Lecture
Sensory conversion disorders
Visual disturbances
1) concentric narrowing of the visual fields;
the longer the perimetric examination continues, the narrower the visual field becomes
2) multiple vision – double or triple vision in one eye, or bilateral quadruple imaging;
closing one eye does not eliminate the double vision
3) macropsia or micropsia (perceiving objects as enlarged or reduced in size);
4) color blindness;
5) impaired visual acuity or amblyopia;
6) hysterical blindness.
The most important diagnostic signs of hysterical blindness:
preservation of the pupillary light reflex,
optokinetic nystagmus,
visual control over behavior (avoiding obstacles while walking)
Deafness:
absence of otoscopic changes,
the cochleopalpebral reflex (a sound produced near the ear with a tuning fork causes a twitch of the upper eyelid) and the cochleopupillary reflex (rapid constriction of the pupils followed by slow dilation, occurring in response to a sudden loud sound) remain normal
deafness disappears under the influence of loud noise
whispering is often heard well, sometimes from a considerable distance, while ordinary speech is not heard at all
good perception of high frequencies
Loss of smell and taste – occurs quite rarely and is combined with anesthesia. Loss of smell also includes impairment of the sensation of pungent odors, for example ammonia, the perception of which depends on stimulation of trigeminal nerve fibers and is not affected by olfactory disorders
Loss of taste is combined with a pathological absence of hunger (anorexia).
Sensory conversion disorders
Anesthesias
Charcot (1889) considered cutaneous anesthesias to be fundamental, persistent stigmata of hysteria (during the witchcraft trials they were regarded as the «devil's mark»):
absence of sensitivity to tactile, painful, and thermal stimuli
the area of anesthesia does not correspond to peripheral innervation; its boundaries are set in accordance with the patient's ideas: the forearm (short gloves), the shoulder (long gloves), the shin (socks), etc.
the boundaries of the anesthesia readily shift depending on distraction of the patient's attention or on the examiner's suggestion;
despite the absence of pain sensitivity, injuries and thermal damage never occur;
despite complete anesthesia of the fingers, the precision of fine and complex movements performed with them is not impaired;
the anesthesia may go unnoticed by the patient, who learns of it only during a medical examination;
the reflex dilation of the pupil in response to a painful stimulus (and sometimes increased respiration when a stream of cold water is directed at the anesthetized area) is preserved
anesthesias are often combined with functional vasospasm, so this area does not bleed after a needle prick or injury
Paresthesias – a peculiar sensation that creates the impression of numbness, burning, tingling, a crawling feeling, and so on.
Pain («regional psychogenic pain»)
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can affect any part of the body, but is most often localized in the head («hysterical nail», «hysterical helmet»).
pain in the sacrum, joints, and limbs, burning pain in the genital area, anus, or oral cavity, pain in other parts of the body
Characterized by the absence of precise localization, and not combined with autonomic symptoms or sleep disturbances
Not accompanied by the emotional reactions and restriction of movement characteristic of organic pain
frequent relief of pain with the use of a placebo, or its persistence despite the use of powerful analgesics
Hysterical stigmata – local bleeding on the forehead, palms, feet, and in the region of the heart, corresponding to religious beliefs about the crucified Christ. Combined with narrowing of consciousness and ecstatic experiences
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