observed under the influence of hypnosis or specially developed methods of interaction.

The duration of such procedures can change or eliminate completely conversion states. Often considered pathologies can imitate the lack of sensitivity of certain parts of the body, loss of smell, deafness, blindness, and a sharp narrowing of the field of vision. No less typical for such situations are loss of motor functions, paralysis, inability to stand, walk, and loss of voice.

There is a coexistence of sensory disturbances and paralysis, for example, at the same time the patient may lose sensation in the arms and legs, as well as the ability to move them.

Behavioral manifestations of the pathology may be more severe, for example, fainting episodes, seizures similar to epileptics, and coordination problems.

Previously, conversion disorder was also defined as a symptom of pain, but modern psychiatric practice does not recognize this symptom as a symptom of a dissociative seizure. All types of phenomena in question remit after a few months or weeks, especially if the cause of their initial manifestation is a traumatic event in life.

Chronic disorders that develop gradually, characterized by amnesia and paralysis, often associated with disrupted interpersonal relationships and insoluble problems. Resistance of dissociative states in relation to therapy is detected if they manifested themselves for 1-2 years before contacting a specialist.

Types of conversion disorders

Conversion disorders manifest themselves in the following conditions.

1. Balance imbalance is presented as a permanent or short-term inability to control the position of one’s own body in space. Signs include incoordination, swaying, unexpected falls, and unsteady gait.
2. Convulsive seizures also occur, but they should be differentiated from true epilepsy. The duration of attacks can range from a couple of seconds to several minutes, and the reasons for their occurrence can be the following:

• unusual memories;
• violent movements;
• sudden feeling of fear;
• feeling a strange taste or smell;
• tingling or twitching in one or another part of the body.

Weakness in the limbs is characterized by a decrease in muscle strength in a certain part of the body, in other words, paresis. Paraparesis is weakness in both legs, hemiparesis is weakness of one limb - arm or leg. This category also includes paralysis, the manifestations of which are represented by the loss of the ability to move due to disruption of connections between nerves and muscles or disorders of the nervous system. The frequency of paresis in medical practice is significantly higher than the frequency of paralysis.

Impaired sensitivity of the limbs - tingling or numbness. The sensations in question are characteristic of the surface of the skin in a certain area and are most often accompanied by tightness, burning or chilliness.

Amnesia is characterized by the inability to remember names, dates, and current events. With such a symptom, it is important not to forget about the possibility of diagnosing alcoholism, Alzheimer's disease or multiple sclerosis.

Causes

It is generally accepted that the disease affects people with the most unstable emotional state - old people and teenagers. Statistics indicate that this phenomenon occurs much less frequently among men than among women. The following are two key reasons:

1. First of all, it is necessary to mention the psychological conflict, which helps to increase a person’s demands on others; there is no critical assessment of the situation. One’s own personality is also underestimated, and therefore the individual seeks to attract attention to himself on a subconscious level at any cost. Even at the expense of his illness, he wants to be the center of attention.
2. The psychological need to avoid social stress or some kind of psychological conflict can also cause the use of physical illness as a shield.

The reasons under consideration belong to the category of unconscious ones, it is impossible to control them, therefore even the patient himself is completely convinced that he is susceptible to a physical illness. In his opinion, everything is logical - the symptoms being tested perfectly correspond to the real disease

The finding of conversion symptoms is often associated with other psychological conditions.

An example is Briquet syndrome or antisocial personality disorders. The first disorder is considered somatized and manifests itself in the form of constant complaints about certain problems with a pronounced need for psychological support and assistance.

Rarely is an isolated conversion disorder developed by a situation of extreme psychological stress. The stability of conversion symptoms can persist for many years and over time they turn into real physiological pathologies.

As an example, it is worth citing a situation where a patient suffers from hysterical paralysis of a leg or arm, and as a result he experiences contracture of the muscles held by the limb or severe atrophy of the muscles that are not used. However, in most cases, the conversion symptom goes away much faster than the real disease begins to develop.

