How to stop uncontrollable fits of laughter. Unreasonable laughter can be a symptom of illness

An uncontrolled variant of laughter in some cases is perceived as a medical symptom, a manifestation of serious health problems. In some cases, the laughing person has a tic, twitches, or seems a little disoriented.

A sick person is able to laugh and sob at the same time, while looking like a victim of violence.

Features of pathological laughter

When you have to laugh often and involuntarily, this may indicate the appearance of pathological laughter, damage to the nervous system.

Our brain is the control center of the nervous system. The brain sends out a signal that controls involuntary actions such as breathing, heartbeat, voluntary actions such as walking or laughing. Where signals due to abnormal brain growth, chemical imbalance, birth defect go awry, there are fits of unaccountable laughter.

Laughter as a symptom of epilepsy

A case is known when in 2007 a three-year-old girl from New York behaved very strangely. From time to time she laughed and winced, as if in pain - all at the same time. Specialists discovered that the patient has a rare type of epilepsy that causes involuntary laughter. Examination revealed a benign brain tumor. The update has been removed. After the operation, involuntary laughter, a symptom of this tumor, also disappeared.

Neurologists and surgeons have repeatedly helped people with a brain tumor or cyst get rid of uncontrollable and involuntary bouts of laughter. This is due to the fact that when these formations are removed, pressure on some areas of the brain can be eliminated. By the way, the state of acute stroke can also be accompanied by pathological laughter.

Laughter as a sign of Tourette's syndrome and Angelman's syndrome

Angelman syndrome is a rare chromosomal disorder that affects the nervous system. The patient may laugh due to increased stimulation of the areas of the brain that control joy. Tourette syndrome is a neurobiological disorder that causes involuntary vocal outbursts and tics. People with Tourette syndrome usually don't need too much treatment unless the symptoms of the disease interfere with daily activities, work, or school. When needed, psychotherapy and medications can help patients minimize their symptoms.

Laughter as a symptom of chemical addiction or drug abuse

The damaged nervous system gives signals, including those that provoke laughter. Feelings of anxiety, dementia, fear, anxiety also cause involuntary laughter.

Pathological affect(synonyms: pseudobulbar affect (PBA), emotional lability, labile affect, emotional incontinence) refers to neurological disorders characterized by involuntary, blatant or uncontrollable bouts of crying, laughing, or other emotional manifestations. PBA often occurs secondary to a neurological disease or brain injury.

Patients may show emotion unreasonably and uncontrollably, or their emotional response may be disproportionate to the importance of the cause capable of causing the disorder. The person is usually unable to stop himself for a few minutes. Episodes may appear inappropriately to the environment and not only in relation to negative emotions - the patient may laugh uncontrollably when angry or upset, for example.

Signs and symptoms of the disorder

The cardinal feature of the disorder is a pathologically reduced threshold for the behavioral response of laughing, crying, or both. The patient often exhibits episodes of laughing or crying without apparent motivation or in response to stimuli that would not have elicited such an emotional response prior to the onset of the underlying neurological disorder. In some patients, the emotional response is exaggerated in intensity, but the valence stimulus provoked matches the nature of the accompanying environmental circumstances. For example, the stimulus of sadness provokes a pathologically exaggerated state of unrestrained crying.

However, in some other patients, the nature of the emotional picture may be inconsistent and even contradict the emotional valence of the provoking stimulus. For example, the patient may laugh in response to sad news or cry in response to very mild stimuli. In addition, after provoking the situation, episodes may go from laughing to crying or vice versa.

Symptoms of pathological affect can be very severe and are characterized by constant and relentless episodes. The characteristics of the latter include:

The onset of an episode can be sudden and unpredictable, with many patients describing the condition as a complete seizure of thought and emotion.
Flashes have a typical duration from a few seconds to a few minutes, no more.
Episodes may occur several times a day.

Many patients with neurological disorders exhibit uncontrollable episodes of laughter, crying, or both, which are either exaggerated or inconsistent with the context in which they occur. When patients have significant cognitive impairment, for example, it may not be clear whether the sign is a symptom of pathological affect or a gross form of emotional dysregulation. However, patients with intact cognition often report the symptom as an anxiety state leading to hysteria. Patients report that their episodes, in best case, are only partially amenable to voluntary self-control, and if they do not experience major changes mental state, often have an idea about their problem and are fully aware of their condition as a violation, and not a character trait.

In some cases, the clinical impact of the pathological affect can be very severe, with relentless and persistent symptoms that can contribute to the unconsciousness of patients and significantly affect the quality of life for those around them.

Social Impact

PBA can have a significant impact on the social functioning of patients and their relationships with other people. Such sudden, frequent, extreme, uncontrollable emotional outbursts can lead to social exclusion and interfere with daily activities, social and professional aspirations, and have a negative impact on the general health of the patient.

The appearance of uncontrolled emotions is usually associated with many additional neurological disorders such as attention deficit hyperactivity disorder, Parkinson's disease, cerebral palsy, autism, epilepsy and migraine. This can lead to serious problems in social adaptation and avoidance of social interactions by the patient, which in turn affects their mechanism for overcoming household obstacles.

Pathological affect and depression

Clinically, PBA is very similar to depressive episodes, however, the specialist must skillfully distinguish between these two pathological conditions, I know the main differences between them.

In depression and emotional incontinence in the form of crying, as a rule, is a sign of deep sadness, while pathological affect causes this symptom regardless of the main mood or significantly exceeds its lysitor stimulus. In addition, the key to differentiating depression from PBA is duration: episodes of sudden PBA occur in a short, episodic manner, while an episode of depression is a longer event and is closely related to the underlying mood state. The level of self-control, in both cases, is minimal or completely absent, however, in depression, emotional expression can be controlled by the situation. Similarly, crying episodes in patients with PBA may be triggered by a non-specific, minimal, or inappropriate situation, but in depression, the stimulus is specific to the mood state.

In some cases, depressed mood and PBA may coexist. Indeed, depression is one of the most common emotional changes in patients with illness or neurodegenerative post-stroke complications. As a result, depression often accompanies PBA. Availability concomitant diseases implies that the present patient is more likely to have a pathological effect than depression.

Causes of PBA

Specific pathophysiological involvement in the frequent manifestation of this debilitating condition is under study. Primary pathogenic mechanisms PBAs remain controversial to date. One hypothesis emphasizes the role of the corticobulbar tract in the modulation of emotional expression and suggests that a pathological affect mechanism develops if there is a bilateral lesion in the descending corticobulbar tract. This condition causes the failure of voluntary control of emotions, which leads to the disinhibition or release of the latter through direct reactions of the centers of laughter or crying in the brain stem. Other theories suspect the involvement of the prefrontal cortex in the development of pathological affect.

Pseudobulbar can be a condition that occurs as a symptom of a secondary neurological disease or brain injury and is the result of malfunctions in the neural networks that control the generation and regulation of emotion engine power. PBA is most commonly seen in people with neurological injuries such as traumatic brain injury and stroke. In addition, neurological diseases, such as Alzheimer's disease, attention deficit hyperactivity disorder (ADHD), multiple sclerosis, lateral amyotrophic sclerosis, Lyme disease and Parkinson's disease. There have been several reports that Graves' disease, or hypothyroidism, in combination with depression, often causes pathological affect.

PBA has also been observed in association with various other brain disorders, including brain tumor, Wilson's disease, syphilitic pseudobulbar palsy and unspecified encephalitis. Less commonly, conditions associated with PBA include gelastic epilepsy, central pontine myelinolysis, lipid accumulation, exposure to chemicals (eg, nitrous oxide and insecticides), and Angelman's syndrome.

It is hypothesized that these primary neurological diseases and injuries can affect the flow of chemical signals in the brain, which in turn leads to disruption of the neurological pathways that control emotional expression.

PBA is one of the symptoms of post-stroke behavioral syndromes, with reported prevalence rates ranging from 28% to 52%. This combination is often found in elderly patients who have had a stroke. The relationship between post-stroke depression and PAD is complex, as depressive syndrome also occurs at a high frequency in stroke survivors. It is worth noting that the pathological affect is more pronounced in patients after a stroke, and the presence of a depressive syndrome can exacerbate the “crying” side of PBA symptoms.

Recent studies show that approximately 10% of patients with multiple sclerosis experience at least one episode. emotional lability. PBA here is usually associated with later stages diseases (chronic progressive phase). Pathological affect in patients with multiple sclerosis is associated with more severe intellectual wear, disability and neurological disability.

Studies show that PBA in TBI survivors shows a prevalence of 5% or more with more severe head trauma, which is consistent with other neurological features indicative of pseudobulbar palsy.

Treatment

Psychological preparation of patients, their families or caregivers is important component appropriate treatment for PBA. Crying associated with the disorder can be misinterpreted as depression, and laughter can occur in a situation that does not in any way imply such a reaction. Others need to understand that this is an involuntary syndrome. Traditionally, antidepressants such as sertraline, fluoxetine, citalopram, nortriptyline, and amitriptyline may have some beneficial effect in the management of symptoms, but in general the disease is incurable.

05/02/2017 at 14:06

Hello dear friends!

Laughter not only prolongs life, but also improves its quality. Thanks to him, a person is able to reduce anxiety, symptoms of stress and even depression. But what if laughter becomes a cause of discomfort?

Have you ever laughed under the wrong circumstances? What to do if an attack of uncontrollable fun caught you at the time of submitting a report or in a clinic? When meeting with important person Or even at a funeral?

In today's article, I would like to tell you about how to properly deal with an avalanche of laughter that hit your head? What should be done to quickly calm down and what are the reasons for such “strange” behavior?

fit of laughter at an awkward moment - this is another test! A person is flooded so much that it is difficult for him to breathe! Tears roll in a hail, and the people around twist their fingers to their temples, wondering if everything is fine?

Doctors of psychological sciences say that laughter, like any other human emotion, cannot go away right away! It can take from 15 minutes to several hours to completely calm down!

Sometimes, a laughable reaction occurs in the form protective function individuals to a difficult life situation. But the most important thing that needs to be done is to learn how to control emotions so that they cannot take over the mind.

It is worth noting that sudden , arbitrary laughter may indicate serious violations in mental state and be a symptom of diseases such as Tourette's syndrome, pre-stroke condition, brain tumor, etc.

Theoretically, it is very difficult to identify the relationship between the disease and unreasonable laughter. Usually people are filled with fun when they feel good. They are happy and carefree, what's the problem? And at the same time, healers still identified several reasons , which can be provocateurs of outbreaks of an attack.

Causes

There are 4 main causes of an attack of uncontrollable laughter:

pathological effect of cognitive impairment in the body(Alzheimer's disease, tumor, head injury, damage to the nervous system);
disorder regulation of the emotional background (dementia: neurosis, depression, psychosis, apathy, etc.);
defensive reaction psyche to an irritant (complexes, emotional barriers, blocks and clamps);
chemical substances(drugs, dependence on poisons - tobacco, drugs, alcohol).

Nervous breakdownmay give rise to episodic bursts of s uncontrollable crying or laughter, repeated several times a day. Sometimes these reactions occur in response to bad news,the novelty of the event or surprise.

