Hysterical symptoms in ophthalmology

Abstract

Ophthalmologic symptoms are often not sufficiently accounted for by organic pathology. The complaints of these patients have been labeled hysterical, psychogenic, non-organic, or functional. The psychiatric nosology in this area may be the most confusing in the whole field of clinical medicine. The Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) offers a classification designed to reduce non-empirical concepts and ideology to a minimum. On this background, we discuss the hysterical symptoms encountered in clinical ophthalmology with special emphasis on psychogenic amblyopia and blepharospasm. Motor symptoms are commonly not of psychogenic origin. It is suggested that ophthalmologists are most likely to treat patients with psychogenic symptoms, using suggestion, patience, and reassurance. Few patients require psychiatric consultation and a specific psychiatric therapy. The association of hysteria with organic brain disease and the issue of symptom lateralization are briefly discussed. Eventually, we reject the psychoanalytic approach and suggest that the concept of abnormal illness behavior and the neurobiological models involving corticofugal inhibition, primitive reflex mechanisms, and an attention disturbance, serve best to understand the nature of the phenomenon hysteria.

Non-organic visual loss

“…15 Although there are no clinical tests to distinguish between psychogenic and feigned visual loss, it has been noted that the malingerer is usually unable to sign his/her name whereas a truly blind person has no difficulty in performing this task 13. Simple tests of proprioception are also easily performed by the genuinely non-seeing patient but malingerers, believing the exercise to be vision dependent, are frequently incapable of bringing their index fingers together in front of their eyes 17. These techniques can be used for suspected monocular or binocular non-organic visual loss, but the good eye should be occluded in cases of monocular complaints (box).…”

“…The pathogenesis of psychogenic visual complaints remains obscure, but it is assumed that higher cortical structures occupied with sensory awareness suffer from a disturbance 17. Conversion and somatization disorders, as well as hypochondriasis, have all been implicated in the process 17.…”

“…Conversion and somatization disorders, as well as hypochondriasis, have all been implicated in the process 17. A conversion reaction uses a physical symptom to express a psychological conflict 37.…”

Detection of Nonorganic Visual Loss with a New Optotype Chart in Simulated Malingerers

“…Decreased visual acuity is probably the most common nonorganic disturbance in ophthalmology [3,4]. It occurs most often in children and young adults [5] and may be conversional or caused by malingering.…”

Visual impairment in hysteria

“…He has noted the lack of consensus on the etiology of hysteria and even on its existence. Weller & Wiedemann [2] have reviewed specifically ophthalmological aspects of hysteria. Merskey [3] stresses the importance of hysteria, as the foundation of psychoanalytic theory and of the understanding of the mind.…”