  
Definition
The term "hysteria"
has been in use for over 2000 years and its definition has become broader and more diffuse over time. In modern psychology
and psychiatry, hysteria is a feature of hysterical disorders in which a patient experiences
physical symptoms that have a psychological, rather than an organic, cause; and histrionic personality disorder characterized
by excessive emotions, dramatics and attention-seeking behavior. Description Hysterical disorders
Patients with hysterical disorders, such as conversion and somatization disorder experience physical symptoms that have no
organic cause. Conversion disorder affects motor and sensory functions, while somatization affects the gastrointestinal, nervous,
cardiopulmonary, or reproductive systems. These patients aren't "faking" their ailments, as the symptoms are very real to
them.
Disorders with hysteric
features typically begin in adolescence or early adulthood. Histrionic personality disorder
Histrionic personality disorder
has a prevalence of approximately 2–3% of the general population. It begins in early adulthood and has been diagnosed
more frequently in women than in men.
Histrionic personalities are
typically self-centered and attention seeking. They operate on emotion, rather than fact or logic and their conversation is full of generalizations
and dramatic appeals. While the patient's enthusiasm, flirtatious behavior and trusting nature may make them appear charming, their need for immediate gratification, mercurial displays of emotion and constant demand for attention often alienates them from others. Causes and symptoms Hysterical disorders
Hysteria may be a defense mechanism to avoid painful emotions by unconsciously transferring this distress to the body. There may be a symbolic function for this, for example a rape victim
may develop paralyzed legs. Symptoms may mimic a number of physical and neurological disorders which must be ruled out before
a diagnosis of hysteria is made. Histrionic personality disorder
According to the Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), individuals with histrionic personality
possess at least 5 of the following symptoms or personality features:
- A need to be the center of attention
- Inappropriate, sexually seductive, or provocative behavior
while interacting with others
- Rapidly changing emotions and superficial expression of emotions
- Vague and impressionistic speech (gives
opinions without any supporting details)
- Easily influenced by others
- Believes relationships are more intimate than they are.
Diagnosis
Hysterical disorders frequently
prove to be actual medical or neurological disorders,which makes it important to rule these disorders out before diagnosing a patient with hysterical disorders.
In addition to a patient interview,
several clinical inventories may be used to assess the patient for hysterical tendencies,
such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) or the Millon Clinical Multiaxial Inventory-III (MCMI-III).
These tests may be administered in an outpatient or hospital setting by a psychiatrist or psychologist. Treatment Hysterical disorders
For people with hysterical disorders, a supportive healthcare environment is critical. Regular appointments with a physician who acknowledges the patient's physical discomfort are important.
Psychotherapy may be attempted to help the patient gain insight into the cause of their distress. Use of behavioral therapy can help to avoid reinforcing symptoms. Histrionic personality disorder
Psychotherapy is generally the treatment of choice for histrionic personality disorder. It focuses on supporting the patient and on helping them develop the skills needed to create meaningful relationships with others. Prognosis Hysterical disorders
The outcome for hysterical disorders varies by type. Somatization is typically a lifelong disorder, while conversion
disorder may last for months or years. Symptoms of hysterical disorders may suddenly disappear,
only to reappear in another form later. Histrionic personality disorder
Individuals with histrionic
personality disorder may be at a higher risk for suicidal gestures, attempts, or threats in an effort to gain attention.
Providing a supportive environment for patients with both hysterical disorders and
histrionic personality disorder is key to helping these patients.
The Hysteria Threshold-Gaining
Control of the Emergency Caller
The child in a tantrum, a
screaming teenager at a Michael Jackson concert, the ex-spouse in a court custody hearing and an emergency caller, may
all have one thing in common. They're out of control. They're h-y-s-t-e-r-i-c-a-l.
The definition of hysteria is listed as " a state of tension or excitement in which there is temporary loss of control over emotions."
Our day-to-day experience
leads us to side-step unpleasantness and avoid confrontations which includes the hysterical. It's a process of natural survival. This tendency also exists
at the dispatch level and has been a lifesaver there for decades-unfortunately, only to the dispatcher.
