Die Hysterie im neuen Gewand und im Wandel der Zeit

Classical symptoms of hysteria – especially symptoms of hysterical neurosis (conversion type) – are not commonly seen any more. On the one hand, general knowledge about the function of hysterical has led to suppression of the underlying hidden conflicts, possibly up to resomatization. On the other hand, those affected may have rather subtle symptoms, e.g., vague pain, circulatory disorders, or fatigue. Overall, the hysterical phenomena have not become less common but have become “contemporary” and, therefore, more difficult to identify. Reliable epidemiological data, however, are difficult to obtain. Rough estimates indicate that 2–6?% of all people have dissociative disorders (ICD-10 definition). Histrionic personality disorder is estimated to occur with a frequency of 2–3?%. In 75?% of cases, the disease manifests relatively early, between the ages of 17 and 32 years and with a 3:1 female to male ratio. An average of 7 years elapses between first manifestation and the start of psychiatric–psychotherapeutic treatment.     

Konzepte der Identifizierung

The authors investigate primary, hysterical, narcissistic identification, and introjection as conceptualised by Freud, Melanie Klein’s projective identification, and Anna Freud’s identification with the aggressor and altruistic surrender. It is pointed out that hysterical identification, narcissistic identification, and introjection are unconscious processes leading into a state of primary identification, and that they can be distinguished on a clinical level as regards the emotional meaning the object has for the subject. In hysterical identification the aspects of an object with which one identifies and all its other aspects retain their emotional meaning, in narcissistic identification these other aspects also keep their emotional meaning, but in this case the aspects with which one identifies lose their emotional meaning, and in introjection all aspects of an object lose their emotional meaning. Furthermore, it is shown that hysterical or narcissistic identifications are the mechanisms underlying the identification with the aggressor, and that—along with projections—hysterical re-identification also plays a decisive role in projective identification and altruistic surrender, whereby in these latter processes the object identifies himself unconsciously with the contents projected onto him in a hysterical or narcissistic manner.     

Hysteria and psychosis

The relationship between endogenous-psychotic and hysterical behavior is presented in this paper on the basis of typical patients' accounts. Various patterns of behavior are revealed: chronic hysterical psychotic syndromes, acute hysterical psychotic syndromes, hysterical exalted psychotic episodes, simulated hysterical psychotic syndromes, hysterical behavior in the attempt to cope with psychosis, and pseudohysterical behavior in endogenous psychoses. The specific aspects of the doctor-patient relationship in the case of these patients are described.     

Causality-Interpretation and Obsessive versus Hysterical Functioning

Relationships were predicted between the relative salience of the theme of voluntary control (VC) and the relative predominance of obsessive versus hysterical personality traits, and between the relative salience of VC and the relative predominance of obsessive versus hysterical neurotic symptoms. A coding system for VC was applied to TAT stories written by 89 males and 96 females solicited from undergraduate populations. 20 males and 20 females who scored high on VC and 20 males and 20 females who scored low on VC were given further instruments pertaining to obsessive/hysterical personality traits and neurotic symptoms. As predicted, high VC Ss were significantly more obsessive (or less hysterical) in their personality traits than low VC Ss. Predicted relationships between VC and obsessive/hysterical neurotic symptoms were not significant.     

Le clinicien face à la crise hystérique : enjeux théoricocliniques de l'épreuve du féminin

Hysterical crisis shows unexpected hallucinations and delirium happening into hysterical structure. Although subject of many psycho-analytical works, hysterical crisis is always matter of debate. That kind of crisis happens when hysterical women and their lover have fallen out. Analysing the case of madam M., we will propose a reflexion about the real raison of those love-affairs to reconsider hysteria in relation to feminity. We will propose a new conception of feminine climax in connection with hallucinations and delirium happening into hysteria. We will debate about position of psycho-clinician, precisely the transference-using face to hysterical subject in state of emergency. Finally, we will propose to think over singularity of subjective structure using the supply concept.     

The value of problem-case discussions for long-term care using the example of psychogenic gait disorders in children

The psychotherapeutic treatment of two patients with hysterical disorder of walk showed the importance of problematical cases seminars for deranged therapist/patient relationship. The seminars effected on the collaborators attitude of the psychotherapeutic ward to the patients. The therapists were so emotional confined by faulty assurance of the diagnostic classification and by non-realistic expectations of rapid results, that the therapeutical treatment began to stop.     