The human brain is the control room for the entire nervous system. Its task is to send clear signals of control over uncontrolled actions, such as systematic breathing or heartbeat.

By the way, by developing awareness and practicing breathing exercises and meditation, it is possible to train and control them! In any case, yogis do it quite well! It also participates in the tight control of voluntary obligations: walking, thinking, concentrating, crying, laughing, ...

If the quality of communication is disturbed, a functional imbalance is observed and the individual demonstrates an attack hysterical laughter, which frightens not only themselves, but also the environment. How to deal with the situation?

Dealing with an attack

Autotraining

If you literally feel the urge to burst into laughter, then I recommend that you resort to the help of auto-training. What it is?This correct installation to help your brain cling to reality. These are powerful affirmations and suggestions that increase sense of control over the situation to her helping to avoid a panic attack at the time of the attack.

Close your eyes and confidently repeat phrases to yourself, avoiding the "not" part: "I hold back laughter", "My emotions are under complete control", "I am safe."

Try to abstract from what is happening, focusing on breathing and reduce its frequency, you can take a deep breath and slowly exhale at least 5 times. Drink cold water or go for a walk.

Don't look at people's faces

If an attack was noticed The child has and at the most inopportune moment, then it should be switched from visual communication with an adult or peers as soon as possible. Laughter is extremely contagious, especially in children!

This is similar to the state of yawning, collective crying in babies, etc. Children have a stronger connection with the Force and energy-informational fields. And, as a result, they more easily adopt the emotional background that surrounds them.

If nearby you already hear chuckles that support the situation, then beware of looking at faces, because then it will be even more difficult for you and people to stop.

muscle activity

In the fight against uncontrollable laughter it is important to understand how to switch the brain? I recommend that you have recourse to muscular distraction.

For example, if you are frozen in anticipation of a seizure when you are called to the carpet to the boss, then try to find and cling to another idea that is the opposite of the real one.

Pain

If nothing helps and attempts are crowned with failure, this means that you are a person with increased emotionality. What to do in this case? Strange as it may seem, but pain is the strongest of human feelings.In order to quickly relieve the symptoms of a seizure in the form of tension in the abdominal muscles, smiling, and even a tick, I advise you to hurt yourself.

Pinch your finger, bite the tip of your tongue, prick your leg with a paperclip, etc., the main thing is to hurt nerve endings, and they will not make you wait quickly.

A couple of seconds and you are in perfect order, cheerful and can calmly look at what is happening without a smile. At the same time, I do not agitate you to get carried away with this item and use it only when absolutely necessary.

On this point!

Subscribe to updates, and in the comments share your ways to overcome inappropriate laughter! Under what circumstances did you have to do this?

See you on the blog, bye bye!

At first glance, the connection between laughter and illness seems strange. After all, we usually laugh when we are happy or find something funny. According to the science of happiness, intentional laughter can even lift our spirits and make us happy. But it's another matter if you're standing in line at the bank or at the supermarket, and suddenly someone suddenly and wildly laughs for no apparent reason. The laughing person may have a nervous tic, twitch, or appear slightly disoriented. A person can laugh and cry at the same time, while looking either childish or as a victim of violence.

If you began to laugh involuntarily and often, this may indicate a symptom such as pathological laughter. It is a sign of an underlying disease or pathological condition that usually affects the nervous system. Researchers are still eager to learn more about this phenomenon (pathological laughter is usually not associated with humor, or with fun, or any other expression of joy).

As you know, our brain is the control center of the nervous system. It sends signals that control involuntary actions such as breathing and heartbeat, as well as voluntary actions such as walking or laughing. If these signals go awry due to a chemical imbalance, abnormal brain growth, or a birth defect, bouts of involuntary laughter can occur.

Let's learn more about diseases and medical symptoms that may be accompanied by laughter, but not a smile.

Laughter due to illness

As a rule, any other signs of the disease are forced to seek help from patients or members of their families, but not laughter. However, laughter is sometimes a medical symptom that deserves close attention.

Here's an example: in 2007, a 3-year-old girl from New York began to behave quite unusually: periodically laugh and wince (as if in pain) at the same time. Doctors discovered that she had a rare form of epilepsy that caused involuntary laughter. Then they found a benign brain tumor in the girl and removed it. After the operation, the symptom of this tumor, involuntary laughter, also disappeared.

Surgeons and neurologists have repeatedly helped people with brain tumors or cysts to get rid of involuntary and uncontrollable fits of laughter. The fact is that the removal of these formations eliminates pressure on the areas of the brain that cause it. Acute stroke can also cause pathological laughter.

Laughter is a symptom of Angelman syndrome - a rare chromosomal disease affecting the nervous system. Patients often laugh because of the increased stimulation of the parts of the brain that control joy. Tourette syndrome is a neurobiological disorder that causes tics and involuntary vocal outbursts. People with Tourette syndrome usually do not need treatment unless their symptoms interfere with daily activities such as work or school. Medications and psychotherapy can help patients minimize their symptoms.

Laughter can also be a symptom of drug abuse or chemical dependency. In both cases, the damaged nervous system gives signals, including those that cause laughter. Dementia, feelings of anxiety, fear and restlessness can also cause involuntary laughter.

hysterical fit

The expression “throw a tantrum” is used by us quite often, but few people think about the fact that this is not a simple behavioral promiscuity, but a real disease, with its symptoms, clinic and treatment.

What is a hysterical fit?

A hysterical seizure is a type of neurosis, manifested by indicative emotional states (tears, screams, laughter, arching, wringing of hands), convulsive hyperkinesis, periodic paralysis, etc. The disease has been known since antiquity, even Hippocrates described this disease, calling it "womb rabies", which has a very understandable explanation. Hysterical seizures are more typical for women, less often they disturb children and only as an exception occur in men.

Professor Jean-Martin Charcot demonstrates to students a woman in a hysterical fit

On this moment the disease is associated with a certain personality type. People who are prone to bouts of hysteria are suggestible and self-hypnotic, prone to fantasizing, unstable in behavior and mood, like to attract attention to themselves with extravagant actions, tend to show theatricality in public. Such people need spectators who will babysit and take care of them, then they get the necessary psychological relaxation.

Often, hysterical seizures are associated with other psychosomatic deviations: phobias, dislike for colors, numbers, pictures, conviction of a conspiracy against oneself. Hysteria affects approximately 7-9% of the world's population. Among these people there are those who suffer from a severe degree of hysteria - hysterical psychopathy. The seizures of such people are not a performance, but a real disease that you need to know, as well as be able to help such patients. Often, the first signs of hysteria appear already in childhood, so parents of children who react violently to everything, arch their backs, scream in a huff, should be shown to a pediatric neurologist.

In cases where the problem has been growing for years and an adult already suffers from pronounced hysterical neuroses, only a psychiatrist can help. Individually for each patient, an examination is carried out, an anamnesis is collected, tests are taken and, as a result, a specific treatment is prescribed that is suitable only for this patient. As a rule, these are several groups of drugs (hypnotics, tranquilizers, anxolytics) and psychotherapy.

Psychotherapy in this case is prescribed to reveal those life circumstances that influenced the development of the disease. With the help of it, they try to level their significance in human life.

Symptoms of hysteria

A hysterical seizure is characterized by an extreme variety of symptoms.

A hysterical seizure is characterized by an extreme variety of symptoms. This is explained by the self-hypnosis of patients, "thanks" to which patients can portray the clinic of almost any disease. Seizures occur in most cases after an emotional experience.

Hysteria is characterized by signs of "rationality", i.e. the patient has only the symptom that he "needs", "beneficial" at the moment.

Hysterical seizures begin with a hysterical paroxysm, which follows an unpleasant experience, a quarrel, indifference from loved ones. The seizure begins with the corresponding symptoms:

Crying, laughing, screaming
Pain in the region of the heart
Tachycardia (rapid heartbeat)
Feeling short of breath
Hysterical ball (feeling of a lump in the throat)
The patient falls, convulsions may occur
Hyperemia of the skin of the face, neck, chest
Eyes closed (when trying to open, the patient closes them again)
Sometimes patients tear their clothes, hair, beat their heads

It is worth noting the features that are not characteristic of a hysterical seizure: the patient has no bruises, a bitten tongue, an attack never develops in a sleeping person, there is no involuntary urination, the person answers questions, there is no sleep.

Sensitivity disorders are very common. The patient temporarily ceases to feel parts of the body, sometimes he cannot move them, and sometimes he experiences wild pains in the body. The affected areas are always diverse, they can be limbs, the stomach, sometimes there is a feeling of a “driven nail” in a localized area of the head. The degree of intensity of the sensitivity disorder is diffuse in nature - from mild discomfort to severe pain.

Disorder of the sense organs:

Visual and hearing impairment
Narrowing of the visual fields
Hysterical blindness (may be in one or both eyes)
hysterical deafness

Hysterical aphonia (lack of sonority of voice)
Silence (cannot utter sounds or words)
Scanning (by syllables)
Stuttering

A characteristic feature for speech disorders is the willing desire of the patient to enter into written contact.

Paralysis (paresis)
Inability to perform movements
Unilateral hand paresis
Paralysis of the muscles of the tongue, face, neck
Trembling of the whole body or individual parts
Nervous tics of facial muscles
Arching the body

It should be noted that hysterical seizures do not imply real paralysis, but an elementary impossibility to perform voluntary movements. Often, hysterical paralysis, paresis, hyperkinesis during sleep disappear.

Disorder internal organs:

Lack of appetite
Swallowing disorder
psychogenic vomiting
Nausea, belching, yawning, coughing, hiccups
Pseudoappendicitis, flatulence
Shortness of breath, imitation of an attack bronchial asthma

The basis of mental disorders is the desire to be always in the center of attention, excessive emotionality, lethargy, psychotic stupor, tearfulness, a tendency to exaggerate and the desire to play a leading role among others. All the patient's behavior is characterized by theatricality, demonstrativeness, infantilism to some extent, it seems that the person is "happy with his illness."

Hysterical seizures in children

Symptomatic manifestations mental seizures in children depends on the nature psychological trauma and from the personal characteristics of the patient (suspiciousness, anxiety, hysteria).

The child is characterized hypersensitivity, impressionability, suggestibility, egoism, instability of mood, egocentrism. One of the main features is recognition among parents, peers, society, the so-called “family idol”.

For children younger age breath holding is characteristic when crying, provoked by discontent, the anger of the child when his requests are not satisfied. At an older age, the symptoms are more diverse, sometimes resembling attacks of epilepsy, bronchial asthma, and suffocation. The seizure is characterized by theatricality, the duration until the child gets what he wants.

Less common is stuttering, neurotic tics, blinking tics, whimpering, tongue-tied. All of these symptoms arise (or are exacerbated) in the presence of persons to whom the hysterical reaction is directed.

A more frequent symptom is enuresis (bedwetting), more often due to changes in the environment (a new kindergarten, school, home, the appearance of a second child in the family). Temporary withdrawal of a baby from a traumatic environment can lead to a decrease in diuresis attacks.