"The caller is
too upset (hysterical) to respond accurately," is a common argument. When confronted
with a screaming, sobbing, threatening caller, what actually can be done?
In 1976, the Phoenix Fire
Department initiated their now renowned program of medical self-help, or pre-arrival instructions, due to a fortunate occurrence in their dispatch center. Some wise soul bothered to make cassette copies of their first recorded successful dispatch interventions and sent them to different agencies along with other requested written information.
After playing the tape over
and over, we noticed some consistent occurrences in each of the successful resuscitation cases on the tape.
While the caller might have been out of control [hysterical] at first, something happened each time that allowed the dispatcher to obtain control of the situation and impact the victim thru the caller.
The first thing we noticed
was ever so simple. The dispatcher didn't hang up the phone!
Normally, a dispatcher will
avoid the confrontation with the hysterical caller. "We'll send someone right over," and then
hang-up! Review a few dispatch calls where the victim is in dire need of immediate BLS and see what happens.
Next we noticed that the dispatchers
in these cases always remained calm but firm. And, faced with an initial disregard to their request to "calm down and listen to me," they repeated the same request in identical phrasing over and over again.
But that process might eventually
take 15 minutes, one hour or two days. Maybe, but not very often. We discovered that with "repetitive persistence" the EMD
can obtain "control" after usually 2 to 3 repetitions. At this point the caller gives in
and becomes a help rather than a hindrance.
But guess what? Thousands
of dispatchers have never gotten past this first request and have gone their entire careers without reaching the level of
control just past the "hysteria threshold."
Once reached, the caller almost
always relinquishes control and becomes not just OK, but begins to follow the dispatcher's
instructions closely, often exactly. Quite a difference from the screaming lunatic that greeted you on the line just
moments before.
There are 4 simple rules
to follow to get past the "hysteria threshold" through the technique of "repetitive persistence":
- You must repeat the described request each time in the same
identical way. Don't vary the sentence structure (i.e., "Ma'am, you're going to have to calm down
if we're going to help your baby." Repeat.). Variation in the spoken format indicates to the caller's subconscious
a weakness in your will, a chink in your verbal armor.
- People who are out of control want people in control to lead them. It's just that, because they're out of control, they never appear that way on the surface. And we fall for it. We agree with and respond to, their behavior instead
of their need.
- Be firm and in charge. Be generic. Don't antagonize the caller or they will re-direct their frustration at you, making your argumentative attitude the subject of their displeasure, not the victim's distressing state.
- You must believe that the threshold actually exists. And while it may vary between different callers-everyone has one. Mine might
be on the next request while yours may be next week. But funny thing-if you don't ask, how will you ever find out?
If we don't start asking the right
questions, we'll never get the right answers.
Keep Breathing
"If a parent gets hysterical when a child gets
a cut, the child gets hysterical. If the parent radiates calm, the child feels more secure. Sometimes a child only starts screaming, once he observes the parent getting upset."
Dr. Elizabeth Goldman
Clinical Professor of Pediatrics
Albert Einstein College of Medicine, New York
City
Remind yourself it's normal for kids to get sick. And remember
they'll naturally get better. Staying aware of this fact may help you (and them) calm
down. When kids get sick or injured, it can be challenging to remember this, because they experience pain and illness so intensely.
Calm your EMOTIONS by breathing easily. Try inhaling and then exhaling slowly and fully. When a child is
sick, parents often get nervous because they don't know what to do.
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Why
does my toddler get hysterical when I leave for work?
By Patricia Shimm
Question: My child used
to have no trouble saying good-bye to me, but now she becomes hysterical when I leave for work. What's going on?
Answer: Don't
worry, what's going on is very normal and it's called separation anxiety. Your child may have gone through an earlier phase of separation
anxiety before she turned 1.
It often pops up again around age 2, when a child begins exploring the world in earnest
armed with her new and improved mobility and agility.
She's learning to be independent, which thrills her, but you're her rock and it agitates her to have you leave her when you go to work.
At the toddler center where I work, we have a mantra we tell the kids when it's time
for them to say good-bye their parents: Mommies always come back, daddies always come back.
