However, when diagnosis is based on the totality of the clinical picture and not on the “discrepancy method,” it can be quite accurate. The physician can be further reassured that in followup studies of patients with so-called conversion disorder (exclusive of pseudoseizures), virtually none develops a neurologic lesion that in retrospect was related to the initial episode as, for example, in the study by Stone and colleagues (2003). It is of interest that in the series cited, most patients had persistent functional disability from their conversion symptoms, even a decade later.
Projective tests (the Rorschach and Thematic Apperception Tests), which for a time were popular with dynamic psychiatrists, are apparently not helpful in diagnosis and are now used very little. The presence of extreme suggestibility and the tendency to dramatize symptoms as measured by one part of the Minnesota Multiphasic Personality Inventory and other psychometric tests is helpful in diagnosis but not pathognomonic; these traits appear under certain conditions in individuals who never develop hysteria.
Finally, it should be emphasized that single bouts of isolated hysterical paresis, blindness, and anesthesia are quite common in neurologic practice and do not presage a chronic hysterical illness. The same is true for transient neurologic signs exhibited during the course of the examination, mainly pertaining to unusual or drifting sensory loss or asthenic weakness of a limb.
Treatment of Hysteria and Hysterical Symptoms
Here, opinions differ but modern approaches that, as mentioned, are non judgmental, straightforward and aimed at returning the patient to good function have great appeal. Treatment may be considered from 2 aspects: the amelioration of the long-standing basic personality defect and relieving the recently acquired physical symptoms. Little or nothing can be done about the former. Psychotherapists have attempted to modify it by long-term reeducation, but their results are uninterpretable and there are no control studies for the few reports of therapeutic success. Many psychiatrists are inclined to regard the female with hysteria who has a lifelong history of ill health as having a severe personality disorder—that is, sociopathy. In other less severe cases and especially in those in whom hysterical symptoms have appeared under the pressure of a major crisis, explanatory and supportive psychotherapy appears to be helpful, and the patients have been able thereafter to resume their places in society.
The acute symptoms can usually be mitigated by persuasion and demonstration. A current approach is to explain the nature of the illness and point out how common it is, and offer support to reverse the main features. Reassurance that recovery is possible and that the patient seems to be in the process of recovering may be useful. Stone and Edwards, who have thought considerably about this subject, have suggested showing the patient objective evidence of the functional nature of weakness, such as Hoover sign, by way of demonstrating the correctness of the diagnosis and demonstrating its potential reversibility. The earlier this is done after the development of symptoms, the more likely they are to be relieved. Sometimes a single symptom such as hemiparesis or tremor can be halted by a particular maneuver and this demonstration suffices to begin recovery. In chronically bedridden patients, pressure to get out of bed and resume function must be applied.