Diagnosis of the disease

The diagnosis can be made by a neurologist or psychiatrist after required examination, during which there is an increase in tendon reflexes, tremor of the fingers. During the examination, patients often behave unbalanced, may groan, scream, demonstrate an increase in motor reflexes, spontaneously shudder, cry.

One of the methods for diagnosing hysterical seizures is color diagnostics. The method is a rejection of a certain color during the development of a particular condition.

For example, an orange color is unpleasant for a person, this may indicate low self-esteem, problems with socialization and communication. Such people usually do not like to appear in crowded places, it is difficult for them to find mutual language with others, make new friends. Rejection of the blue color and its shades indicates excessive anxiety, irritability, agitation. Dislike for the red color indicates violations in the sexual sphere or psychological discomfort that arose against this background. Color diagnostics is currently not very common in medical institutions, but the technique is accurate and in demand.

First aid

Quite often it is difficult to understand whether the sick person in front of you or the actor. But despite this, it is worth knowing the mandatory first aid recommendations in this situation.

Do not persuade a person to calm down, do not feel sorry for him, do not become like a patient and do not panic yourself, this will only incite the hysteroid even more. Be indifferent, in some cases you can go to another room or room. If the symptoms are violent and the patient does not want to calm down, try to splash him in the face cold water, bring to inhale ammonia vapor, give a slight slap in the face, press on the painful point in the cubital fossa. In no case do not indulge the patient, if possible remove strangers or take the patient to another room. After that, call the attending physician, before arrival medical worker don't leave the person alone. After an attack, give the patient a glass of cold water.

Do not hold during an attack of the patient by the arms, head, neck or leave him unattended.

To prevent seizures, you can drink courses of tincture of valerian, motherwort, use sleeping pills. The patient's attention should not be fixed on his disease and its symptoms.

Hysterical seizures appear for the first time in childhood or adolescence. With age, clinical manifestations are smoothed out, but in menopause can again remind themselves of themselves and become aggravated. But under systematic observation and treatment, exacerbations pass, patients begin to feel much better without seeking help from a doctor for years. The prognosis of the disease is favorable when the disease is detected and treated in childhood or adolescence. It should not be forgotten that hysterical seizures may not always be a disease, but represent only a personality warehouse. Therefore, it is always worth consulting with a specialist.

Hysteria and hysterical neurosis

As a rule, hysterical neurosis is characterized by increased suggestibility of patients who, by hook or by crook, seek to attract the attention of others to their person. This form of neurosis is manifested by various disorders: motor, autonomic and sensitive.

Hysteria is manifested by such emotionally violent reactions as laughter, screaming and tears. It can also be expressed in convulsive hyperkinesis (violent movements), paralysis, deafness and blindness, loss of consciousness and hallucinations.

Causes

Mental experiences associated with the breakdown of mechanisms nervous activity- the main reasons for the appearance hysterical neurosis. Moreover, nervous tension can be associated with both external factors and intrapersonal conflict.

Hysteria in such people can occur literally out of the blue, thanks to a completely insignificant reason. Often the disease begins suddenly: due to severe mental trauma or due to a prolonged traumatic situation. The causes of hysterical seizures lie in the quarrels that precede them, entailing mental unrest.

Symptoms of hysteria and hysterical neurosis

A hysterical fit begins with a sensation of a lump in the throat, a sudden increase in heart rate and a feeling of lack of air. Often these symptoms are accompanied by unpleasant sensations in the region of the heart, which incredibly frighten the patient. The condition continues to deteriorate rapidly, the person falls to the ground, after which convulsions appear, during which the patient stands on the back of the head and heels - this position of the body is called the "hysterical arc".

The attack is accompanied by redness and blanching of the face. Often patients begin to tear their clothes, shout out some words and beat their heads on the floor. In addition, such a convulsive seizure may be preceded by crying or hysterical laughter.

A frequent manifestation of hysteria is anesthesia, in which there is a complete loss of sensitivity of one half of the body. Also, headaches, reminiscent of the feeling of a “driven nail”, are not excluded.

Visual and hearing impairments also occur, but are temporary. In addition, it is impossible to exclude speech disorders, consisting in the loss of sonority of the voice, in stuttering, in pronunciation in syllables and silence.

Symptoms appear already in adolescence and are pronounced: the desire to always be in the spotlight, sudden mood swings, tearfulness and constant whims. At the same time, the impression often arises that the patient is quite satisfied with life, since his behavior is distinguished by some theatricality, demonstrativeness and pomposity.

Hysteria occurs chronically, with periodic exacerbations. With age, the symptoms disappear, but only to return to the climacteric period, known for the complete restructuring of the female body.

Varieties

In young children, hysterical states occur as acute reaction fear, which is usually unfounded. Also, hysterical seizures in babies can provoke punishment from parents. Such disorders usually pass quickly if the parents realize their mistake and reconsider their attitude towards the punishment of the child.

In adolescents, manifestations of hysteria are often observed among pampered girls and young men with a weak will, who, moreover, are not accustomed to work and do not accept words of refusal. Such children will gladly flaunt their illness.

In women, hysteria has its origins in the features hormonal metabolism, therefore, it is closely related to the sex glands that produce steroids, which strongly affect mood swings during menstruation. It is fluctuations in hormone levels that lead to hysteria during puberty and at the end of the childbearing period.

Treatment of hysterical neurosis

In hysterical neurosis, treatment is aimed at eliminating the causes of its occurrence. And in such cases, one cannot do without psychotherapy, the main assistants of which are trainings, hypnosis and all kinds of suggestion methods that positively affect the elimination mental disorder, because the patient needs to be explained that this disease is caused by "escape to the disease" and only a full awareness of the depth of the problem can change it.

It does not do here without general strengthening and psychotropic drugs that improve the health and mental state of patients. In addition, massage, vitamin therapy and bromine preparations are shown, as well as andexin, librium, and small doses of reserpine and chlorpromazine.

An attack of hysteria in children is successfully treated by simplified methods, the most effective of which are suggestion and false treatment. If the cause of the neurosis relates to a lack of attention, then for treatment it is only necessary to spend more time with the child.

Hysteria can be treated folk remedies. Traditional medicine is rich in various recipes to calm an overly excitable person. It is necessary to use teas and decoctions from herbs such as motherwort, mint, chamomile and valerian. All herbs have a calming effect, and taking them on an empty stomach and at bedtime helps to cure hysterical seizures.

Prevention

The most important thing in prevention unpleasant disease- this is the lack of excessive care and sympathy among the patient's relatives, since their reverent attitude can be misinterpreted: patients may well simulate the disease not only in order to earn a large portion of attention to their person, but also to obtain some benefit. Ignoring the seriousness of the problem can lead to the fact that hysteria will either disappear, or the very need for its spectacular demonstration will disappear.

After consulting with a specialist, you can use sedatives and psychotropic drugs, and do not forget about teas and herbal infusions.

An important point in prevention is the creation of conditions that reduce the traumatization of the psyche at work and at home.

Outbursts of laughter in teenagers

Modern scientists attribute uncontrolled laughter to the symptoms of multiple sclerosis, Parkinson's disease, Lou Gehrig's disease, Alzheimer's disease and other diseases. However, according to Professor Robert Provine of the University of Maryland, any manifestation of laughter does not depend on human consciousness. "You can't choose when you laugh the way you choose when you talk," writes psychology professor R. Provine in his work "Laughter: A Scientific Investigation."

In his book, the scientist cites as an example a case that occurred in Tanzania in 1962. Several girls from the class suddenly started laughing. Looking at them, a few more girls began to laugh, and soon the whole school began to suffer from uncontrollable laughter, which lasted for 6 months. The school then had to temporarily close.

Any neurologist will explain why a sick person, not feeling happy or especially unhappy, suddenly starts screaming or laughing, but it is very difficult to explain why this happens to healthy people. However, Stanford University professor Joseph Parvizi, who studies the problems of seizures and pathological laughter and crying, agrees that outbursts of such emotions are beyond human control. Laughter and crying are the result of interaction various structures brain that occur without the participation of consciousness. The brain simply sends a signal to the heart to beat faster, so situations when one fell down the stairs and the other starts laughing out loud do not mean that the second is an evil person.

During the experiment, scientists learned to cause laughter and crying by artificial means. So, stimulation of the subthalamic nucleus caused tears, and the anterior cingulate cortex caused laughter. At the same time, patients did not experience the emotions necessary for such manifestations of feelings.

Scientists compare the appearance of laughter with the sudden appearance of the desire to eat ice cream. "The fact that I want ice cream at the moment is beyond my control. I can buy or not buy ice cream for myself. But I can't make my brain not want it," says J. Parvizi.

Laughter for no reason: a symptom of bipolar disorder

Symptoms of Bipolar Disorder

One of the symptoms of bipolar disorder is the so-called periods of mania, when positive emotions go through the roof.

In the manic period, a person covers:

feeling of energization
reduced need for sleep
there is excessive self-confidence.

At first glance, there is nothing wrong with this. However, during periods of mania, people with bipolar disorder spend money, get into debt, end relationships, and are prone to impulsive and often life-threatening behavior.

Bipolar disorder is unique in that it makes positive emotions dangerous and unwanted.

Inappropriate emotions of people with bipolar disorder

Yale University psychologist Dr. Gruber observed people with bipolar disorder in remission and found that even in such moments they experience more positive emotions than people who have never suffered from this disease. It seems that expressing positive emotions is not a problem, however, in some cases, their manifestation may be inappropriate.

During the study, people with bipolar disorder experienced more positive emotions both while watching comedies and watching frightening or sad films, such as the scene when a child cries over his father's grave. The survey revealed that patients can feel great even when a loved one says unpleasant or sad things to their face.

Too many positive vibes

Studies can help in identifying an impending relapse of the disease. Showing positive emotions in inappropriate situations is a warning sign.

In another study, Dr. Gruber interviewed students who had never shown symptoms of bipolar disorder before. As a result of the survey, it turned out that those who have positive emotions predominate in both positive and negative and neutral situations are at risk of developing bipolar disorder.

It should be noted that with bipolar disorder, patients experience a certain type of positive emotions. Such emotions, as a rule, are selfish and self-directed - these are pride, ambition, self-confidence, etc. These emotions do not contribute to social interactions and relationships, unlike, for example, love and empathy.

People with bipolar disorder set themselves high goals, are very sensitive to praise and rewards, and during periods of mania, some even believe that they have superpowers.

Positive emotions should be appropriate

Positive emotions are not always useful for people who do not suffer from bipolar disorder. While positive emotions are generally good for psychological state, in moments when they take on excessively pronounced forms or appear in an inappropriate situation, their positive effect is leveled. Thus, positive emotions are good and useful at the right time and in the right place.

How to overcome an inappropriate and uncontrollable attack of laughter?

Hello dear friends!

Have you ever laughed under the wrong circumstances? What to do if an attack of uncontrollable fun caught you at the time of submitting a report or in a clinic? When meeting an important person or even at a funeral?