Risk group

Among adolescents and women, the largest number of cases with the disease in question was identified. Among the most relevant factors are the following:

• passive-aggressive, passive-dependent, or histrionic personality disorders;
• anxiety, depression or other additional mental disorders;
• genetic predisposition due to the presence of relatives in the family with chronic diseases;
• sexual or physical abuse, especially in childhood;
• presence of psychological or personality diseases in the past;
• low socio-economic status, financial difficulties;

Symptoms of the disorder

Previously, symptoms were represented exclusively by mental disorders, seizures, paralysis of varying severity and fainting, but with the help of subsequent studies it was possible to prove that there are no boundaries in this matter and manifestations can affect any human system or organ.

As a result, all symptoms are divided into four groups:

1. Motor symptoms, represented by the absence or impairment of motor function. Manifestations include pseudoparalysis, gait disturbances and much more. In the presence of other people, seizures often and suddenly occur, and they also disappear suddenly under the influence of some irritant. This could be the appearance of a new person or a loud sound. Seizures may include unnatural bending, rolling on the floor, screaming, or falling.
2. The second group includes sensory symptoms, represented by the absence or impairment of sensitivity to temperature or pain. Impaired sense of smell, taste, as well as blindness and deafness are the most pronounced symptoms. The range of sensations and duration may vary.
3. The third group is represented by autonomic symptoms, which involve the patient feeling spasms of blood vessels or smooth muscles of internal organs. In this case, imitation of almost any disease is possible.
4. Mental symptoms represent the fourth group. These may be lapses in memory, expressed by imaginary amnesia, hallucinations, delusions or harmless fantasies.

Diagnosis of the disease

Obtaining the most reliable diagnosis requires the following conditions:

• psychogenic conditioning must presuppose a clear connection between relationship disturbances, problems or stressful events over time, even if the patient denies the presence of such;
• there must be no neurological or physical impairment associated in any way with the identified symptoms;
• Clinical features should be outlined for individual disorders.

Problems that may be encountered during diagnosis:

1. Since the symptoms of a particular disease really exist, the initial stage of development of the pathology in question is quite difficult to detect. The doctor will not be able to completely rule out the present disease, so only decision The challenges will be long-term follow-up, clinical studies and numerous tests.
2. The unconsciousness of symptoms characteristic of conversion disorder makes it difficult to differentiate them from intentional ones, that is, a person can deliberately pass them off as real. If the patient truly has conversion disorder, he may consciously exaggerate the significance of his unconscious symptoms.
3. Diagnosis can be complicated by the stereotype that a person is modern society seizures and other obvious motor symptoms are not inherent and are considered an anachronism. In any case, determining the disease requires careful and long-term observation and numerous examinations.

Treatment

As with any other psychological illness, treatment for conversion disorder must be as careful and carefully planned as possible. If the patient is told that all his symptoms are fiction, there is a high risk of worsening the situation.

Modern medicine recognizes complex treatment of dissociative seizures, which involves pharmacotherapy and psychotherapy.

These directions are equal in importance and are aimed at eliminating symptoms. Their character is rather pathogenetic, but clearly not etiotropic. The time factor can also have a therapeutic effect and drug improvement can contribute to stable remission.

1. Psychotherapy in this particular case should be aimed at correctly determining the situation in which the patient finds himself. This is done in order to quietly and carefully eliminate the factors that provoke the disease. It is equally important to determine the benefit that the patient receives from the disorder. Yes, hypnosis is considered to be the most effective.
2. Drug treatment is most important in severe cases of remission or relapses. Among the popular psychopharmacological agents are tranquilizers, neuroleptics, thymoleptics, nootropic drugs, as well as psychostimulants and antidepressants.

The main role in successful treatment is played by timely initiation, since the longer the disorder lasts, the more rapidly the chances of recovery decrease.

■ Genuine conversion hysteria is quite rare in children. In reality, we see somatization mixed with neurotic and psychosomatic manifestations. Within this framework, very theatrical neuropathic attacks and neurological disorders are observed (paralysis in a pseudoepileptic attack of epileptiform hysteria).

In fact, it is more interesting to consider children's hysteria as a dramatization, a production of a fantasy, as a “language” performed in the body and through the body, to the extent that “it is visible or identifiable to another” (Ajuriaguerra, p. 686). In this case, the body is an instrument and not a victim, as in psychosomatic patients (Recamier).