In
the morning while you're getting her ready, let her know ahead of time what to expect. For example, say, "We get to have breakfast together, isn't that fun? And then I have to go to work but I'll think about you all day while you play with your nanny / have fun at daycare."
Leave her with a picture of you so she can look at you whenever she wants. Always
let her know how much you miss her during the day and how you look forward to seeing her after work. Toddlers are very egocentric
at this age, so it helps her to know that she's important to you even when you aren't with her.
When you say good-bye, try not to linger.
While you may have the best of intentions and think that you need to comfort your child when she's upset, prolonging the moment only riles her up even more.
By doing so, you communicate your own anxiety about leaving her for the day and that makes her even more nervous. Comings and goings are part
of life and it's good to teach your child to become more comfortable with good-byes.
While you may be tempted to slip out when you think she won't notice to avoid a scene, build trust by giving her the chance to say good-bye, even if it makes her sad.
Bedtime panic attacks: 'My child gets hysterical before bedtime'
My 9 year-old
daughter goes into a panic as bedtime nears. She cries hysterically and
asks to sleep w/me. How do I help my child overcome her fear of bedtime?
Pam / New Jersey
Sleeping is an important part of your child's daily (& nightly)
routine. But each child is different and has his or her own way of approaching sleep. To help your child develop healthy sleep
habits, consider these tips:
- Encourage your child to sleep in her own bed.
- Set a routine sleep pattern that doesn't vary much, even on
weekends.
- Establish regular mealtimes, which helps set daily body rhythms.
- Establish a bedtime routine, such as brushing teeth, reading
a story, going to the toilet and then getting into bed.
Children also benefit from
a transition object, something that helps the child make the transition from wake to sleep. It shouldn't be food or a pet.
Good transition objects include a doll, blanket, stuffed animal or lullaby recording.
Television watching can be
a problem in getting your child to sleep. Turn the TV off at least 1 hour before bedtime. TV can be too disruptive and stimulating
for children, even if they're not actually watching it but are in the same room.
If the TV is off, parents
also may be more available for reading, cuddling and settling the child down for sleep.
The key is that children must
learn to get into their bed awake and relax to fall asleep in that bed, not in someone else's bed or with someone else. Once children learn how to do this, they can
use this same skill to put themselves back to sleep in the middle of the night.
If your daughter's panic attacks continue, talk to her doctor. In children younger than age 5, you can assign the role of "staying awake to keep watch"
to a favorite doll or stuffed toy.
For children age 5 and older,
it's important to get them to talk about their fears. If the child can't identify any specific fears, the problem may be an anxiety disorder.
In this case, your doctor
may refer you to a child psychologist or psychiatrist. You may also consider scheduling a time to check on your child, before
she calls you in and leaving a small light on in the room. These may help the child relax.
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The Attach-China Story
When my daughter came home
with me, she was bright, happy and well nourished - 17 pounds at 9 months of age. She caught up with language and physical development in two months.
Even bedtime seemed idyllic.
I'd give her a bottle, sing special lullabies and rock her to sleep. As time passed, instead of falling asleep in my arms,
she'd reach out to her crib and fall asleep on her own. I thought this was great.
It all changed when I returned
to work full time 5 months later. She would only nap for 15 to 30 minutes at daycare. She started to get asthma at night and
would wake up coughing. I brought her into my bed because I needed to sleep and she'd stop coughing as long as she was in bed with me.
I finally let her sleep with
me permanently. Then she started having trouble falling asleep and would become hysterical
if I left the room.
After trying everything, I
resorted to the Ferber method. I let her cry it out while periodically going back in to reassure her. She was completely hysterical each time and after a week developed such a severe case of asthma that she was nearly
hospitalized.
I had a hunch that the mind/body connection was at work here and have since learned that asthma attacks of this sort are a symptom of PTSD.
After that she was terrified of going to sleep. She became hypervigilant. She couldn't fall asleep unless I was already asleep for fear that I would leave her.
Some nights she'd stay awake
until 11 or 12. Some nights she would rage if I lay down with her, kicking me out of the bed. Then she would rage if I took a step away from the bed. She wouldn't let me rock her, but also wouldn't let me put her down.
