Conversion Disorder/Hysteria in Fibromyalgia

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Unanatomical symptoms in fibromyalgia[edit]

In the fibromyalgia literature there are mentions of “unantomical symptoms”. (See for example: Nondermatomal somatosensory deficits: overview of unexplainable negative sensory phenomena in chronic pain patients. Mailis-Gagnon A, Nicholson K. Curr Opin Anaesthesiol. 2010 Oct;23(5):593-7.) This may be one of the new code words used by people who are trying to avoid using the more controversial and older term, “hysteria”.

Current status of the word “hysteria” in the medical world[edit]

Hysteria is still (as of 2013) an ICD diagnostic code and is listed as Code 300.10 in the 2013 ICD-9-CM. ICD stands for the International Classification of Diseases. The ICD is the United Nations-sponsored World Health Organization’s "standard diagnostic tool for epidemiology, health management and clinical purposes." [See: http://www.who.int/classifications/icd/en/] The entry for this diagnosis says: “Hysteria, unspecified behavior exhibiting excessive or uncontrollable emotion, such as fear or panic; mental disorder characterized by emotional excitability and sometimes by amnesia or a physical deficit, such as paralysis, or a sensory deficit, without an organic cause.” [Italics added after the fact for emphasis.]

Ties between fibromyalgia, hysteria and neurasthenia[edit]

Before it was popular to diagnose fibromyalgia, we had the diagnosis of “neurasthenia”, which was a similar idea. It was, however, a broader concept. It was similar to fibromyalgia syndrome, plus the many fibromyalgia co-morbidities. Even at the beginning of the 19th century, doctors were aware of a relationship between hysteria and neurasthenia. Clarke even wrote a book on the subject (Hysteria and Neurasthenia. Clarke, John Mitchell, J. Lane, London; New York, 1905. For the section of this book on hysterical anaesthesia see: https://archive.org/stream/39002010911429.med.yale.edu#page/32/mode/1up).

There appears to be a connection between hysteria an hypnotizability, which means that the subjects have a special susceptibility to suggestion. For example, Dell states that “several psychiatric diagnoses are marked by an unexpectedly large proportion of patients with high hypnotizability. This is especially true of the diagnostic categories that were subsumed by the 19th-century concept of hysteria: dissociative identity disorder, somatization disorder, and complex conversion disorders.” (Is high hypnotizability a necessary diathesis for pathological dissociation? Dell PF1. J Trauma Dissociation. 2016 May 23:1-30. [Epub ahead of print])

Further information[edit]

For further information on hysteria, see the entries in the Encyclopedia of Touch, Body Sense and Pain for Hysterical Hemiparesthesia, Hysterical Somatosensory Reactions and Hysterical Touch Disorders, Henry Head’s Reflections On.