This multi-role dramatization can only appear if there is sufficient differentiation of instances and objects (as established in the Oedipus stage) and if the conflict is expressed through repression or symbolization.

■ Children's physiological neurosis most often has a hysterical form. Hysterical resolution

One of those that is accessible to a child: seduction of an adult or adults, lack of saturation of contacts followed by retreat, theatricalization of conflicts, etc.

This hysterical phase can be embodied in the character structure throughout the entire period of childhood and adolescence. Some of the child’s symptoms are associated with hysteria: psychogenic mutism and somnambulism, as well as some states of stupefaction, for which it is difficult to draw a border with epilepsy (see: “epilepsy” with “deficient types of organization” p. 294).

■ Boundaries of hysteria in a child. In reality, children's hysteria is often nothing more than a mask, and the genital character of this structure seems very doubtful: relationships with another, or rather with others, are eroticized in a very extensive way, without genuine choice. Therefore, children's hysteria should be considered as a disorder of identification, which takes it beyond a strictly neurotic framework and forces us to assume:

Or depression in child malingerers, whose behavior can reach the point of self-harm;

Or psychopathy in a child-mythomaniac (whose perverse mythomania significantly exceeds the usual and normal “family romance”).

Or, in some cases, an underlying prepsychotic structure.

■ Formation of a hysterical structure in children. Adult hysteria rarely occurs in a hysterical child; it usually occurs after asymptomatic childhood neuroses, classified as “egosyntonic.”

Only the reconstruction of the past can make it possible to retrospectively discover or construct the hysterical core of childhood. Some obsessive neuroses, on the contrary, manifest themselves in childhood with hysterical features.

According to Lebovici, the future of child malingerers can vary from normal to psychotic.

Hysterical symptoms (mutism, somnambulism, seizures, etc.) can also develop in the direction of psychosis, severe characterological disorders or hysteria of fear (also called phobic neurosis).

A child with a hysterical character is apparently distinguished by a weakness of neurotic processing, combined with a very archaic core of the register of prepsychosis, depression or psychopathy. This core can make treatment nearly impossible in adulthood.

■ Metapsychology of childhood hysteria. Hysteria can be seen as a way of being, as a method of dealing with drives during the Oedipus phase. Its connections with the phallic phase are evident in both sexes. The body here can acquire meaning and the place of an absent, threatened or overvalued phallus.

It is also possible, by analogy with what 3. Freud called the difference in the maturation of the ego and libido in obsessive neurosis, to assume that the hysterical child has precociousness of libidinal development, combined with weakness of the ego. In some cases, this prematurity is undeniable, in particular in girls ( demonstrating hysteria at the same time more vivid and more harmless in comparison with hysteria in a boy, representing rather forms that are associated with mechanisms and which we are about to move on to consider).

But childhood hysteria may also have other functions: protection against orality and psychosis. She may be a false neurotic manifestation of a conformist false // (self) (Winnicott).

■ Phobias and hysteria of fear. Numerous phobias or manifestations similar to them are found in a child outside the neurotic area (see Malle). The anxiety of the eighth month can be seen as the fear of losing the maternal object, a fear displaced on an unfamiliar face. Nightmares demonstrate simple difficulties in controlling desire through orgasm and sensory release. In these two cases, one of the elements of the phobia is missing: either anxiety in front of the forbidden

genital attraction, or displacement. On the other hand, pseudophobias of a psychotic or prepsychotic nature are found, associated with overwhelming fears of decay and bodily transformation, the invasion of another (some psychotic dysmorphophobia of adolescents).

Quite common school phobias can occur at the two extreme poles of pathology.

They may be a simple defense against the parent's anxiety to see the child individuating, choosing a different pattern of identification, and the symptom being used by the child to satisfy regressive needs that can easily become a bargaining chip when it comes to the parents. Then the phobia is accompanied by intellectual inhibition. On the contrary, it can express very archaic anxiety and form the beginning of psychotic development.

