Hysteria in Neurological Practice

The Somatoform and Dissociative Disorders* of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) are the current representation of a disease known of old, hysteria; they amount to “hysteria split asunder,” as one of the leaders of the nosological revolution in contemporary psychiatry put it (2). Although the current diagnostic formulation is arguably a pale reflection of previous conceptualizations (the argument is made below), the disorder is certainly still a clinical presence. It has, as Sir Aubrey Lewis said, “outlive [d] its obituarists” (3). In this chapter, I set the scene for understanding neurological presentations of Somatoform and Dissociative Disorders by pointing to a historical moment in the development of the understanding of hysteria; provide a review of the current diagnostic categories and describe the clinical features of patients fitting into those categories, with greatest emphasis on Conversion Disorder because of its importance in neurological practice; offer a summary of the known risk factors for somatization, as well as describing the limited information available on its neurobiology; and provide a set of recommendations for clinical management by the physician not specializing in psychological medicine.