An attack of laughter at an awkward moment is another test! A person is flooded so much that it is difficult for him to breathe! Tears roll in a hail, and the people around twist their fingers to their temples, wondering if everything is fine?

Doctors of psychological sciences say that laughter, like any other human emotion, cannot go away right away! It can take from 15 minutes to several hours to completely calm down!

Sometimes, a laughing reaction occurs in the form of a protective function of an individual to a difficult life situation. But the most important thing that needs to be done is to learn how to control emotions so that they cannot take over the mind.

It is worth noting that sudden, arbitrary laughter can indicate serious mental disorders and be a symptom of diseases such as Tourette's syndrome, pre-stroke condition, brain tumor, etc.

Theoretically, it is very difficult to identify the relationship between the disease and unreasonable laughter. Usually people are filled with fun when they feel good. They are happy and carefree, what's the problem? And at the same time, healers still identified several reasons that may be provocateurs of outbreaks of an attack.

Causes

There are 4 main causes of an attack of uncontrollable laughter:

the pathological effect of cognitive impairment in the body (Alzheimer's disease, tumor, head injury, damage to the nervous system);
dysregulation of the emotional background (dementia: neurosis, depression, psychosis, apathy, etc.);
defensive reaction of the psyche to an irritant (complexes, emotional barriers, blocks and clamps);
chemicals (drugs, dependence on poisons - tobacco, drugs, alcohol).

A nervous breakdown can provoke the appearance of episodic bursts of uncontrollable crying or laughter, repeated several times a day. Sometimes these reactions occur in response to bad news, novelty, or surprise.

The human brain is the control room for the entire nervous system. Its task is to send clear signals of control over uncontrolled actions, such as systematic breathing or heartbeat.

By the way, by developing awareness and practicing breathing exercises and meditation, it is possible to train and control them! In any case, yogis do it quite well! He also participates in the strict control of arbitrary obligations: walking, thinking, concentration, crying, laughing,.

If the quality of communication is disturbed, a functional imbalance is observed and the individual demonstrates an attack of hysterical laughter, which frightens not only themselves, but also the environment. How to deal with the situation?

Dealing with an attack

Autotraining

If you literally feel the urge to burst into laughter, then I recommend that you resort to the help of auto-training. What it is? This is the right mindset to help your brain cling to reality. These are powerful affirmations and suggestions that increase the feeling of control over the situation, helping to avoid a panic attack at the moment of an attack.

Close your eyes and confidently repeat phrases to yourself, avoiding the "not" part: "I hold back laughter", "My emotions are under complete control", "I am safe."

Try to abstract from what is happening, focusing on breathing and reduce its frequency, you can take a deep breath and slowly exhale at least 5 times. Drink cold water or go for a walk.

Don't look at people's faces

If an attack was noticed in a child and at the most inopportune moment, then it should be switched from visual communication with an adult or peers as soon as possible. Laughter is extremely "contagious", especially in children!

This is similar to the state of yawning, collective crying in babies, etc. Children have a stronger connection with the Force and energy-informational fields. And, as a result, they more easily adopt the emotional background that surrounds them.

If nearby you already hear chuckles that support the situation, then beware of looking at faces, because then it will be even more difficult for you and people to stop.

muscle activity

In the fight against uncontrollable laughter, it is important to understand how to switch the brain? I recommend that you have recourse to muscular distraction.

For example, if you are frozen in anticipation of a seizure when you are called to the carpet to the boss, then try to find and cling to another idea that is the opposite of the real one.

If nothing helps and attempts are crowned with failure, this means that you are a person with increased emotionality. What to do in this case? Strange as it may seem, but pain is the strongest of human feelings. In order to quickly relieve the symptoms of a seizure in the form of tension in the abdominal muscles, smiling, and even a tick, I advise you to hurt yourself.

Pinch your finger, bite the tip of your tongue, prick your leg with a paperclip, etc., the main thing is to touch the nerve endings, and they will not keep you waiting quickly.

Subscribe to updates, and in the comments share your ways to overcome inappropriate laughter! Under what circumstances did you have to do this?

Hysterical neurosis (hysteria)

Hysteria (syn.: hysterical neurosis) is a form of general neurosis, manifested by a variety of functional motor, autonomic, sensitive and affective disorders, characterized by great suggestibility and self-suggestibility of patients, the desire to attract the attention of others by any means.

Hysteria as a disease has been known since ancient times. Many mythical and incomprehensible things were attributed to her, which reflected the development of medicine of that time, the ideas and beliefs prevailing in society. These data are now of a general nature only.

The term "hysteria" itself comes from the Greek. hystera - the uterus, since the ancient Greek doctors believed that this disease occurs only in women and is associated with a violation of the function of the uterus. Wandering around the body for the purpose of satisfaction, it allegedly squeezes itself, other organs or vessels going to them, which causes unusual symptoms illness.

The clinical manifestations of hysteria, according to the medical sources of that time that have come down to us, were also somewhat different and more pronounced. However, the leading symptom was and remains hysterical seizures with convulsions, insensitivity of certain areas of the skin and mucous membranes, headache compressive character ("hysterical helmet") and pressure in the throat ("hysterical lump").

Hysterical neurosis (hysteria) is manifested by demonstrative emotional reactions (tears, laughter, screams). There may be convulsive hyperkinesis (violent movements), transient paralysis, loss of sensation, deafness, blindness, loss of consciousness, hallucinations, etc.

The main cause of hysterical neurosis is a mental experience that led to the disruption of the mechanisms of higher nervous activity. nervous tension may be associated with some external moment or intrapersonal conflict. In such persons, hysteria can develop under the influence of an insignificant reason. A disease occurs either suddenly under the influence of severe mental trauma, or more often, under the influence of a long-term traumatic unfavorable situation.

Hysterical neurosis has the following symptoms.

More often, the disease begins with the appearance hysterical signs. Usually a seizure is provoked by unpleasant experiences, a quarrel, emotional excitement. The attack starts with discomfort in the region of the heart, a sensation of a “lump” in the throat, palpitations, a feeling of lack of air. The patient falls, convulsions appear, often tonic. Convulsions are in the nature of complex chaotic movements, like opisthotonus or, in other words, a “hysterical arc” (the patient stands on the back of the head and heels). During an attack, the face either turns red or pale, but is never purplish red or bluish, as in epilepsy. The eyes are closed, when you try to open them, the patient closes his eyelids even more. Pupillary response to light is preserved. Often, patients tear their clothes, beat their heads on the floor without causing significant damage to themselves, groan or shout out some words. A seizure is often preceded by crying or laughing. Seizures never occur in a sleeping person. There are no bruises or biting of the tongue, involuntary urination, no sleep after a seizure. Consciousness is partially preserved. The patient remembers the seizure.

One of the frequent phenomena of hysteria is a disorder of sensitivity (anesthesia or hyperesthesia). This can be expressed as a complete loss of sensation in one half of the body, strictly in the midline, from the head to lower extremities also increased sensitivity and hysterical pains. Frequent headaches and classic symptom in hysteria, there is a feeling of a “driven nail”.

Disorders of the function of the sense organs are observed, which are manifested in transient visual and hearing impairments (transitory deafness and blindness). There may be speech disorders: loss of sonority of the voice (aphonia), stuttering, pronunciation in syllables (scanted speech), silence (hysterical mutism).

Movement disorders are manifested by paralysis and paresis of muscles (mainly of the limbs), forced position of the limbs, inability to perform complex movements.

Patients have character traits and behaviors: egocentrism, a constant desire to be in the center of attention, to take a leading role, mood variability, tearfulness, capriciousness, a tendency to exaggeration. The patient's behavior is demonstrative, theatrical, it lacks simplicity and naturalness. It seems that the patient is satisfied with his illness.

Hysteria usually begins in adolescence and proceeds chronically with periodic exacerbations. With age, the symptoms are smoothed out, and in the menopause they become aggravated. The prognosis is favorable when the situation that caused the exacerbation is eliminated.

In the Middle Ages, hysteria was not considered a disease requiring treatment, but demonic possession, reincarnation in animals. The patients were afraid of church rites and objects of religious worship, under the influence of which they had convulsive seizures, they could bark like a dog, howl like a wolf, clucked, neighed, croaked. The presence of pain-insensitive areas of skin in patients, which is often found in hysteria, served as evidence of a person’s connection with the devil (“the seal of the devil”), and such patients were burned at the stake of the Inquisition. In Russia, such a state was considered as "hysteria". Such patients could behave calmly in home environment, but it was believed that they were possessed by a demon, therefore, due to the great suggestibility in the church, seizures often occurred with shouting out - “shouting out”.

IN Western Europe in the 16th and 17th centuries. there was a kind of hysteria. The sick gathered in crowds, danced, lamented, went to the chapel of St. Vitus in Zabernet (France), where healing was considered possible. Such a disease was called "great chorea" (actually hysteria). This is where the term "St. Vitus' dance" originated.

In the 17th century the French physician Charles Lepoix observed hysteria in males, which disproved the role of the uterus in the onset of the disease. Then there was an assumption that the reason lies not in the internal organs, but in the brain. But the nature of the brain damage, of course, was unknown. At the beginning of the XIX century. Brickle considered hysteria a "brain neurosis" in the form of disturbances of "sensory perceptions and passions."

Deep scientific study hysteria was carried out by J. Charcot (1825-1893) - the founder of the French school of neurologists. Together with him worked on this problem 3. Freud and well-known neuropathologist J. Babinsky. The role of suggestion in the origin of hysterical disorders, such manifestations of hysteria as convulsive seizures, paralysis, contractures, mutism (lack of verbal communication with others with the preservation of the speech apparatus), and blindness were studied in detail. Attention was drawn to the fact that hysteria can copy (simulate) many organic diseases of the nervous system. Charcot called hysteria "the great simulant," and even earlier, in 1680, the English physician Sydenham wrote that hysteria imitates all diseases and "is a chameleon that ceaselessly changes its colors."

Even today, neurology uses such terms as “Charcot minor hysteria” - hysteria with movement disorders in the form of tics, tremors, twitching of individual muscles: “Charcot great hysteria” - hysteria with severe movement disorders (hysterical seizures, paralysis or paresis ) and (or) violations of the functions of the sense organs, such as blindness, deafness; "Charcot hysterical arc" - an attack of generalized tonic convulsions in patients with hysteria, in which the body of the patient with hysteria arches with support on the back of the head and heels; “Charcot hysterogenic zones” are painful points on the body (for example, on the back of the head, arms, under the collarbone, under the mammary glands, on the lower abdomen, etc.), pressure on which can cause a hysterical seizure in a patient with hysteria.

Causes and mechanisms of development of hysterical neurosis

According to modern views, in the occurrence of hysterical neurosis important role belongs to the presence of hysterical personality traits and mental infantilism as a factor of internal conditions (V. V. Kovalev, 1979), in which heredity undoubtedly plays a significant role. From external factors V. V. Kovalev and other authors attached importance to family education according to the “family idol” type and other types of psycho-traumatic effects, which can be very different and to a certain extent depend on the age of the child. So, in early childhood, hysterical disorders can occur in response to an acute fright (more often it is an apparent threat to life and well-being). In preschool and primary school age, such conditions in some cases develop after physical punishment, with the expressed dissatisfaction of the parents with the act of the child or a categorical refusal to fulfill his request. Such hysterical disorders are usually temporary, they may not recur in the future if the parents understand their mistake and treat the child more carefully. Therefore, we are not talking about the development of hysteria as a disease. This is just an elementary hysterical reaction.

