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ORIGINAL CONTRIBUTION |
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| Year : 2000 | Volume
: 54
| Issue : 8 | Page : 335-338 |
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Hysterical aphonia - an analysis of 25 cases
MS Bhatia1, Laxmi Vaid2
1 Department of Psychiatry, University College of Medical Sciences & Guru Teg Bahadur Hospital, Dilshad Garden, Delhi-110095, India
2 Department of ENT University College of Medical Sciences & Guru Teg Bahadur Hospital, Dilshad Garden, Delhi-110095, India
Correspondence Address:
M S Bhatia
D-1, Naraina Vihar, New Delhi 110028
India
PMID: 11143747
How to cite this article:
Bhatia M S, Vaid L. Hysterical aphonia - an analysis of 25 cases. Indian J Med Sci 2000;54:335-8 |
Term "Hysteria" has been derived from Greek word 'Hysteria' (uterus). As defined by Hippocrates, it is considered to be due to the diabolic possession in the middle ages. In simple Non Fredian terms, conversion is an unconscious expression of emotional conflicts in the form of physical symptoms. It is this unconscious expression that differentiates conversion hysteria from malingering or hypochondriasis. Earlier, hysteria was considered to be a female disease, but many studies have found it more common in females than males. [1],[2],[3],[4],[5] The incidence has been reported to be 6.5 to 10.6% in various studies probably because of variations in the diagnostic criteria used by different workers. [2],[3],[6],[7] Some of the prestntations of hysteria have not been studied in detail. They include aphonia which is defined as `loss of speech'. Hysterical aphonia is defined as functional loss of speech due to hysteria, also called bilateral adductor paralysis. Therefore the present study was undertaken to find out the sociodemographic and clinical details of hysterical aphonia.
| ¤ Material and Methods | |  |
The present study was conducted in a tertiary care teaching hospital. All the consecutive cases of hysterical aphonia were studied over a period of three years (August 1996 to July 1999). All the patients were subjected to detailed history taking, physical examination and mental status examination. Relevant blood and radiological (CT Scan etc) investigations were done wherever required to assess the physical status. Indirect laryngoscope was done in every case to rule out the organic involvement of larynx. The patients having unreliable history and doubtful organi city were excluded. The associated comorbid psychiaric disorder was classified according to ICD-10 (WHO, 1992). The sociodemographic and clinical details alongwith percipitating factors of the cases with hysterical aphonia were analysed at the end of the study period.
| ¤ Results | | |
Out of total 796 cases of conversion disorder seen during the study period, 25 (3.2%) were having aphonia. There were 17 females and 8 males [Table 1]. Stress at examination or failure was the comma nest precipitating factor [Table 2].
| ¤ Discussion | | |
The incidence of hysteria in our psychiatric unit is estimated to be between 6-8%. [8] This is in comparison to 6.5% to 10.6% reported in various studies. [2],[3],[9],[10],[11] probably due to variations in the diagnostic criteria and the population studied. The incidence of hysterical aphonia among conversion disorder cases was 3.2%. There were 17(6.8%) females and 8 (32%) males. Hysteria has been reported to be more common in females. [1],[2],[3],[4],[5] Mean age among females and males were 18.4 years and 21.2 years respectively. The age of onset reported by most of the workers2-4, 10, 12-14 is usually in adole scene or early childhood.
Majority of studies 3, 8, 10, 13 have reported hysteria to be common among illiterate group or those who studied upto school levels. The present study, including all the conversion hysteria cases, also is in consensus with the above findings whereas in the hysterical aphonia group, majority of causes have studied upto primary class or high school.
high school. In contrast to a number of studies3, 4, 8, 14, 15 a majority (60%) in the present study belonged to joint families. There were 76% from urban background which could be due to the facts that a majority attending the hospital belonged to urban background and also, a number of patients from rural background still go to the traditional healers. Duration of symptoms in a majority was within 2 weeks. This is in contrast to other studies. [3],[8] which report the onset as insidious except that in army personnel. [15] Hysterical aphonia also presents as a psychiatric emergency. In a majority of cases, stress of examination or a recent failure acted as a precipitating factor followed by quarelling at home. The presence of life events have been found to be more common in the onset of hysteria in prevous studies., [16],[17] The comorbid psychiatric disorders eg sleep disorders, eating disorders, suicidal attempts, depression, anxiety disorder have been reported8, 14, 16, 17 in hysteria. The present study also found comorbid psychiatric disorder in 80% cases, the most common being mixed anxiety and depression followed by generalized anxiety disorder etc. More studies are war ranted to study the epidemiological, personality profile, psychodynamics and outcome details of patients presenting with hysterical aphonia and other conversion disorders.
| ¤ Summary | | |
Hysteria is a common neurotic disorder in psychiatric practice. Many of its conversion symptoms have not been studied in detail. In the present prospective study in a tertiary care teaching hospital, 25 cases of hysterical aphonia were analysed. There were 17 females and 8 males. Mean age of presentation was 18.4 years in females and 21.2 years in males. Majority of patients were literate upto primary class, belonging to joint family and , had urban background. Duration of symptoms was within 2 weeks. Most common precipitating factor was stress of examination or failure followed by quarrels with peers or spouse. In 20% cases, cause was not known. Ca morbid psychiatric disorders were found in 80% cases, the most common being mixed anxiety and depressive disorder (36%) followed by generalized anxiety disorder (20%).
| ¤ References | | |
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[Table 1], [Table 2]
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