If I tried to keep her in
bed while I sat on the edge of the bed, she seemed to comply, but would rage at me constantly the next day. At preschool she became violent toward other kids.
Her fear of abandonment intensified in other ways too. She became very clingy - I couldn't go into another room without her or pay attention to anyone
but her.
After her first time with
a babysitter, she became hysterical when she saw any of our friends, afraid that I would leave her with them. After working late one night, she became totally hysterical and disoriented when I picked
her up at our friend's house.
Since they'd changed her into
PJs, she thought I was giving her to another family and she raged for 2 hours. It was one of the most scary experiences I've ever had -- not knowing how to comfort my daughter who was so obviously terrified and hysterical.
By then, I knew something
was very wrong, but despite consulting many professionals, I couldn't find anyone who understood the severity of the terror which I was seeing in my child. After a year and a half, I finally found someone who knew
exactly what I was describing.
She diagnosed RAD and taught
me Holding Time. After the first time I did Holding Time with my daughter, her behavior changed instantly. She had become very destructive when angry, typically sweeping everything off of the coffee table. This time, she very carefully moved an object just to the edge of the table, looked at me and ran to the kitchen, saying "Don't hold me. Hold me. Hold
me."
Recently my daughter has also
been diagnosed w/Post-Traumatic Stress Disorder (PTSD), both because of the trauma of her abandonment and because of an injury she received in the orphanage. PTSD in a child is difficult to diagnose, because not only can
a small child not verbalize what's wrong, but many PTSD behaviors look like oppositional defiant behaviors,
when in reality they are the child's attempt to maintain control of her fear and environment.
In my daughter's case, her
day dreaming, spacing out in day care; her expressions of anger when she's afraid - because something in the present is reminding her of the past; her terror at falling asleep and the disruption of her circadian rhythm; her extreme car sickness (a psychosomatic symptom), which eventually was revealed to be
connected to her fear of being kidnapped - all of these are symptoms of PTSD.
Because of this, I can't do
something as routine as help a friend's daughter with her seat belt or go to an FCC meeting without my daughter becoming terrified
that I'm going to trade her for another child. It seems unthinkable, but in her experience it's perfectly logical.
After all, her birth mother
left her and so did her Ayi in China. I'm actually her 3rd mother, in a sense and logic would dictate that history will repeat
itself.
I started the Attach-China
e-mail list and web site, because from my extensive reading about RAD, I knew that many more children adopted from China had
to be experiencing the same thing and I didn't want other parents to waste time not knowing where to find help.
It's my effort to change poison
into medicine. It was on that list that I met Nancy D'Antonio, who invited me to the weekly group at the Mothering Center
led by Dr. Martha Welch.
I recently had my daughter
evaluated to find the best school situation for her given her PTSD. She tested as gifted and therefore isn't eligible for special needs help. We'll be homeschooling next year to continue working
on her feelings of attachment and security.
While I'm grateful that she's so bright, I'm still grieving the loss of having a normal, securely attached child and sharing her grief for the terrors she has and still is experiencing.
But, I'm very encouraged by the great progress of our therapy and feel confident that since we have started doing this work now, she will fully recover to become an empathetic teenager and adult who is capable of loving her husband and children.
Hysteria: A Symptom of Domestic Violence
Kathleen Howe
It was a very hot summer day in the downtown area of Grand
Rapids, Michigan. Today, those of you who have never had the pleasure of visiting Grand Rapids are missing so many interesting
sights downtown. The time I'm speaking about, when one of my most memorable fits of hysteria occurred, the downtown population
of Grand Rapids was limited due to the construction taking place in adding all the interesting sights I mentioned above. The
main walking aread downtown had been blocked off so that traffic could no longer intervene where people spent their lunch
hours, talking, eating & shopping.