Partial phobias, related to the area of ​​hysteria of fear, appear in the Oedipus phase and represent “a tool for delimiting part of the passive genital drives that the I could not restrain.” They have the functions of protecting a good parental image (and passive, love relationship to it) after splitting and projection of aggressiveness onto a phobogenic object and often manifests itself in a small boy. Modern authors insist on low tolerance in families and our society towards hysteria of fear in a boy (due to the “cultural” revaluation of the phallus and admiration for virility). Even within the framework of childhood hysteria of fear, elements of another circle appear: drive phobias, rituals, etc. OBSESSIVE MENTAL

Functional movement disorders include somatoform disorder, factitious/factitious disorder, and malingering. Somatoform disorder includes conversion disorder and somatization disorder.

Conversion means the replacement (conversion) of anxiety with somatic symptoms, which often resemble a neurological disease (for example, psychogenic paralysis).

Dissociation means the origin of symptoms from insufficient interaction between various mental functions and is manifested by symptoms of mental disorders (for example, psychogenic amnesia).

In ICD-10, the terms “dissociative” and “conversion” disorders are identical. In DSM–IV, the terms specified have different meaning: the concept of “conversion disorder” is used to define those psychologically determined disorders that are manifested by somatic symptoms; Dissociative disorders refer to disorders that involve psychological symptoms, such as amnesia ( note: the term “hysteria” is excluded from the DSM-IV and ICD-10 classifications as “compromising” and is replaced by “conversion”, “dissociation”, “histrionic personality disorder”, “psychogenic disorder”, “functional disorder”, “functional- neurological disorder".

Conversion disorder is a mental disorder involving the appearance of one or more physical symptoms that mimic a physical illness and purportedly serve to reduce anxiety.

Basic things to remember clinical features"conversions":

■ the diagnosis of conversion disorder is established only in the absence of physical or neurological disorders or in the absence of an etiological connection between conversion and these disorders (absence of an organic etiological factor);
■ conversion (conversion symptoms) - an expression of emotional conflict, that is, conversion symptoms usually develop in close connection with psychological stress and often appear suddenly;
■ conversion is always based on unconscious and unintentional mental mechanisms, that is, patients with this disorder do not realize what psychological basis causes their violations, so they cannot control them arbitrarily;
■ despite the fact that conversion symptoms are not intentional and intentional, they are formed under the influence of the patient’s idea of ​​how a physical illness should manifest itself, and in some cases, patients with conversion disorder are often conscious and intentional; in patients who are well informed about the clinical picture and course of these diseases, conversion symptoms are sometimes difficult to distinguish from a somatic or neurological disease;
■ as a rule, during conversion there is a discrepancy between the clinical picture of the conversion disorder and the clinical picture of similar somatic and neurological diseases due to the patients’ “naive” ideas about anatomical innervation; often there is an unconscious copying of the symptoms of diseases observed in others, which are extremely significant for patients, for example parents;
■ the primary unconscious benefit of conversion is the avoidance of internal psychological conflicts (for example, with dissipative amnesia, the most unpleasant events disappear from the patient’s memory);
■ the secondary (social) benefit of conversion is to receive significant benefits as a result of their illness (avoiding obligatory and difficult everyday situations, because everything is forgiven for them; they receive help, support and attention from others, which they would not have received without it); Despite the nature of secondary benefit for conversion and dissociative disorders, it cannot be used in making a diagnosis.

Conversion Types(conversion disorder). There are motor and sensory conversion disorders, as well as dissociative disorders with mental symptoms:

■ motor disorders in conversion disorder include stupor, paralysis, gait disturbances, tremors and tics, aphonia and mutism, convulsions;
■ sensory impairments include hyperesthesia, paresthesia, anesthesia, blindness, deafness and tunnel vision;
■ dissociative disorders with mental symptoms:
- (dissociative) amnesia (psychogenic amnesia);
- (dissociative) fugue (psychogenic flight reaction, dissociative flight reaction, stupor (hysterical stupor, psychogenic stupor, pseudocatatonic stupor, emotional stupor);
- Ganser syndrome (a rare condition in which dissociative memory impairment is accompanied by psychogenic somatic symptoms, visual hallucinations and twilight stupefaction);
- disorder in the form of multiple personality (dissociative identification disorder; an extremely rare condition in which a person identifies with several personalities that seem to exist in him alone);
- (dissociative) disorder in the form of trance (a disorder of consciousness with a significant decrease in the ability to respond to external stimuli).

