The document presents an overview of hysterical disorders, including their epidemiology, definition, clinical features, diagnosis, treatment, prognosis, and outcomes. It emphasizes that these disorders are psychological reactions rather than physical ailments, with no pharmacological treatments established as effective, and highlights the importance of non-pharmacological management and supportive therapy. Good prognostic factors include short history, minimal personality dysfunction, and a strong support system.

1. HYSTERICAL DISORDERS
Presented By
Dr Vani Kulhalli, MD
Psychiatrist

2. SCOPE OF PRESENTATION
Overview of:
• Epidemiology
• Definition
• Clinical features and diagnosis
• Treatment
• Prognosis and outcome

3. EPIDEMIOLOGY
• Not common disorder- but epidemics are known
• Age and gender- certain symptoms seen in certain groups
• Risk factors- personality issues, history of trauma or
abuse, genetic factors unknown- but familial cases
• Co-morbities- depression/ anxiety/ personality/ stress
reactions
• Mechanism of occurrence- essentially psychological
reaction to unbearable situation
3 factors
Personality
Disease
Environment

4. DEFINITION
• Origin from word ‘hysteros’ related to uterus
• No longer called hysterical- but dissociative and
conversion
• Defence mechanisms- dissociation and
conversion
• ……partial or complete loss of the normal
integration between memories of
past, awareness of identity and immediate
sensations, and control of bodily
movements…..

5. CLINICAL FEATURES
• Specific constellation of symptoms
• No evidence of physical disorder to explain
symptoms
• Evidence of psychological causation
TO BE NOTED:
Onset, duration, test reports, good
mood, recurrence or past history are not
diagnostic

6. DIAGNOSIS
• History- note organic and psychosocial factors
• General examination- level of consciousness
• Focused systemic examination- what type?
• Relevant investigation
• Diagnostic formulation

7. PHARMACOLOGICAL MANAGEMENT
• No evidence for use of any pharmacological
agent
• Benzodiazepine in small doses- anti- anxiety or
placebo effect
• Treat the co-morbid psychiatric disorder

8. NON PHARMACOLOGICAL MANAGEMENT
• Immediately
Confidence building measures
Removal of stressor
Normalisation of behavior
Differential reinforcement
• Short-term
Individual and family counseling- supportive
• Long term
Specific individual or family therapy
social intervention

9. PROGNOSIS AND COMPLICATIONS
• Good prognostic factors
Short duration of history
Acute and circumscribed stress
Minimal personality dysfunction
Presence of co-morbidity
Adequate support system
• Complications
Chronicity
Disruption of family
Deliberate self harm

10. CONCLUSIONS
• Psychological aspects more important
Symptoms as well as treatment-wise
• Psychiatrists rarely able to treat this disorder
• Empathic approach essential
• No medicine proved to be useful

11. DR VANI KULHALLI, Psychiatrist
MD (NIMHANS, 2003)
Clinics:
Vile Parle East and West
Hospitals:
Four Care Hospital, VPEast
Jewel Hospital, VPWest
For Appointments
Contact:
9819269628
Between 5 PM to 8 PM