Further studies on deprivation/enhancement patterns.

Four studies were done to explore the construct validity of a previously established sex difference in TAT fantasy patterns. The results, both with various clinical groups and with normal children, support the notion that Deprivation/Enhancement fantasy patterns are meaningfully related to sexual identity and sex role development. The correlates of extreme D/E patterns are more clear for women than for men and involve elements of the "hysterical" character and cognitive style.     

Rorschach and pain characteristics of patients with low back pain and "conversion V" MMPI profiles

Two studies examined the relationship between Rorschach determinants, MMPI scale scores, and pain reports in order to clarify the meaning of the MPI "conversion V" pattern among patients with low back pain. Study I showed that patients without demonstrable organic disease of the back produce Rorschach response summaries marked by lower F+%, lower Sum C, and higher F% than patients with demonstrable organic disease. Study 2 showed that only the increase in F% was associated with significant elevations of the MMPI Hs and Hy scales. The results suggest that elevated MMPI "conversion V" profiles are indicative of psychological disturbance among patients with low back pain. It is unlikely, however, that the disturbance is hysterical. Instead, the psychopathology is probably marked by tension and constraint rather than the over-reactivity of hysteria. The implications of these findings for diagnosis are discussed.     

A conceptual model and case study for the psychological assessment of hysterical pseudo-seizures with the Rorschach

Conceptual models are being increasingly utilized to guide psychological assessment of complex clinical problems. In this article, I present a conceptual model to direct the assessment of personality processes involved in producing hysterical pseudo-seizures. Pathological personality processes present in hysterical reactions are outlined. Rorschach parameters that have been validated and that are therefore considered good indicators of the relevant personality processes are presented. A case study of a patient with both documented genuine and hysterical pseudo-seizures demonstrates use of the model. I offer a treatment plan that is related to the psychological structure of the patient. Use of this model may improve psychological consultation in medical settings.     

The Relationship between Defense Preference and Response to Free Association

Psychoanalytic theories suggest that individuals with obsessive defenses, with hysterical defenses, and borderline psychotic individuals respond differently to free association. An experimental analogue of the psychoanalytic session was used to test these ideas. The subjects were 68 male college students, chosen on the basis of the Rorschach and MMPI. Contrary to predictions, obsessive subjects generally associated more freely and showed more involvement in the sessions than hysterical subjects. As expected, hysterical subjects were more silent and blocked and made fewer self-observations than obsessive subjects. Borderline subjects were judged to have less control over drive than the two defensive types.     

The choice of a name: "Dora" and Freud's relationship with Breuer

I have suggested that Freud's choice of the pseudonym Dora for his eighteen-year-old hysterical patient, Ida Bauer, was over-determined. Dora, it seems likely, was named not only after Freud's sister's nursemaid, as Freud himself explained, but also after Dora Breuer, Josef Breuer's youngest daughter. This theory is based on an examination of the similarities in the lives and symptoms of Anna O. (Breuer's famous hysterical patient of 1880-1882) and Dora; on an analysis of the transferences and countertransferences in the cases of these two young women; and on evidences of the persistent significance of Josef Breuer in Freud's life after 1895. These specific inquiries also call attention to the nature of hysteria at the end of the nineteenth century and to the ever-present complexities of the physician-patient relationship.     

Hysteria,A Century Later: Post-Kleinian Theory and Technique

ABSTRACT

Freud developed many of his theories and technique while attempting to help hysterical patients. This article approaches hysteria not just as a syndrome consisting of a group of signs and symptoms, but primarily as an inner world configuration that fuels object relations patterns. The internal world hysterical profile informs the transference/countertransference experience and the therapeutic process. I attempt to describe some of the technical problems psychoanalysts have to deal with while working with these patients. Hysterical object relations do not necessarily manifest themselves as somatic symptoms—epileptic-like, paralysis, blindness, etc.—even in patients that show the relational hysterical patterns. These object relations modes can appear in any analysis irrespective of the primary diagnostic conceptualization.     

Female anatomy and hysterical duality

The American Journal of Psychoanalysis - This article attempts to add another layer to our understanding of the phenomenon of hysterical duality. The author postulates that hysterical duality can...     