Before moving on to the stages of diagnosing the somatic and neurological manifestations of conversion disorder, it is necessary to list those circumstances that complicate the diagnosis of conversion disorder:

■ the difficulties that a doctor encounters when diagnosing hysteria in therapeutic and neurological practice are due, first of all, to the traditional focus of the doctor on an organic disease if the patient has one or another somatic or neurological symptoms;
■ the situation is aggravated by the erroneous point of view, widespread among doctors, that gross “bodily” manifestations of hysteria were observed only in the time of Charcot and are a rarity in modern civilized society;
■ a frequent combination of conversion and organic neurological/somatic syndromes in one patient often shifts the diagnostic concept towards a more threatening and psychologically more acceptable organic suffering for the doctor and the patient; in this case, all hysterical symptoms are assessed as organic, or, in extreme cases, so-called “functional layers” are diagnosed;
■ conversion somatic and neurological syndromes traditionally imply the presence of psychogenic circumstances and characteristic personality disorders, however, in practice, only in 20% of cases do hysterical syndromes develop in patients with a hysterical personality.
■ detection of characteristic psychogenia presents significant difficulties due to the unconscious nature of the conflict, repression of traumatic circumstances from memory;
■ even greater obstacles to the adequate diagnosis of conversion disorder are created by the characteristic tendencies of exaggeration, deceit and “simulation” characteristic of this category of patients.

Stages of diagnosing somatic and neurological manifestations of conversion:

Stage 1: negative diagnosis; at this stage, the doctor, using clinical and paraclinical methods, excludes organic pathology as the cause of the symptoms presented or establishes the presence of organic pathology and determines which clinical syndromes are a manifestation of conversion and which cannot be explained based on organic damage to an organ or system;

Stage 2: positive diagnosis of conversion manifestations:
- an analysis of a somatic or neurogenic symptom is carried out by identifying its characteristic features of a psychogenic nature, as well as by searching for “polysyndromicity” and using clinical tests and provoking methods;
- analyze characteristic accompanying symptoms and syndromes (expressive behavior and speech, psychovegetative and neuroendocrine syndromes, hysterical stigmas);
- analyze the dynamic factors of the disease, features of its course, analyze personal characteristics patient (analysis of psychogenic factors).

You can obtain additional (full) information about the stages of diagnosing neurological and somatic manifestations of conversion disorder in the article by G.M. Dyukova “Basic principles of diagnosing hysteria” (Department of Nervous Diseases of the I.M. Sechenov Federal Faculty of Professional Education MMA).

Let us consider in more detail the features of conversion (psychogenic) paresis and paralysis, which are most often encountered in neurological practice. Speaking about conversion paresis and paralysis, most likely we are talking about “local akinesis”, “paralysis of movement”, and not muscles.

There are five forms of conversion paresis and paralysis:

■ stable and severe motor defect, deforming the patient’s motor appearance;
■ mild paresis within the framework of polysyndromic hysteria, heard in the complaints of patients and revealed during examination;
■ transient pseudoparesis, which usually occurs after psychogenic seizures (“Todd’s palsy”);
■ short-term pseudoparesis (weakness and numbness), usually occurring in the hand in response to a stressful (emotional) situation;
■ paresis that does not appear in complaints and is not actively presented to patients, but occurs during a doctor’s examination and is associated with his indirect suggestion.

Features of conversion paresis (compared to organic ones):

■ psychogenic patients often actively complain of weakness;
■ paresis in the arms is often lateralized, and in the legs they are usually detected on both sides;
■ upon objective examination, weakness in the limbs is more pronounced and wider in localization;
■ testing reveals the phenomenon of “stepped weakness”;
■ often pseudoparesis develops against the background of diffuse muscle hypotonia and symmetrical hyperreflexia, pathological postures and contractures are possible;

anisoreflexia, which the doctor sometimes detects during the first examination, can be caused, firstly, by voluntary inhibition or strengthening of the reflex, and secondly, by residual effects of previous somatic or neurological diseases (joint diseases, radicular syndromes, neuropathies, injuries, etc. );

■ frequent combinations with other psychogenic symptoms on the same side of the body: pain, sensitivity, motor (tremor, pseudohemispasm, etc.).

