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Hysteria is real, study finds

Dec. 11, 2006
Courtesy American Academy of Neurology
and World Science staff

For cen­turies, wom­en with an un­ex­plained pa­ral­y­sis or numb­ness in part of the body have been off­ered a di­ag­no­sis with a rath­er de­mean­ing ring to it: hys­te­ria.

In re­cent dec­ades, doc­tors have dropped the term as sex­ist. Amid that back­lash, some be­gan de­ny­ing any such con­di­tion even ex­ists.

Ber­tha Pap­pen­heim (1859-1936), a pa­tient di­ag­nosed with hys­te­ria and dis­cussed in sem­i­nal writ­ings of Sig­mund Freud. She was doc­u­mented to have an un­u­su­al range of symp­toms in­clud­ing pa­ral­y­sis, numb­ness, spasms, fairy-tale fan­tasies and mood swings. Her trou­bles not­with­stand­ing, she went on to be­come a not­ed so­cial work­er, au­thor and fem­i­nist.

Now, sci­en­tists say they have strong ev­i­dence from a brain im­ag­ing study that the dis­or­der is real. 

Today wide­ly called con­ver­sion dis­or­der, the con­d­i­tion is be­lieved to strike men al­so, though less of­ten than wom­en. It is a dia­g­no­sis nor­m­al­ly giv­en only af­ter tests have ruled out all pos­si­ble known phys­i­cal ex­plan­a­tions for the ma­la­dy. Sym­p­toms gen­er­al­ly ap­pear fol­low­ing some dis­tres­sing so­cial or psy­cho­lo­gic event, ac­cord­ing to The Merck Ma­nu­al of Med­i­cal In­for­ma­tion.

But in the new study, Omar Ghaf­far of Sun­ny­brook Health Sci­ences Cen­tre in To­ron­to, On­tar­io, Can­a­da and col­leagues said they also found signs of a phys­i­cal cause. 

It seems to be a dys­func­tion in the cer­e­brum, the larg­est part of the brain, they arg­ued.

The find­ings open up a new win­dow to un­der­stand­ing hys­te­ria, which has re­mained un­ex­plained to date, ac­cord­ing to Ghaf­far. The study is pub­lished in the Dec. 12 is­sue of the re­search jour­nal Neu­rol­o­gy. 

The study in­volved three wom­en with the dis­or­der who com­plained of numb­ness in their left hand or foot. The re­search­ers used Mag­net­ic Res­o­nance Im­ag­ing, a brain scan­ning tech­nol­o­gy, to study how their brains re­sponded to stim­u­la­tion of their numb body parts.

In all three cases, the study found stim­u­la­tion of the numb hand or foot failed to ac­ti­vate the side of the brain which re­sponds to tou­ch. How­ev­er, that part of the brain did re­spond when re­search­ers stim­u­lat­ed both the numb body part and the oth­er, nor­mal-feel­ing hand or foot.

“S­tim­u­la­tion of the numb body part did not ac­ti­vate the so­matosen­sory re­gion of the brain, while stim­u­lat­ing both limbs did,” said Ghaf­far. The so­matosen­sory ar­ea is a zone not­ed for pro­cess­ing sen­so­ry stim­u­li from oth­er parts of the body.

Ghaf­far said one pos­si­ble ex­pla­na­tion could be stim­u­la­tion on both sides acts as a dis­trac­tion, shift­ing the pa­tien­t’s at­ten­tion. That could over­come an in­hi­bi­tion that nor­mally blocks the sen­sa­tion.

“To our knowl­edge, this rep­re­sents a nov­el re­sult that may help ex­plain the dif­fer­ing re­sults” in past re­search, he added. “Fu­ture stud­ies plan to build on these find­ings by scan­ning more sub­jects and healthy con­trols,” he added, and “a study ex­am­in­ing the role of dis­trac­tion in con­ver­sion dis­or­der is un­der­way.”

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For centuries, women with an unexplained paralysis or numbness in part of the body have received a diagnosis with a rather demeaning ring to it: hysteria. In recent decades, doctors have dropped the term as sexist. Amid the backlash, some began denying any such condition even exists. Now, scientists say they have strong evidence from a brain imaging study that the disorder is real. Now more widely called conversion disorder, it strikes men also, though less often than women, by most accounts. Omar Ghaffar of Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada and colleagues said they found evidence of a dysfunction in the cerebrum, the largest part of the brain. The study’s findings open up a new window to understanding hysteria, which has remained unexplained to date, according to Ghaffar. The study is published in the Dec. 12 issue of the research journal Neurology. The study involved three women with the disorder who complained of numbness in their left hand or foot. The researchers used Magnetic Resonance Imaging, a brain scanning technology, to study how their brains responded to stimulation of their numb body parts. In all three cases, the study found stimulation of the numb hand or foot failed to activate the side of the brain which responds to touch. However, that part of the brain did respond when researchers stimulated both the numb body part and the other normal feeling hand or foot. “Stimulation of the numb body part did not activate the somatosensory region of the brain, while stimulating both limbs did,” said Ghaffar. The somatosensory area is a zone noted for processing sensory stimuli from other parts of the body. Ghaffar said one possible explanation could be stimulation on both sides acts as a distraction, shifting the patient’s attention. That could overcome an inhibition that normally blocks the sensation. “To our knowledge, this represents a novel result that may help explain the differing results” in past research, he added. “Future studies plan to build on these findings by scanning more subjects and healthy controls,” he added, and “a study examining the role of distraction in conversion disorder is underway.”