Reconsidering the role of psychosocial factors in functional dysphonia

Abstract

Current research confirms that functional dysphonia is associated with multiple psychosocial factors. However, these findings are shown to be true of other medically unexplained symptoms in which vocal problems are absent. It is argued that, whilst intuitively appealing, there is insufficient evidence to support the popular notion that the loss of voice is the consequence of unexpressed emotion.

Pragmatic detection of anxiety and depression in a prospective cohort of voice outpatient clinic attenders

“…This highlights previous research that has shown no psychological difference between the diagnoses of functional and organic dysphonia and suggested that organic pathology of the larynx may be secondary to voice misuse or abnormal muscle functioning . Despite popular belief that functional dysphonia is associated with high levels of psychological distress, there is no evidence to support this, and our findings reiterate this. There was a higher rate of comorbidity in those with higher HADS score, in line with expectation, as comorbidity is known to increase rates of anxiety and depression …”

Psychosis improved dysphonia

“…It is frequently noted to be a transient phenomenon (albeit not in this case except when the patient was psychotic) and is more common in women. Other factors associated with this conversion disorder include lower socioeconomic class, postinfection, a history of larynogpharyngeal reflux or underlying mucosal disease, fatigue and certain occupational factors (occupations specifically using one's voice) or personality risk factors (anxious, anankastic) 3 4. Functional dysphonia and aphonia are often regarded as disorders on a continuum of severity and are believed to share a common aetiology 5.…”

Managing dysphonia in occupational voice users

“…A recent review regarding functional voice problems [41] proposed a cognitive behavioral model to deal with these patients. Individual factors (genetics, early experience, and personality), precipitating factors (life events and coping, vocal vulnerability), and perpetuating factors (anxiety, depression, and general fatigue) were proposed to be causative in voice problems.…”