Clinical tests and diagnostic tests provide some assistance in diagnosing conversion paresis. Their fundamental basis is the inability of a patient with conversion disorder to reproduce those neurological patterns that are characteristic of organic patients. In particular, a patient with conversion disorders cannot reproduce paresis of individual muscle groups, he does not develop local atrophies, there are no pathological synkinesis, while automated movements are preserved, which is manifested in characteristic dissociations between the “impossibility” of performing voluntary movements and the preservation of involuntary movements ( supporting, expressive, defensive) in the same limbs.

As already indicated, patients with conversion disorders do not develop local atrophies, however, with prolonged forced posture of the limb, trophic changes may occur in the form of diffuse hypotrophy, swelling, discoloration and contractures. Local muscle tension in combination with intense pain and contracture (frozen shoulder syndrome) is much less common.

Since the patient is not familiar with the neurological topic, he presents symptoms that cannot be explained from the standpoint of the laws of topical diagnosis and are not observed in organic patients (for example, Babinski’s symptom, caused from the chest level, lack of vibration sensitivity on half of the skull, etc.).

One of the most famous and used tests aimed at identifying paresis in the legs is the Hoover test (C.F. Hoover, 1908). It is based on the phenomenon of physiological synkinesis, that is, involuntarily occurring friendly movements in one limb, accompanying the performance of active movements in the other. Its modification, which allows quantitative assessment of indicators in pseudoparetic and intact legs using household scales, allows the test to be used in routine neurological practice.

To identify psychogenic paresis in the hand, the test of the contralateral sternocleidomastoid muscle (m. sterno-cleido-mastoideus) - SKM test (G.M. Diukova et al., 2001) is used. The test is based on known fact that turning the head to the sides is carried out primarily with the help of the sternocleidomastoid muscles, each of which receives central innervation from both hemispheres of the brain. In this regard, lateralized cerebral lesions (strokes, tumors, foci of demyelination, etc.) do not lead to weakness of this muscle and, accordingly, despite the gross unilateral organic deficiency, sideways movements of the head are practically not impaired. In contrast, hysterical patients with lateralized pseudoparesis exhibit weakness of the muscles that turn the head in the direction opposite to the pseudoparesis.

Thus, taking into account the clinical features of conversion paresis (paralysis) and using appropriate samples and tests, a neurologist can quite accurately diagnose conversion paralysis during the initial examination.

Principles of therapy for conversion disorder. It is necessary, if possible, to eliminate traumatic circumstances or mitigate their impact. The leading method of treatment is psychoanalytic psychotherapy. In some cases, hypnosis and behavioral psychotherapy are successful. An important condition for successful treatment of conversion (conversion disorder) is the study of the patient’s social situation in order to eliminate secondary benefits from the disease. Drug therapy plays a minor role in the treatment of conversion disorders, except when they occur secondary and are caused by depressive disorders.

Psychogenic dystonia

Psychogenic movement disorders (PDD) can take the form of any known movement disorder with an organic nature. Most often, such disorders manifest themselves in the form of tremor, dystonia, myoclonus, and gait disturbances. Psychogenic dystonia is one of the most difficult conditions to diagnose in this group. Among patients who consult a doctor about dystonia, psychogenic dystonia occurs in 2 - 3% of cases.

The pathology of the extrapyramidal nervous system is a very complex branch of clinical neurology, which is associated with a number of factors: the variety of manifestations, individual variability and dynamics of extrapyramidal disorders, the lack of clear clinical and paraclinical criteria for recognizing syndromes and determining their nosological affiliation, insufficient knowledge of issues of etiology and pathogenesis, lack of development of treatment methods. Its genetic heterogeneity also plays a role in the difficulty of diagnosing idiopathic dystonia.

The clinical manifestations of idiopathic dystonia are represented by prolonged muscle contractions that lead to sustained repetitive contorting movements and pathological postures in the involved area. Dystonia has certain specific features that can only be assessed during a clinical examination; routine neurophysiological examination methods cannot be used either for diagnosis or classification of dystonia, as well as routine neuroimaging methods (MRI). Almost 90% of cases of dystonia are primary (idiopathic) dystonia, which is represented almost exclusively by dystonic hyperkinesis.

