Abstract

Hysteria was first documented 4,000 years ago by the Egyptians, who believed the symptoms originated from the uterus, hence the name (hysterus).1 "Hysterical" conditions included combinations of seizures, paralysis, and anesthesia. During the 17th and 18th centuries, a variety of disorders such as hypochondriasis, hysteria, dyspepsia, and "gas and spleen disease" (vapors) were included under the general heading of "nervous disorder," a term created by Briefe in 1603, that was subsequently replaced with the vague term "nervous temperament."2 The modern age of nerve pathology commenced in 1843, the year Du Bois Reymond demonstrated electrical conduction in nerves. No electrical disturbances were found in the "nervous temperament," leading to the hypothesis of a psychogenic origin for these disorders.3 The term "hysterical conversion" was created approximately 100 years before Freud's birth, in an attempt to justify the existence of hysteria as a diagnosis. Lhermitte wrote "hysteria is the mother of deceit and trickery." Babinski defined hysteria as a disease with a psychological etiology, with no clear physiologic or morphologic evidence, and characterized hysteric patients as hyper suggestible and easy to hypnotize.2,3 Paul Briquet was the first to make an association between conversion disorder and central nervous system disorders during the 19th century. He claimed conversion disorder was due to stress and environmental situations, affecting "affective" areas in the brain of a person with premorbid hypersensitivity.4 His follower, Charcot, hypothesized that these patients were suffering from a global disorder in the brain, exposing them to the development of conversion disorder. Lately, his work has regained recognition, when the component of his theory concerning the pathophysiology of trauma was introduced into modern theories regarding PTSD and somatoform disorder.5 Freud, a student of Charcot, defined "La Grande Hysterie," which overlapped the definition of motor paralysis. According to his traumatic model of hysteria, published in 1899, hysterical symptoms stem from sexual trauma, that activates an old traumatic event (Nachtriglichkeit). Freud argued that through analysis, the childhood trauma is restored and the neurotic symptoms released via a transfer mechanism.6 Presently, the term conversion disorder (hysterical neurosis - conversion type) is listed in the DSM-IV7 under somatoform disorder group (code 300.11), and is described as a psychological disorder, characterized by somatic symptoms with no physiologic abnormalities, but with an underlying psychological basis.