Hysterical personality and sexuality of the female

The investigation involved 30 hysterical women, who were interviewed and who completed four questionnaires relating to: psychosexual development; attitude towards sexuality; sexual activity; and reactivity. Dysharmonic sexual development, and low levels of activity and reactivity in their sexual life was revealed. Contrasted with other groupings of female psychiatric patients, from a sexual point of view the female hysterical personality presents a special psychological case.     

Hysteria and Self Psychology

ABSTRACT

The article uses a self psychological lens to explore the notion of hysterical personality from our earliest understanding of it as the root of all psychogenic disorders, as discovered by Breuer and Freud, to its present elimination in the DSM-V. Can hysteria still be considered an applicable diagnosis or character style in the modern time? Or is it a culturally and historically limited phenomenon that no longer holds validity? Considering the case of Dora from Heinz Kohut’s revolutionary view, which privileges the subjective and empathic stance in treatment, one can infer that Dora’s own hysterical symptoms were not pathological, as Freud thought, but rather healthy attempts to bolster an enfeebled self. Nevertheless, both Kohut and his followers conclude that from a self psychological perspective both object-instinctual understandings, and self-object transferences, are essential for successful analytic treatment.     

Treatment of atypical and neurotic depression

Hitherto it has not been usual to talk in the German language about the therapy-oriented concept of two forms of the progress of atypical depression (Type A and Type V). The characteristic symptom of Type A is angst, together with phobias, physical complaints, etc. In Type V there are vegetative symptoms, often towards evening (Hypersomnia, difficulty in getting to sleep, increased appetite, increased weight, increased libido), accompanied by hysterical extrovert personality traits, and of intermittent occurrence. These clinical pictures are amenable to psychopharmalogical therapy. In conformity with the assumption of "somatic accommodation" treatment with antidepressives is recommended in the case neurotic depression, too, at least in the initial stages of treatment.     

Rorschach Anatomy Response Correlates in Rehabilitation Failure Subjects

Studies have linked rehabilitation failure to personality factors and psychological test findings, including the Rorschach Anatomy Response. Objective psychological tests were administered to 112 PMRS patients who met the criterion of over 30% anatomy on the Rorschach. Test scores and demographic variables were statistically analyzed in an intercorrelational design using medical success—failure judgements as criterion. Outcomes were judged 100% failure and the group resembled somatization and hysterical reactions, with positive comparisons to passive-dependency and delayed recovery from disease. Inspection of the intercorrelations suggested two patterns: an open psychopathology configuration and a control-defensive personality organization. Discussion focused upon the value of anatomy percentage as a failure predictor, the type of personality involved, and the need for more specific research.     

The Marital System of the Hysterical Individual

The purpose of the present article is to supplement the considerable body of clinical literature that focuses on hysterical behavior from an individual perspective. Based on findings from a total sample of 16 couples, this paper accomplishes this task in a threefold manner. First, the characteristic type of individual who selects and is selected by the hysterical individual as a life partner is described. Second, the type of relationship these two individuals typically develop, which promotes and reinforces severely maladaptive behavior on the part of both is delineated. Third, a number of specific recommendations regarding psychotherapy for this type of relationship are proffered.     

Field independence, lateralization and defensive style

This study investigated the relationship between field independence and defense clustering as measured by the Defense Mechanisms Inventory and lateral eye movements. Subjects had previously been classified either as hysterical or obsessive style by the Rorschach and WAIS Comprehension subtest. Previous findings indicate that these subjects have a preferred direction of lateral eye movement in a questioning format (hysterical style = left; obsessive style = right). This study found no relationship between field independence and defense clustering and lateral eye movements. To the extent that eye gaze indexes hemispheric activation, we conclude that neither field independence nor defense clustering was related to hemispheric lateralization.     

Therapeutic neglect omission of individual treatment of secondary defective developments

The increasing application of group psychotherapy involves the danger that secondary defective developments which cannot be cured within the group, will be neglected. For these, a specific psychotherapy is necessary and particularly urgent since these cases show a tendency towards becoming chronic. Such cases include obsessional neurosis, situation phobia, nosophobia, occupation neurosis, expectation neurosis, psychogenic impotence, anorexia nervosa, and compulsive vomiting. Secondary defective developments in the majority part of patients who consult a psychotherapist. As fear neuroses, they have to be separated from wishful neurosis (hysterical neurosis). There is an urgent need for psychotherapists to be trained and given continued training in the treatment of secondary defective developments so as to be able to treat such patients.