The clinical epidemiology of hysteria: vanishingly rare, or just vanishing?

Abstract

Vanish 1. intr. To disappear from sight or become invisible, esp. in a rapid and mysterious way (Shorter Oxford English Dictionary, 1972).There is a well-known view that hysteria has virtually disappeared in the Western world. There are two versions of this argument: one is that there was never a clinical disorder that coincided with the diagnosis, and hysteria has now been reconstructed as something else (e.g. Micale, 1993). The other is that hysteria did exist but has now become much rarer than it was (most famously, Veith, 1965). According to this view, hysteria is to be found in patients from developing countries, but in Western countries it is ‘virtually a historical curiosity’ (BMJ 1976). It is the latter view that is – in our experience – most commonly held by our colleagues in general psychiatry. Yet, this opinion is not shared by those who are involved in the clinical care of patients with neurological disorders: ‘to a psychiatrist who sees patients on the medical and surgical services of a general hospital, it appears that hysteria remains a rather common phenomenon’ (Brownsberger, 1966). A number of descriptions from liaison psychiatry services support this opinion (Akagi & House, 2001). There are good reasons why it might be difficult to judge just how common (or rare) hysteria really is. Epidemiology depends on reliable case definition, case ascertainment and selection of a suitable population to study (Neugebauer et al. 1980), and each of these poses problems in the study of hysterical disorders.

Incidence and 12-Month Outcome of Non-Transient Childhood Conversion Disorder in the Uk and Ireland

“…Our study indicates that conversion disorder is less common in children than in adults where incidence rates of 5-12 per 100 000 have been reported. 7 The higher incidence in adults could be related to the role of trauma in the pathogenesis of conversation disorder, 8 such that the cumulative effect of trauma in the journey from childhood to adulthood would increase the risk. It might also be related to developmental immaturity, since we, as in previous studies, 2 found the incidence to be lower in the younger children.…”

War Syndromes: The Impact of Culture on Medically Unexplained Symptoms

“…Furthermore, it has been suggested that the limited number of epidemiological investigations into hysteria has contributed to the impression that this remains a rare phenomenon. 100 The major cultural change to impact on war syndromes in the last quarter of the twentieth century appears to be a general fear of toxins spread as a result of modern industrial life. Of the 218 Gulf War veterans in our study who gave an explanation, 34.3 per cent believed that their condition was caused by some form of poisoning.…”

Non-organic language disorders: Three case reports

“…Several prognostic risk factors have been identified, such as the duration of symptoms, the presence of psychiatric and medical co-morbidity, and poor social life perception (Thomas, Vuong, & Jankovic, 2006). The prevalence is estimated to be as high as 50 per 10,0000, with an over-representation of women (Akagi & House, 2002).…”