In children of middle and older (in fact, in adolescents) school age, hysteria usually occurs as a result of a long-acting psychotrauma that infringes on the child as a person. It has long been noticed that various clinical manifestations of hysteria are more often observed in pampered children with a weak will and immunity to criticism, not accustomed to work, not knowing words"can't" and "should". They are dominated by the principle of "give" and "I want", there is a contradiction between desire and reality, dissatisfaction with their position at home or in the children's team.

IP Pavlov explained the mechanism of occurrence of hysterical neurosis by the predominance of subcortical activity and the first signal system over the second, which is clearly formulated in his works: “. the hysterical subject lives to a greater or lesser extent not rationally, but emotional life, is controlled not by cortical activity, but by subcortical activity. ".

Clinical manifestations of hysterical neurosis

The clinic of hysteria is very diverse. As indicated in the definition of this disease, it is manifested by vegetative motor, sensory and affective disorders. These violations in varying degrees of severity can be in the same patient, although sometimes only one of the above symptoms occurs.

Clinical signs of hysteria are most pronounced in adolescents and adults. In childhood, it is less demonstrative and often monosymptomatic.

A distant prototype of hysteria can be conditions that are often found in children of the first year of life; a child who does not yet consciously pronounce individual words, but can already sit and sit on his own (at 6-7 months), stretches out his hands to his mother, thereby expressing a desire to be taken. If for some reason the mother does not fulfill this wordless request, the child begins to act up, cry, and often throws her head back and falls, screams, and trembles all over. It is worth taking him in your arms, as he quickly calms down. This is nothing but the most elementary manifestation of a hysterical fit. With age, the manifestation of hysteria becomes more and more complicated, but the goal remains the same - to achieve your “I want”. It can only be supplemented by the opposite desire, “I don’t want to,” when demands are made to the child or instructions are given that he does not want to fulfill. And the more categorically these demands are presented, the more pronounced and diverse the reaction of the protest. The family, according to the figurative expression of V. I. Garbuzov (1977), becomes a real “battlefield” for the child: the struggle for love, attention, care, a central place in the family, unwillingness to have a brother or sister, to let go of oneself parents.

With all the variety of hysterical manifestations in childhood, motor and vegetative disorders and relatively rare sensory disorders are most common.

Movement disorders. It is possible to distinguish individual clinical forms of hysterical disorders accompanied by motor disorders: seizures, including respiratory affective, paralysis, astasia-abasia, hyperkinesis. They are usually combined with affective manifestations, but may be without them.

Hysterical seizures are the main, most striking manifestation of hysteria, which made it possible to isolate this disease into a separate nosological form. It should be noted that at present, both in adults and in children, there are practically no or only rarely developed hysterical seizures are observed, which were described by J. Charcot and 3. Freud at the end of the 19th century. This is the so-called pathomorphosis of hysteria (as well as many other diseases) - a persistent change in the clinical manifestations of the disease under the influence of environmental factors: social, cultural (customs, morality, culture, education), advances in medicine, preventive measures, etc. Pathomorphosis is not one of hereditary fixed changes, which does not exclude manifestations in their original form.

If we compare hysterical seizures, on the one hand, in adults and adolescents, and on the other hand, in childhood, then in children they are more elementary, simple, rudimentary (as if underdeveloped, remaining in their infancy) in nature. To illustrate, several characteristic observations will be given.

Grandmother brought three-year-old Vova to the appointment, who, according to her, is "sick with a nervous disease." The boy often throws himself on the floor, kicks his legs, cries. This state occurs when his desires are not fulfilled. After an attack, the child is put to bed, parents sit around him for hours, then they buy a lot of toys and immediately fulfill all his requests. A few days ago, Vova was with his grandmother in the store, asking her to buy a chocolate bear. Knowing the nature of the child, the grandmother wanted to fulfill his request, but there was not enough money. The boy began to cry loudly, scream, then fell to the floor, banging his head against the counter. At home there were similar attacks until his wish was fulfilled.

Vova is the only child in the family. Parents spend most of their time at work, and the upbringing of the child is completely entrusted to the grandmother. She loves her only grandson very much and "breaks her heart" when he cries, so all the boy's whims are fulfilled.

Vova is a lively, active child, but very stubborn, and gives standard answers to any instructions: “I won’t”, “I don’t want to”. Parents regard this behavior as a great independence.

On examination from the side of the nervous system, no signs of its organic damage were found. Parents are advised not to pay attention to such attacks, to ignore them. Parents followed the advice of doctors. When Vova fell to the floor, the grandmother went into another room, and the attacks stopped.

The second example is a hysterical fit in an adult. During my work as a neuropathologist in one of the regional hospitals in Belarus, one day the chief doctor came into our department and said that the next day we should go to the vegetable base and sort out the potatoes. All of us silently, but with enthusiasm (before it was impossible otherwise) met his order, and one of the nurses, a woman of about 40 years old, fell to the floor, arched her back and then began to convulse. We knew about the presence of such seizures in her and provided the necessary assistance in such cases: sprinkled with cold water, patted her cheeks, gave her a sniff of ammonia. After 8-10 minutes, everything went away, but the woman experienced great weakness, she could not move herself. She was taken home in a hospital car and, of course, she did not go to work at the vegetable base.

From the story of the patient and the conversations of her acquaintances (women always like to gossip), the following was found out. She grew up in a village in a wealthy and hardworking family. She graduated from 7 classes, she studied mediocrely. Her parents early taught her to work around the house and brought her up in harsh and demanding conditions. Many desires in adolescence were suppressed: it was forbidden to go to gatherings with peers, make friends with the guys, attend dances in village clubs. Any protests in this regard met with a ban. The girl felt hatred for her parents, especially for her father. At 20, she married a divorced fellow villager who was much older than her. This man was lazy and had a certain passion for drinking. They lived separately, there were no children, the household was neglected. Divorced a few years later. She often came into conflict with neighbors who tried to infringe on a “lonely and defenseless woman” in some way.

During conflicts, she had seizures. The villagers began to shun her, only with a few friends she found a common language and understanding. Soon she left to work as a nurse in a hospital.

In behavior, she is very emotional, excitable, but tries to restrain and hide her emotions. At work, he does not enter into conflicts. She loves very much when she is praised for her good work, in such cases she works tirelessly. He likes to be fashionable in the "urban manner", flirt with male patients and talk on erotic topics.

As can be seen from the above data, there were more than enough reasons for the neurosis: this is an infringement sexual desires in childhood and youth, and unsuccessfully developed family relationships, and material difficulties.

As far as I know, this woman has not had hysterical seizures for 5 years, at least at work. Her condition was quite satisfactory.

If we analyze the nature of hysterical seizures, we may get the impression that this is a simple simulation (pretense, i.e. imitation of a disease that does not exist) or aggravation (exaggeration of the signs of an existing disease). In reality, this is a disease, but proceeding, as A. M. Svyadosh (1971) figuratively writes, according to the mechanism of “conditional desirability, pleasantness for the patient, or “flight into illness” (according to 3. Freud).

Hysteria is a way to protect yourself from difficult life situations or achieve a desired goal. With a hysterical fit, the patient seeks to evoke sympathy from others, they do not occur if there are no strangers.

In a fit of hysteria, a certain artistry is often visible. Patients fall without getting bruises and injuries, there are no bites of the tongue or oral mucosa, urinary and fecal incontinence, which often occurs with an epileptic seizure. Still, it's not easy to tell them apart. Although in some cases there may be induced disorders, including due to the behavior of the doctor during a seizure in a patient. So, J. Charcot, during a demonstration of hysterical seizures to students, discussed with patients their difference from epileptic ones, paying special attention to the absence of involuntary urination. The next time he demonstrated the same patient, he urinated during a fit.

Respiratory affective seizures. This form seizures are also known as spasmodic crying, crying-sobbing, breath-holding attacks, affect-respiratory seizures, convulsions of rage, crying of anger. The main thing in the definition is respiratory, i.e. pertaining to breathing. The seizure begins with crying caused by negative emotional impact or pain.

Crying (or screaming) becomes more and more loud, breathing quickens. Suddenly, during inhalation, the breath is held due to spasm of the muscles of the larynx. The head is usually thrown back, the veins in the neck swell, cyanosis occurs skin. If this lasts no more than 1 minute, then only pallor and a slight cyanosis of the face appear, more often only the nasolabial triangle, the child takes a deep breath and everything stops. However, in some cases, holding the breath can last several minutes (sometimes up to 15-20), the child falls, partially or completely loses consciousness, and there may be convulsions.

This type of seizure is observed in 4-5% of children aged 7-12 months and accounts for 13% of all seizures in children under 4 years of age. Respiratory affective seizures are described in detail by us * san in the "Medical Book for Parents" (1996), where their relationship with epilepsy is indicated (in 5-6% of cases).

In this section, we only note the following. Respiratory affective seizures are more common in boys than girls, they are psychogenic and are a common form of primitive hysterical reactions in children. early age, usually disappear by 4-5 years. In their occurrence, a certain role is played by hereditary burden with similar conditions, which, according to our data, took place in 8-10% of the examined.

What to do in such cases? If the child is crying and “goes in”, then you can sprinkle him with cold water, slap or shake him, i.e. apply another pronounced irritant. Often this is enough and the seizure does not develop further. If the child falls and convulsions occur, then he should be put on the bed, hold his head and limbs (but do not hold them by force) to avoid bruises and injuries, and call a doctor.

Hysterical paresis (paralysis). In terms of neurological terminology, paresis is a restriction, paralysis is the absence of movement in one or more limbs. Hysterical paresis or paralysis are the corresponding disorders without signs of organic damage to the nervous system. They can capture one or more limbs, are more often in the legs, and sometimes are limited to only part of the leg or arm. At partial lesion one limb weakness may be limited to only the foot or foot and lower leg; in the hand, this will be the hand or the hand and the forearm, respectively.

Hysterical paresis or paralysis are much less common than the above hysterical motor disorders.

Let me give you one of my personal observations as an example. A few years ago, I was asked to counsel a 5-year-old girl who had paralyzed her legs a few days ago. Some of the doctors even suggested poliomyelitis. The consultation was urgent.

The girl was carried in her arms. Her legs did not move at all, she could not even move her toes.