I had been staying at the domestic violence shelter that was
close to the downtown area. I'd been there for a few weeks. I had experienced a very ironic incident, and had ended up more
physically injured while living in the shelter that I was when I entered. I had a broken nose, many of the small facial bones
beneath my face were broken, I had a dislocated knee and shoulder. I had been doing my job, my assigned chores, on the
third floor of the monstrous house that was in essence, "the shelter from the storm." I had finished my cleaning of the third
floor bathroom and had in my hand the bucket, the mop, cleaning fluids, sponges & so on and my 18 month old son in
the other arm. As I stepped off the top floor to the steps my shoe caught on the carpeting. I was going down, falling
fast, face first. It was a sprial staircase.
As I tumbled down the first three steps, head over heels,
I realized that at the first turn around that my son had fallen and stopped rolling at the first landing, thank God. But as
the split second of recognition of that fact settled into my thoughts, everything suddenly went dark. I was unconscious. My
face had come up and hit the wooden handrail, right on the bridge of my nose. I kept going though, until at the end of the
14 or so steps, I was a lifeless mass of bruises, cuts & displaced bones. My 18 month old son stayed where he was at the
top landing on the first corner turn, crying, needing his mommy.
The shelter workers called a cab for me after finding me. They had heard the baby crying.
I couldn't walk. They carried me to the taxi and slid me in the back seat. They placed my 18 month old son on top of me to
hold. They weren't allowed to be responsible for him. He had to go with me. I was having trouble thinking. My mind was fuzzy.
My body was hurting me all over and my head was throbbing horribly. The baby was laughing and cooing. He was reaching for
my face. I just held on until I got to the hospital.
The triage nurse told me I had to contact someone to come take care of my son. I was forced
to call my exhusband. The previous abuser, who had been a police officer and yet had never told me there were places like
domestic violence shelters, until it served him positively to do so. He had told me after my next abuser took over where he
had left off. This one physically abusive as the last had been both, but more emotionally abusive, verbally abusive than physical.
Although he had cast me out in the darkness of the night, naked, in front of my three children - letting me bang on the door,
calling to him, begging him to let me back in - I had to call him and my ex-best friend who had stolen my husband and was
stealing my son as well. They arrived quickly, notepad in hand. The custody fight was still pending.
Anyone would have been hysterical over this entire mess, but I held on. I kept my wits about me. They sent me back to
the shelter, bandaged, on crutches, and with clear cut instructions for bedrest. I couldn't stay in bed. I got up. I did what
I had to do. I couldn't be help prisoner in the shelter all day and after about one week of "in house" only, I threw out the
crutches and took my son for a walk a few blocks down the street. I made the mistake of going downhill for the walk. It was
afternoon. While downhill was easy at first, uphill on the way back was very slow going. I was trudging my way up the hill,
foot in front of foot, it seemed like hours of this energy draining footwork. Suddenly a car veered off the road, came up
on the sidewalk in front of me. I recognized it immediately. It was my husband.
He began yelling at me immediately. He saw my black eyes,
my bandaged nose, my bandages showing from beneath my shirt and my knee encased in an ace bandage as well. He began screaming
at me to give him my son. He was livid. He wasn't making any sense. He began to try to take my son out of my arms. I began
screaming, hysterically.
At that very spot, I was standing in front of
an attorney's office. I ran inside as quick as I could. I knew he was right behind me. I was hysterically explaining to the
receptionist, "I have to hide! Get me out of here! Call the police! He's trying to take my baby from me!"
She panicked as well. How often did this happen on a very
hot summer day in the Dutch Reformed community of Grand Rapids, Michigan? Almost never, but it was happening now. An attorney
came in immediately and took my arm, taking me into a conference room. He sat me down, held my arm, asked me to slow down
and explain. I did. He told me that no one could see "in" the conference room although you could see out! I was so thankful.
I kept thanking him. He assured me the police had been called.
They took him away. The police arrested him. He was driving
with a suspended license or something like that. They took him to the police station. The lawyer called a taxi to take me
back to the shelter once the police had taken him away.
I was still hysterical. I couldn't calm down. I was panicking.
I needed to leave this place. I needed to go to a shelter out of town. He was always finding me. The next day I was transferred
to Traverse City, Michigan.
Hysteria... a symptom of domestic violence... it never ends
until you lose him somehow - for good.
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i·cal·ly adv.
