Hysteria: the reverse of anosognosia

Hysteria has been the subject of controversy for many years, with theorists arguing about whether it is best explained by a hidden organic cause or by malingering and deception. However, it has been shown that hysterical paralysis cannot be explained in any of these terms. With the recent development of cognitive psychiatry, one may understand psychiatric and organic delusions within the same conceptual framework. Here I contrast hysterical conversion with anosognosia. They are indeed remarkably similar, though the content of their respective delusions is the opposite. In hysterical paralysis, patients are not aware of their preserved ability, whereas in anosognosia for hemiplegia, patients are not aware of their disability. Four main explanations have been provided to account for anosognosia: metacognitive, attentional, motor, and motivational views. I will apply each of these accounts to hysterical paralysis and show that, at each level, hysterical conversion is the reverse of anosognosia. I will suggest that hysterical paralysis results from the interaction between attentional somatosensory amplification and affective inhibition of action

From Photography to fMRI

Hysteria, a mysterious disease known since antiquity, is said to have ceased to exist. Challenging this commonly held view, this is the first cross-disciplinary study to examine the current functional neuroimaging research into hysteria and compare it to the nineteenth-century image-based research into the same disorder. Paula Muhr's central argument is that, both in the nineteenth-century and the current neurobiological research on hysteria, images have enabled researchers to generate new medical insights. Through detailed case studies, Muhr traces how different images, from photography to functional brain scans, have reshaped the historically situated medical understanding of this disorder that defies the mind-body dualism

overview and meta-analysis of neuroimaging studies on motor conversion disorder

Background Conversion Disorders (CD) are prevalent functional disorders. Although the pathogenesis is still not completely understood, an interaction of genetic, neurobiological, and psychosocial factors is quite likely. The aim of this study is to provide a systematic overview on imaging studies on CDs and investigate neuronal areas involved in Motor Conversion Disorders (MCD). Methods A systematic literature search was conducted on CD. Subsequently a meta-analysis of functional neuroimaging studies on MCD was implemented using an Activation Likelihood Estimation (ALE). We calculated differences between patients and healthy controls as well as between affected versus unaffected sides in addition to an overall analysis in order to identify neuronal areas related to MCD. Results Patients with MCD differ from healthy controls in the amygdala, superior temporal lobe, retrosplenial area, primary motor cortex, insula, red nucleus, thalamus, anterior as well as dorsolateral prefrontal and frontal cortex. When comparing affected versus unaffected sides, temporal cortex, dorsal anterior cingulate cortex, supramarginal gyrus, dorsal temporal lobe, anterior insula, primary somatosensory cortex, superior frontal gyrus and anterior prefrontal as well as frontal cortex show significant differences. Conclusions Neuronal areas seem to be involved in the pathogenesis, maintenance or as a result of MCD. Areas that are important for motor-planning, motor-selection or autonomic response seem to be especially relevant. Our results support the emotional unawareness theory but also underline the need of more support by conduction imaging studies on both CD and MCD

UNA PERSPECTIVA NEUROCIENTÍFICA SOBRE LA HISTERIA

En la última década, el desarrollo y la puesta en marcha delas modernas técnicas de neuroimagen en el campo de laneurociencia cognitiva han proporcionado una nueva vía deacercamiento al estudio experimental de algunos trastornosmentales. Dentro de esta perspectiva, denominada por algunosautores “neuropsiquiatría cognitiva”, la histeria (o trastornode conversión, de acuerdo con la clasificación psiquiátricaactual) ha cobrado un amplio protagonismo. De acuerdo conlo anterior, el objetivo del presente trabajo consiste en introducirestudios pioneros basados en una perspectiva neurocientíficade la histeria. Conviene destacar que, si bien estosaportan evidencia significativa sobre algunas de las áreascerebrales y las disfunciones cognitivas comprometidas enel mencionado trastorno, los resultados obtenidos a la fechadistan aún de ser concluyentes

Emotion regulation in Conversion Disorder: Towards an integrative perspective

The role emotion regulation plays in Conversion Disorders is still unknow. This study has the aim to deepen in this subject. Emotion regulation impairments are studied both theoretically and experimentally. In first place, different conversion symptoms were considered separately and those emotional impairments and neurobiological features linked to them were studied. Frontolimbic and vegetative patterns were found to be different in diverse clinical manifestations. While negative symptoms showed a pattern linked to over-regulation of affect, positive symptoms were vinculated to under-regulation of affect and finally, other symptoms such as tonic immbility were found to be a result of the combination of both strategies. A model cathegorizing different conversion manifestations according to emotion regulation patterns is proposed. Similar hipothesis are studied for the whole spectrum of trauma related disorders. Moreover, specific emotion regulation impairments are studied comparing a clinical sample to healthy controls. Difficulties on emotion regulation, alexithymia and negative emotional intensity were associated to Conversion Disorder