From the questioning of the parents (anamnesis), it was possible to establish that 4 days ago the girl began to walk poorly for no apparent reason, and soon she could not make the slightest movement with her feet. When lifting the child, the armpits of the legs hung down (dangling). When they put their feet on the floor, they buckled. She could not sit down, and planted by her parents immediately fell on her side and back. Neurological examination revealed no organic lesions of the nervous system. This, along with many assumptions that develop in the process of examining the patient, suggested the possibility of hysterical paralysis. Fast development this condition required to find out its connection with certain causes. However, their parents did not find them. He began to clarify what she was doing and what she had done a few days before. Parents again noted that these were ordinary days, they worked, the girl was at home with her grandmother, she played, ran, was cheerful. And, as if by the way, my mother noted that she had bought skates for her and had been taking her to learn to skate for several days. At the same time, the girl's expression changed, she seemed to start up and turned pale. When asked if she liked skates, she vaguely shrugged her shoulders, and when asked if she wanted to go to the rink and become a figure skating champion, at first she didn’t answer anything, and then quietly said: “I don’t want to.”

It turned out that the skates were somewhat large for her, she could not stand on them, she could not skate, she constantly fell, and after the skating rink her legs ached. There were no traces of bruises on the legs, walking to the skating rink lasted several days with minimal shifts. next visit The skating rink was scheduled for the day the illness began. By this time, the girl had a fear of the next skating, she began to hate skating, she was afraid to skate.

The cause of the paralysis has become clear, but how can it be helped? It turned out that Sna loves and knows how to draw, she likes fairy tales about good animals, and the conversation turned to these topics. Skating and skating were “put an end to” right there, and the parents firmly promised to give the skates to their nephew and never visit the skating rink again. The girl perked up, willingly talked to me on topics she liked. During the conversation, I stroked her legs, lightly massaging her. I also understood that the girl was suggestible. This gives hope for success. The first step was to get her lying down a little rested her feet in my hands. It worked out. Then she was able to sit up and sit on her own. When this was also possible, he asked her, sitting on the sofa and lowering her legs, to press them to the floor. So gradually, stage by stage, she began to stand on her own, at first staggering and bending her knees. Then, with breaks for rest, she began to walk a little, and in the end, it was almost good to jump on one or the other leg. Parents all this time sat silently, not uttering a word. After completing the entire procedure, he said to her with a touch of the question “Are you healthy?” She first shrugged her shoulders, then answered yes. Her father wanted to take her in his arms, but she refused and went from the fourth floor on foot. I watched them discreetly. The child's gait was normal. They didn't contact me again.

Is it always so easy to cure hysterical paralysis? Of course not. I and the child were lucky in the following: early treatment, establishing the cause of the disease, suggestibility of the child, the correct response to a traumatic situation.

In this case, there was a clear interpersonal conflict without any sexual layers. If the parents had stopped visiting the skating rink in time, bought her skates in size, and not "for growth", perhaps there would not have been such a hysterical reaction. But, as you know, all's well that ends well.

Astasia-abasia in literal translation means the inability to stand and walk independently (without support). At the same time, in horizontal position in bed, active and passive movements in the limbs are not disturbed, the strength in them is sufficient, the coordination of movements is not changed. It occurs in hysteria mainly in females, more often in adolescence. We have seen similar cases in children, both boys and girls. An association with acute fright is suggested, which may be accompanied by weakness in the legs. There may be other reasons for this disorder.

Let's take a look at some of our observations. A 12-year-old boy was admitted to the children's neurological department with complaints of the inability to stand and walk independently. Sick for a month.

According to his parents, he stopped going to school 2 days after he went with his father for a long walk in the forest, where he was frightened by a suddenly fluttering bird. Immediately buckled legs, sat down and everything went away. At home, his father teased him that he was cowardly and physically weak. It was the same at school. He reacted painfully to the ridicule of his peers, worried, tried to “pump up” muscle strength with the help of dumbbells, but after a week he lost interest in these activities. Initially treated in children's department district hospital, where the diagnosis of astasia-abasia of psychogenic origin was correctly made. Upon admission to our clinic: calm, somewhat slow, reluctant to make contact, answers questions in monosyllables. He is indifferent to his condition. On the part of the nervous system and internal organs, no pathology was detected, he sits in bed and sits on his own. When trying to put it on the floor, it does not resist, but the legs immediately bend as soon as they touch the floor. The whole sags and falls towards the accompanying personnel.

At first, he fulfilled his natural needs in bed on the ship. However, soon after the ridicule of his peers, he asked to be taken to the toilet. He was noted to have good foot support on the way to the toilet, although bilateral support was required.

In the hospital, courses of psychotherapy were carried out, he took nootropic drugs (aminalon, then nootropil), rudotel, darsonvalization of the legs. He responded poorly to treatment. A month later, he could walk around the department with unilateral assistance. Disorders of coordination significantly decreased, there was a pronounced weakness in the legs. Then several more times he was treated in the hospital of the psycho-neurological dispensary. After 8 months from the onset of the disease, the gait was completely restored.

The second case is more peculiar and unusual. A 13-year-old girl was admitted to our children's neurological clinic, who had previously been in the intensive care unit of one of the children's hospitals for 7 days, where she was taken by ambulance. And the prehistory of this case was as follows.

The girl's parents, residents of one of the Union republics former USSR, often came to trade in Minsk. Recently, they have been living here for about a year, doing their business. Their only daughter (let's call her Galya - she really has a Russian name) lived with her grandmother and aunts in her homeland, went to the 7th grade. In the summer I came to my parents. Here she was met by a 28-year-old native of the same republic, and he liked her very much.

It has long been a custom in their country to steal brides. This form of getting a wife has now become more common. The young man met Galya and her parents, and soon, as Galina's mother said, he stole her and took her to his apartment, where they stayed for three days. Then the parents were informed about the incident and, according to the mother, allegedly according to the customs of Muslim countries, the girl stolen by the groom is considered his bride or even wife. This custom was followed. The newlyweds (if you can call them that) began to live together in the groom's apartment. Exactly 12 days later, Galya became ill in the morning: pain appeared in the lower abdomen on the left, her head ached, she could not get up, and soon she stopped talking. was called " ambulance” and the patient was taken to one of the children's hospitals with suspected encephalitis (inflammation of the brain). Naturally, not a word was said about the previous events to the ambulance doctor.

In the hospital, Galya was examined by many specialists. Data suggestive of acute surgical disease, not installed. The gynecologist found pain in the ovary on the left and assumed the presence of an inflammatory process. However, the girl did not make contact, could not stand and walk, and during a neurological examination, she was tense all over, which did not allow us to judge the presence of organic change nervous system.

A comprehensive clinical and instrumental examination internal organs and nervous system, including computed tomography and magnetic resonance imaging of the brain, which did not reveal organic disorders.

In the first days of the girl's stay in the hospital, her "husband" managed to enter her ward. Seeing him, she began to cry, shouting something in her own language (she knows Russian extremely poorly), she shook all over and waved her hands. He was quickly taken out of the room. The girl calmed down, and the next morning she began to sit down on her own and talk with her mother. Soon she endured the visits of her "husband" calmly, but did not come into contact with him. Doctors suspected something was wrong, and the idea arose about the mental nature of the disease. The mother had to tell some details of what had happened, and a few days later the girl was transferred to us for treatment.

On examination, it was found: tall, slender, somewhat inclined to be overweight, secondary sexual characteristics are well developed. In appearance, you can give 17-18 years. It is known that in women of the East puberty occurs earlier than in our climatic zone. She is somewhat wary, neurotic, makes contact (through her mother as an interpreter), complains of compressive headaches, periodically occurring tingling in the region of the heart.

When walking, she drifts a little to the sides, staggers while standing with her arms outstretched forward (Romberg's test). He eats well, especially spicy dishes. The possibility of pregnancy has not been proven. In the ward behaves adequately with others. During the visit of the groom, they retire and talk about something for a long time. He asks his mother why he does not come every day. And in general condition noticeably improves.

In this case, a hysterical reaction in the form of astasia-abasia and hysterical mutism is clearly visible - the absence of verbal communication with the preservation of the speech apparatus and its innervation.

The condition was caused by early sex life child with an adult man. Perhaps, in this regard, there were some other circumstances about which the girl is unlikely to tell her mother, and even more so the doctor.

Hysterical hyperkinesis. Hyperkinesias are involuntary, excessive movements in various external manifestations. various parts body. In hysteria, they can be either simple - trembling, shuddering with the whole body or twitching of various muscle groups, or very complex - peculiar artsy, unusual movements and gestures. Hyperkinesis can be observed at the beginning or at the end of a hysterical seizure, occur periodically and without a seizure, especially in difficult life situations, or are observed constantly, especially in adults or adolescents.

As an example, I will cite one personal observation, or my “first encounter” with hysterical hyperkinesis, which took place in the first year of my work as a district neuropathologist.

On the main street of our small urban village, in a small private house, a young man of 25-27 years old lived with his mother, who had an unusual and strange gait. He lifted his leg, bending it at the hip and knee joints, took it to the side, then forward, rotating the foot and lower leg, and then put it on the ground with a stamping movement. The movements were the same on both the right and left sides. This man was often accompanied by a crowd of children, repeating his strange gait. The adults got used to it and didn't pay any attention. This man was known all over the district because of the strangeness of walking. He was slender, tall, and trim, always wearing a khaki military tunic, jodhpurs, and polished boots. After observing him for several weeks, I approached him myself, introduced myself and asked him to come to the reception. He was not particularly enthusiastic about this, but he nevertheless appeared at the appointed time. I learned from him only that such a state lasts for several years and has come for no apparent reason.

Examination of the nervous system did not reveal anything bad. He answered each question briefly and deliberately, saying that he was very worried about his illness, which many tried to cure, but no one achieved even a minimal improvement. He did not want to talk about his past life, not seeing anything special in it. However, it was clear from everything that he does not allow interference either in his illness or in his life, it was only noted that he artistically demonstrates to everyone his walk with some kind of pride and contempt for the opinions of others and the ridicule of children.

I learned from local residents that the patient's parents have been living here for a long time, the father left the family when the child was 5 years old. They lived very poorly. The boy graduated from a construction college and worked at a construction site. He was self-centered, proud, could not stand other people's remarks, often entered into conflicts, especially when it came to his personal qualities. He met a divorced woman of "easy" behavior and older than him. We talked about the wedding. However, suddenly everything was upset, allegedly on a sexual basis, his former acquaintance told about this to one of her next gentlemen. After that, none of the girls and women wanted to do business with him, and the men laughed at the "weakling".

He stopped going to work and did not leave the house for several weeks, and his mother did not let anyone into the house. Then he was seen in the yard with a strange and unsteady gait which has stuck for many years. He received the second group of disability, while his mother received a pension for long service. So they lived together, growing something in their small garden.

I, like many doctors who treated and advised the patient, was interested in the biological meaning of such an unusual walk with a kind of hyperkinesis in the legs. He told the attending physician that when walking, the genitals "stick" to the thigh, and he could not do right move until "breakdown" occurs. Perhaps it was so, but subsequently he avoided discussing this issue.

What happened here and what is the mechanism of hysterical neurosis? It is obvious that the disease arose in a person with hysterical personality traits (accentuation according to the hysterical type), the psycho-traumatic role was played by a subacute conflict situation in the form of problems at work and in personal life. Man everywhere was pursued by failures, creating a contradiction between the desired and the possible.

