Hysteria is no longer considered a separate diagnosis. Now these patients are put in the category of a conversion disorder, a dissociative or somatic symptom disorder.
I have had two patients I diagnosed as Hysterical Paralysis before the classification was changed. One was a woman from Florida who was diagnosed at the University of Florida as having a form of muscular dystrophy. Her internist called me and asked if I would see her. She arrived at my office in San Francisco in a wheel chair. After a complete examination I could not find any signs of muscular dystrophy. We did a muscle biopsy under a local anesthetic and it was completely normal. Her blood tests, such as a CPK, were also within normal limits. In taking a detailed history, I found that she had gone through some very traumatic times. I talked with her doctor in Florida and also arranged for physical therapy while she was in California. In outlining a P.T. plan and some good psychological therapy when she got back home, she was able to be out of her wheel chair within a few months and lead a normal life.
The other patient was an overweight teenager youth, who on coming back from some time at a summer camp, suddenly fell and became unable to walk. He seemed very unhappy when I examined him, but it was hard to get a good history from him. I handed him a crayon and a big pad of paper and asked him to draw what he was feeling. He pressed so hard on the paper that it was almost torn. The picture he drew showed volcanoes spewing fire. I had a muscle biopsy and lab work done and both were completely normal. I am not sure what happened at the camp but I suspect he was bullied and teased because he was overweight and quite uncoordinated. With some good psychological counseling, an eating plan, and physical therapy he was able to return to school and resume his normal activities.
I wish we had more physicians with neuromuscular training but this country is sadly lacking in them. Neurologists rarely get adequate training in these disorders unless they are in a training program that has an interest in them.
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