Hysteria scale elevations in low back pain patients: A risk factor for misdiagnosis?

Abstract

The nature of elevations on the Hysteria scale of the Minnesota Multiphasic Personality Inventory in low back pain patients was examined by comparing Harris and Lingoes subscale elevation patterns in 53 female and 40 male low back pain patients and 61 female and 41 male normal controls. Subscales reflecting somatic complaints were more powerful predictors of diagnostic status than subscales with nonsomatic content. Overlap between items on the Hysteria and Hypochondriasis scales was also investigated, and both overlapping and nonoverlapping items were found to contribute significantly to the discrimination between patients and controls. However, nonoverlapping items were less notable contributors to the discriminant function in women than in men. The data suggest that more evidence than a "Conversion V" profile is required for the diagnosis of hysterical dynamics in association with somatic complaints.The frequency of the diagnosis of conversion disorder in individuals who experience chronic pain has received increasing scrutiny with the accumulation of psychological evaluation data concerning the chronic pain population. In initial research on mean Minnesota Multiphasic Personality Inventory (MMPI) profiles of chronic low back pain patients (Gentry, Shows, and Thomas, 1974;Hanvik, 1951) "Conversion V" profiles with Hypochondriasis (Hs) and Hysteria (Hy) scale scores elevated and higher than Depression (D) scale scores were found to be characteristic oflow back pain patient groups. This profile is commonly interpreted as indicating that physical symptoms provide a patient a way to cope with psychological distress that he or she is unwilling or unable to acknowledge or confront, although physical dysfunction may indeed be documentable by medical examination (Greene, 1980). The psychological distress is often assumed to be kept out of the patient's awareness by means of denial and/or repression mechanisms, and thus hysterical or histrionic personality traits are inferred to be present.

Psychiatric diagnoses in patients with fibromyalgia are related to health care–seeking behavior rather than to illness

“…However, the cornmu-437 nity residents were older than the clinic patients in their study, and many of the community residents also had other painful conditions for which they had consulted physicians during the 6 months prior to the study assessment. Moreover, psychological distress was assessed using questionnaires that tend to yield inflated scores among individuals with chronic pain conditions (8)(9)(10). Thus, the high levels of psychological distress reported by the community residents may have been related to painful comorbid conditions that often required medical treatment, and/or to extraneous measurement factors, rather than to FMS per se.…”

A fourth empirically derived cluster of chronic pain patients based on the Multidimensional Pain Inventory: Evidence for repression within the dysfunctional group.

“…Pain severity, life interference due to pain, activity levels, and social disruption are other crucial elements of chronic pain conditions, which are simply not tapped by the MMPI or the SCL-90−R. Moreover, patterns of elevations on MMPI scales, which would usually signal disturbance or psychopathology, may be confounded with physical symptoms in chronic pain patients (e.g., Ornduff, Brennan, & Barrett, 1988; Prokop, 1986), thus making interpretation of profiles purely in terms of psychopathology difficult and fraught with ambiguity.…”

“…Research using multivariate cluster analyses supported Sternbach's contention regarding the existence of several distinct categories and suggested as well the presence of a group characterized by a conversion-V profile (Armentrout et al 1982; Bradley et al, 1978; McCreary, 1985; McGill et al, 1983). Although the validity of diagnosing hysterical personality dynamics from the conversion-V profile in chronic pain patients has been questioned (e.g., Ornduff et al, 1988; Prokop, 1986), findings with the MMPI converge to suggest that a group exists that is described by a sharp contrast between the degree of their physical complaints and their emotional concerns; that is, a group of patients who may be reluctant to report emotional distress but more readily report physical problems.…”

Conversion “V” Profiles in Torticollis

“…The aim of the present study was to determine whether MMPI profiles of torticollis patients were suggestive of conversion disorder. The mean scores of the group on the Hs, D, and Hy scales of the MMPI were midway between scores reported for normals (Gough, 1963;Prokop, 1986) and patients with mild neurosis (Gough, 1963)_ This pattern of MMPI scores confirms the findings of the previous study of torticollis patients on measures of intraversion, neuroticism, trait anxiety, and obsessionality (Jahanshahi and Marsden, 1988b), and was also noted to be characteristic of scores obtained on various personality measures by sufferers of other physical and neurological disorders_ In effect, 36% of the sample had normal MMPI profiles with scores on all scales being below 70. Scores above 70 on the Hs, D, and Hy scales were respectively obtained by 30%,57% and 25% of the sample_ The reason for the finding that a quarter to one-third of the sample obtained scores above 70 respectively on the Hy and Hs scales, may partly reside in the structure of these scales.…”