The patient was consulted by all the leading neurological luminaries of that time who worked in Belarus, he was repeatedly examined and treated, but there was no effect. Even hypnosis sessions did not work positive action, and no one was engaged in psychoanalysis at that time.

The psychological significance for this person of his hysterical disorders is understandable. In fact, this was the only way to obtain disability and the possibility of existence without work.

If he had lost this opportunity, everything would have gone to waste. But he did not want to work, and, apparently, he could no longer. Hence the deep fixation of this syndrome and the negative attitude towards treatment.

Vegetative disorders. Autonomic disorders in hysteria, they usually concern violations of the activity of various internal organs, the innervation of which is carried out at the expense of the autonomic nervous system. These are more often pains in the heart, epigastric (pit of the stomach), headaches, nausea and vomiting, a feeling of a lump in the throat with difficulty swallowing, urination disorders, bloating, constipation, etc. Children and adolescents especially often experience tingling in the heart, a burning sensation, shortness of breath and fear of death. At the slightest excitement and different situations requiring mental and physical stress, patients clutch at the heart, swallow medicines. They describe their feelings as "excruciating, terrible, terrible, unbearable, terrible" pain. The main thing is to attract attention to yourself, to arouse compassion among others, to avoid the need to carry out any assignments. And, I repeat, this is not pretense or aggravation. This is a kind of disease in a certain type of personality.

Vegetative disorders can be in children of early and preschool age. If, for example, they try to force-feed a child, then he complains of abdominal pain with crying, and sometimes while crying from displeasure or unwillingness to complete some task, the child begins to hiccup often, then there is an urge to vomit. In such cases, parents usually change their anger to mercy.

Due to increased suggestibility, vegetative disorders can occur in children who see the illness of their parents or other persons. Cases are described when a child, seeing urinary retention in an adult, stopped urinating on his own, and even had to drain urine with a catheter, which led to an even greater fixation of this syndrome.

It is a common property of hysteria to take on the forms of other organic diseases, mimicking those diseases.

Vegetative disorders often accompany other manifestations of hysteria, for example, they can be in the intervals between hysterical seizures, but sometimes hysteria manifests itself only in the form of various or persistent autonomic disorders of the same type.

Sensory disorders. Isolated sensory disturbances in hysteria in childhood are extremely rare. They are expressed in adolescents. However, in children, changes in sensitivity are also possible, usually in the form of its absence in a certain part of the body on one or both sides. A unilateral decrease in sensitivity to pain or its increase always extends strictly along the midline of the body, which distinguishes these changes from changes in sensitivity in organic diseases of the nervous system, which usually do not have clearly defined boundaries. Such patients may not feel parts of a limb (arm or leg) on one or both sides. Hysterical blindness or deafness may occur, but is more common in adults than in children and adolescents.

affective disorders. In terms of terminology, affect (from Latin affectus - emotional excitement, passion) means a relatively short-term, pronounced and violently flowing emotional experience in the form of horror, despair, anxiety, rage and other external manifestations, which is accompanied by screaming, crying, unusual gestures or a depressed mood and decreased mental activity. The state of affect can be physiological in response to a pronounced and sudden feeling of anger or joy, which is usually adequate to the strength of external influence. It is short-term, quickly transient, leaving no long-lasting experiences.

We all periodically rejoice in the good, experience sorrows and hardships that are often encountered in life. For example, a child accidentally broke an expensive and beloved vase, plate, or spoiled some thing. Parents can shout at him, scold him, put him in a corner, show an indifferent attitude for a while. This is a common phenomenon, a way of instilling in a child the prohibitions (“no”) necessary in life.

Hysterical affects are of an inadequate nature; do not correspond to the content of the experience or the situation that has arisen. They are usually pronounced, outwardly brightly decorated, theatrical and may be accompanied by peculiar postures, sobs, wringing of hands, deep breaths etc. Similar conditions can occur on the eve of a hysterical seizure, accompany it, or occur in the interval between attacks. In most cases, they are accompanied by vegetative, sensory and other disorders. Often, at a certain stage in the development of hysteria, they can manifest themselves exclusively as emotional-affective disorders, which in most cases are joined by other disorders.

Other disorders. Among other hysterical disorders, aphonia and mutism should be noted. Aphonia - the absence of sonority of the voice while maintaining whispered speech. It is predominantly laryngeal or true in nature, occurs in organic, including inflammatory, diseases (laryngitis), with organic lesions nervous system with impaired innervation of the vocal cords, although it can be psychogenic (functional), which in some cases occurs with hysteria. Such children speak in a whisper, sometimes straining their face to give the impression that normal verbal communication is impossible. In some cases, psychogenic aphonia occurs only in certain situation, for example, in kindergarten when communicating with a teacher or at school lessons, while when talking with peers, speech is louder, and at home it is not disturbed. Consequently, there is a speech defect only for a certain situation, something objectionable to the child, in the form of a peculiar form of protest.

A more pronounced form of speech pathology is mutism - the complete absence of speech with the preservation of the speech apparatus. It can occur in organic diseases of the brain (usually in combination with paresis or paralysis of the limbs), severe mental illness(for example, with schizophrenia), as well as with hysteria (hysterical mutism). The latter can be total, i.e. noted constantly in various conditions, or selective (electoral) - occurs only in a certain situation, for example, when talking on certain topics or in relation to specific persons. Total psychogenic mutism is often accompanied by expressive facial expressions and (or) concomitant movements of the head, torso, limbs (pantomime).

Total hysterical mutism in childhood is extremely rare. Separate casuistic cases of it in adults are described. The mechanism of this syndrome is unknown. The previously generally accepted position that hysterical mutism is due to inhibition of the speech-motor apparatus does not contain any concretization. According to V. V. Kovalev (1979), elective mutism usually develops in children with speech and intellectual insufficiency and traits of increased inhibition in character with increased requirements for speech and intellectual activity while attending kindergarten (less often) or school (more often). This may occur in children at the beginning of their stay in psychiatric hospital when they are silent in class but have verbal contact with other children. The mechanism of the occurrence of this syndrome is explained by the “conditional desirability of silence”, which protects the individual from a traumatic situation, for example, making contact with a teacher who did not like it, responding to lessons, etc.

In the case of a child with total mutism, a thorough neurological examination should always be carried out in order to exclude organic disease nervous system.

Hysteria(syn.: hysterical neurosis) - a form of general neurosis, manifested by a variety of functional motor, autonomic, sensory and affective disorders, characterized by great suggestibility and self-suggestibility of patients, the desire to attract the attention of others in any way.

Hysteria as the disease has been known since ancient times. Many mythical and incomprehensible things were attributed to her, which reflected the development of medicine of that time, the ideas and beliefs prevailing in society. These data are now of a general nature only.

The term itself hysteria"derived from the Greek. hystera - the uterus, since the ancient Greek doctors believed that this disease occurs only in women and is associated with a violation of the function of the uterus. Wandering around the body for the purpose of satisfaction, it allegedly squeezes itself, other organs or vessels going to them, which causes unusual symptoms of the disease.

Clinical manifestations hysteria, according to the medical sources of that time that have come down to us, were also somewhat different and more pronounced. However, the leading symptom was and remains hysterical seizures with convulsions, insensitivity of certain areas of the skin and mucous membranes, a compressive headache (“hysterical helmet”) and pressure in the throat (“hysterical lump”).

The main cause of hysterical neurosis is a mental experience that led to the disruption of the mechanisms of higher nervous activity. Nervous tension may be associated with some external moment or intrapersonal conflict. In such persons, hysteria can develop under the influence of an insignificant reason. A disease occurs either suddenly under the influence of severe mental trauma, or more often, under the influence of a long-term traumatic unfavorable situation.

Hysterical neurosis has the following symptoms.

More often the disease begins with the appearance of hysterical symptoms. Usually a seizure is provoked by unpleasant experiences, a quarrel, emotional excitement. The attack begins with unpleasant sensations in the region of the heart, a sensation of a “lump” in the throat, palpitations, and a feeling of lack of air. The patient falls, convulsions appear, often tonic. Convulsions are in the nature of complex chaotic movements, like opisthotonus or, in other words, a “hysterical arc” (the patient stands on the back of the head and heels). During an attack, the face either turns red or pale, but is never purplish red or bluish, as in epilepsy. The eyes are closed, when you try to open them, the patient closes his eyelids even more. Pupillary response to light is preserved. Often, patients tear their clothes, beat their heads on the floor without causing significant damage to themselves, groan or shout out some words. A seizure is often preceded by crying or laughing. Seizures never occur in a sleeping person. There are no bruises or biting of the tongue, involuntary urination, no sleep after a seizure. Consciousness is partially preserved. The patient remembers the seizure.

One of the frequent phenomena of hysteria is a disorder of sensitivity (anesthesia or hyperesthesia). This can be expressed as a complete loss of sensation in one half of the body, strictly along the midline, from the head to the lower extremities, as well as an increase in sensitivity and hysterical pain. Headaches are common, and the classic symptom of hysteria is the feeling of being driven in a nail.

Movement disorders are manifested by paralysis and paresis of muscles (mainly of the limbs), forced position of the limbs, inability to perform complex movements.

In the Middle Ages, hysteria was not considered a disease requiring treatment, but demonic possession, reincarnation in animals. The patients were afraid of church rites and objects of religious worship, under the influence of which they had convulsive seizures, they could bark like a dog, howl like a wolf, clucked, neighed, croaked. The presence of pain-insensitive areas of skin in patients, which is often found in hysteria, served as evidence of a person’s connection with the devil (“the seal of the devil”), and such patients were burned at the stake of the Inquisition. In Russia, such a state was considered as "hysteria". Such patients could behave calmly at home, but it was believed that they were possessed by a demon, therefore, due to their great suggestibility, seizures often occurred in the church with shouting out - “shouting out”.

Western Europe in the 16th and 17th centuries. there was a kind of hysteria. The sick gathered in crowds, danced, lamented, went to the chapel of St. Vitus in Zabernet (France), where healing was considered possible. Such a disease was called "great chorea" (actually hysteria). This is where the term "St. Vitus' dance" originated.

A deeply scientific study of hysteria was carried out by J. Charcot (1825-1893), the founder of the French school of neurologists. Together with him worked on this problem 3. Freud and well-known neuropathologist J. Babinsky. The role of suggestions in the origin of hysterical disorders was clearly established, such manifestations of hysteria as convulsive seizures, paralysis, contractures, mutism (lack of verbal communication with others while the speech apparatus was preserved), and blindness were studied in detail. Attention was drawn to the fact that hysteria can copy (simulate) many organic diseases of the nervous system. Charcot called hysteria "the great simulant," and even earlier, in 1680, the English physician Sydenham wrote that hysteria imitates all diseases and "is a chameleon that ceaselessly changes its colors."