The diagnosis of PDR is based on a clinical assessment of the motor phenomenon, a detailed analysis of the medical history, as well as a number of classical signs determined during a neurological examination. Distinctive features PDRs are: sudden onset of manifestations, the presence of “incompatible” symptoms, the patient’s distractibility and suggestibility, the addition of new symptoms, lack of response to the use of effective pharmacological drugs:

Psychogenic movement disorders are the result of a mental rather than a neurological disorder, which introduces a number of features into the clinical picture of PDD, which, in turn, create additional difficulties in recognizing and interpreting the manifestations of this suffering. Psychogenic dystonia implies the presence of psychogenic circumstances and characteristic personality disorders in the patient, while in practice only in 20% of cases hysterical syndromes develop in patients with a hysterical personality, and in some cases, when testing such patients, there are no changes according to the psychological tests used. As a rule, hysterical movement disorders are accompanied by a decrease in muscle tone, the absence of asymmetry of reflexes, and the absence of muscle atrophy. One of the most common hysterical neurological phenomena is paresis. In essence, this peculiar pseudoparesis can be considered as “local akinesis” or paralysis of movement, rather than a muscle or muscle group.

There is no consensus in the literature regarding the terminology of these disorders. Some authors prefer to use the term "functional" or "conversion (hysterical)", others prefer the terms "psychogenic" or "somatoform". In practice, the term functional/psychogenic movement disorders is most often used. In the ICD-10 classifications and the updated version of ICD-10 (2016), psychogenic movement disorders can be coded in the category F45.8 “Other somatoform disorders”, in the DSM-V - in the category 300.81 “Somatoform disorder, unspecified”. According to the currently discussed version of ICD-11, psychogenic movement disorders are included in the category 7B4Z “Bodily distress disorder, unspecified.” It should, therefore, be stated that today the terminological design of the PDR remains debatable.

Used and recommended literature:

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Conversion disorder (hysterical neurosis)– a psychogenic disease with a variety of symptoms, reminiscent of a variety of disorders, in the absence of an organic cause of the disease.

Due to the pejorative assessment with which the term “hysterical” is used in everyday life, this concept is currently not used in medicine.

Conversion disorder occurs more often in at a young age, mainly in women, who are characterized by emotional instability, increased demonstrativeness, the desire to be in the center of attention, at any cost (even with the help of illness).

It is believed that the basis of hysterical neurosis is a psychological conflict associated with excessively inflated claims of the individual, combined with underestimation or complete ignorance of objective real conditions or the demands of others. He is distinguished by an excess of demands on others over demands on himself and a lack of a critical attitude towards his behavior.

Typically, the varied symptoms of this neurosis are accompanied by such manifestations as: a lump in the throat, fainting, unusual postures, and exalted behavior. The mechanism of formation of hysterical symptoms is conversion, because in this case, unpleasant mental experiences are forced out of the sphere of consciousness and transformed into a wide variety of disturbances, often unconsciously used by the patient to attract the attention of others. As a result, the illness situation itself becomes “conditionally pleasant, desirable,” which significantly complicates the treatment process.

All conversion symptoms can be divided into motor, sensitive (sensory), autonomic and mental.

Movement disorders are expressed in the form of various movement disorders (pseudoparalysis, pseudoparesis, persistent muscle spasms - contractures), gait disturbances and stuttering. A striking manifestation of hysteria are specific seizures that develop in someone’s presence, when the patient falls harmlessly slowly, after which he begins to roll on the floor, screams, arches, and so on. The seizure lasts from several minutes to several hours (with the sympathy of others) and can be interrupted by some external influence: loud sound, dousing cold water and so on.

Sensory disorders manifested by decreased sensitivity to touch, pain, and temperature effects. Sometimes hysterical blindness, deafness, loss of smell or taste occurs. Hysterical pains of varying localization and duration may also occur.

Autonomic disorders associated with spasms of the smooth muscles of internal organs and blood vessels. They can mimic any disorder. Mental disorders during hysteria can also be different, similar to mental illnesses: memory loss, hallucinations (patients see, hear, feel something that is not there), fantasies similar to delusions, disturbances of consciousness.