Causes and mechanisms of development of hysterical neurosis

According to modern views, an important role in the occurrence of hysterical neurosis belongs to the presence of hysterical personality traits and mental infantilism as a factor in internal conditions (V. V. Kovalev, 1979), in which heredity undoubtedly plays a significant role. Of the external factors, V. V. Kovalev and other authors attached importance to family education according to the “family idol” type and other types of psycho-traumatic effects, which can be very different and to a certain extent depend on the age of the child. So, in early childhood, hysterical disorders can occur in response to an acute fright (more often it is an apparent threat to life and well-being). In preschool and primary school age, such conditions in a number of cases develop after physical punishment, with parents expressing dissatisfaction with the child's act or a categorical refusal to fulfill his request. Such hysterical disorders are usually temporary, they may not recur in the future if the parents understand their mistake and treat the child more carefully. Therefore, we are not talking about the development of hysteria as a disease. This is just an elementary hysterical reaction.

In children of middle and older (in fact, in adolescents) school age, hysteria usually occurs as a result of a long-acting psychotrauma that infringes on the child as a person. It has long been noticed that various clinical manifestations of hysteria are more often observed in pampered children with a weak will and immunity to criticism, who are not accustomed to work, who do not know the words "it is impossible" and "must". They are dominated by the principle of "give" and "I want", there is a contradiction between desire and reality, dissatisfaction with their position at home or in the children's team.

I. P. Pavlov explained the mechanism of the emergence of hysterical neurosis by the predominance of subcortical activity and the first signal system over the second, which is clearly formulated in his works: , and subcortical ... ".

Clinical manifestations of hysterical neurosis

Clinical signs of hysteria are most pronounced in adolescents and adults. In childhood, it is less demonstrative and often monosymptomatic.

With all the variety of hysterical manifestations in childhood, motor and vegetative disorders and relatively rare sensory disorders are most common.

Vova is a lively, active child, but very stubborn, and gives standard answers to any instructions: “I won’t”, “I don’t want to”. Parents regard this behavior as a great independence.

During conflicts, she had seizures. The villagers began to shun her, only with a few friends she found a common language and understanding. Soon she left to work as a nurse in a hospital.

As can be seen from the above data, there were more than enough reasons for neurosis: this was the infringement of sexual desires in childhood and adolescence, and unsuccessful family relationships, and material difficulties.

As far as I know, this woman has not had hysterical seizures for 5 years, at least at work. Her condition was quite satisfactory.

Respiratory affective seizures. This form of seizure is also known as spasmodic crying, sobbing, breath-holding attacks, affect-respiratory seizures, convulsions of rage, crying of anger. The main thing in the definition is respiratory, i.e. pertaining to breathing. The seizure begins with crying caused by negative emotional impact or pain.

Crying (or screaming) becomes more and more loud, breathing quickens. Suddenly, during inhalation, the breath is held due to spasm of the muscles of the larynx. The head is usually thrown back, the veins in the neck swell, and cyanosis of the skin occurs. If this lasts no more than 1 minute, then only pallor and a slight cyanosis of the face appear, more often only the nasolabial triangle, the child takes a deep breath and everything stops. However, in some cases, holding the breath can last several minutes (sometimes up to 15-20), the child falls, partially or completely loses consciousness, and there may be convulsions.

In this section, we only note the following. Respiratory affective seizures are more common in boys than girls, they are psychogenic and are a common form of primitive hysterical reactions in young children, usually disappear by 4-5 years. In their occurrence, a certain role is played by hereditary burden with similar conditions, which, according to our data, took place in 8-10% of the examined.

Hysterical paresis (paralysis). In terms of neurological terminology, paresis is a restriction, paralysis is the absence of movement in one or more limbs. Hysterical paresis or paralysis are the corresponding disorders without signs of organic damage to the nervous system. They can capture one or more limbs, are more often in the legs, and sometimes are limited to only part of the leg or arm. With partial damage to one limb, weakness may be limited to only the foot or foot and lower leg; in the hand, this will be the hand or the hand and the forearm, respectively.

Hysterical paresis or paralysis are much less common than the above hysterical motor disorders.

The girl was carried in her arms. Her legs did not move at all, she could not even move her toes.

From the questioning of the parents (anamnesis), it was possible to establish that 4 days ago the girl began to walk poorly for no apparent reason, and soon she could not make the slightest movement with her feet. When lifting the child, the armpits of the legs hung down (dangling). When they put their feet on the floor, they buckled. She could not sit down, and planted by her parents immediately fell on her side and back. Neurological examination revealed no organic lesions of the nervous system. This, along with many assumptions that develop in the process of examining the patient, suggested the possibility of hysterical paralysis. The rapid development of this condition required to find out its connection with certain causes. However, their parents did not find them. He began to clarify what she was doing and what she had done a few days before. Parents again noted that these were ordinary days, they worked, the girl was at home with her grandmother, she played, ran, was cheerful. And, as if by the way, my mother noted that she had bought skates for her and had been taking her to learn to skate for several days. At the same time, the girl's expression changed, she seemed to start up and turned pale. When asked if she liked skates, she vaguely shrugged her shoulders, and when asked if she wanted to go to the rink and become a figure skating champion, at first she didn’t answer anything, and then quietly said: “I don’t want to.”

It turned out that the skates were somewhat large for her, she could not stand on them, she could not skate, she constantly fell, and after the skating rink her legs ached. There were no traces of bruises on the legs, walking to the skating rink lasted several days with minimal shifts. The next visit to the skating rink was scheduled for the day the illness began. By this time, the girl had a fear of the next skating, she began to hate skating, she was afraid to skate.

Astasia-abasia in literal translation means the inability to stand and walk independently (without support). At the same time, in a horizontal position in bed, active and passive movements in the limbs are not disturbed, the strength in them is sufficient, the coordination of movements is not changed. It occurs in hysteria mainly in females, more often in adolescence. We have seen similar cases in children, both boys and girls. An association with acute fright is suggested, which may be accompanied by weakness in the legs. There may be other reasons for this disorder.

Let's take a look at some of our observations. A 12-year-old boy was admitted to the children's neurological department with complaints of the inability to stand and walk independently. Sick for a month.

According to his parents, he stopped going to school 2 days after he went with his father for a long walk in the forest, where he was frightened by a suddenly fluttering bird. Immediately buckled legs, sat down and everything went away. At home, his father teased him that he was cowardly and physically weak. It was the same at school. He reacted painfully to the ridicule of his peers, worried, tried to “pump up” muscle strength with the help of dumbbells, but after a week he lost interest in these activities. Initially, he was treated in the children's department of the district hospital, where he was correctly diagnosed with astasia-abasia of psychogenic origin. Upon admission to our clinic: calm, somewhat slow, reluctant to make contact, answers questions in monosyllables. He is indifferent to his condition. On the part of the nervous system and internal organs, no pathology was detected, he sits in bed and sits on his own. When trying to put it on the floor, it does not resist, but the legs immediately bend as soon as they touch the floor. The whole sags and falls towards the accompanying personnel.

The girl's parents, residents of one of the Soviet republics of the former USSR, often came to trade in Minsk. Recently, they have been living here for about a year, doing their business. Their only daughter (let's call her Galya - she really has a Russian name) lived with her grandmother and aunts in her homeland, went to the 7th grade. In the summer I came to my parents. Here she was met by a 28-year-old native of the same republic, and he liked her very much.

It has long been a custom in their country to steal brides. This form of getting a wife has now become more common. The young man met Galya and her parents, and soon, as Galina's mother said, he stole her and took her to his apartment, where they stayed for three days. Then the parents were informed about the incident and, according to the mother, allegedly according to the customs of Muslim countries, the girl stolen by the groom is considered his bride or even wife. This custom was followed. The newlyweds (if you can call them that) began to live together in the groom's apartment. Exactly 12 days later, Galya became ill in the morning: pain appeared in the lower abdomen on the left, her head ached, she could not get up, and soon she stopped talking. An ambulance was called and the patient was taken to one of the children's hospitals with suspected encephalitis (inflammation of the brain). Naturally, not a word was said about the previous events to the ambulance doctor.

In the hospital, Galya was examined by many specialists. There is no evidence of acute surgical disease. The gynecologist found pain in the ovary on the left and assumed the presence of an inflammatory process. However, the girl did not make contact, could not stand or walk, and during a neurological examination, she became tense, which did not allow us to judge the presence of organic changes in the nervous system.

A comprehensive clinical and instrumental examination of the internal organs and nervous system was carried out, including computed tomography and magnetic resonance imaging of the brain, which did not reveal any organic disorders.

The cause of the condition was the early sexual life of a child with an adult man. Perhaps, in this regard, there were some other circumstances about which the girl is unlikely to tell her mother, and even more so the doctor.

Hysterical hyperkinesis. Hyperkinesis - involuntary, excessive movements in various parts of the body, diverse in external manifestations. In hysteria, they can be either simple - trembling, shuddering with the whole body or twitching of various muscle groups, or very complex - peculiar artsy, unusual movements and gestures. Hyperkinesias can be observed at the beginning or at the end of a hysterical seizure, occur periodically and without a seizure, especially in difficult life situations, or are observed constantly, especially in adults or adolescents.

As an example, I will cite one personal observation, or my “first encounter” with hysterical hyperkinesis, which took place in the first year of my work as a district neuropathologist.

He stopped going to work and did not leave the house for several weeks, and his mother did not let anyone into the house. Then he was seen in the yard with a strange and unsteady gait, which was fixed for many years. He received the second group of disability, while his mother received a pension for long service. So they lived together, growing something in their small garden.

I, like many doctors who treated and advised the patient, was interested in the biological meaning of such an unusual walk with a kind of hyperkinesis in the legs. He told the attending physician that when walking, the genitals “stick” to the thigh, and he cannot take the right step until “sticking” occurs. Perhaps it was so, but subsequently he avoided discussing this issue.

What happened here and what is the mechanism of hysterical neurosis? It is obvious that the disease arose in a person with hysterical personality traits (accentuation according to the hysterical type), a psycho-traumatic role was played by a subacute conflict situation in the form of malfunctions at work and in personal life. Man everywhere was pursued by failures, creating a contradiction between the desired and the possible.

The patient was consulted by all the leading neurological luminaries of that time who worked in Belarus, he was repeatedly examined and treated, but there was no effect. Even hypnosis sessions did not have a positive effect, and no one was engaged in psychoanalysis at that time.

The psychological significance for this person of his hysterical disorders is understandable. In fact, this was the only way to obtain disability and the possibility of existence without work.

Vegetative disorders. Vegetative disorders in hysteria usually relate to a violation of the activity of various internal organs, the innervation of which is carried out by the autonomic nervous system. These are more often pains in the heart, epigastric (pit of the stomach), headaches, nausea and vomiting, a feeling of a lump in the throat with difficulty swallowing, urination disorders, bloating, constipation, etc. Children and adolescents especially often experience tingling in the heart, a burning sensation, shortness of breath and fear of death. At the slightest excitement and various situations requiring mental and physical stress, patients clutch at the heart, swallow medicines. They describe their feelings as "excruciating, terrible, terrible, unbearable, terrible" pain. The main thing is to attract attention to yourself, to arouse compassion among others, to avoid the need to carry out any assignments. And, I repeat, this is not pretense or aggravation. This is a kind of disease in a certain type of personality.

Vegetative disorders can also occur in children of early and preschool age. If, for example, they try to force-feed a child, then he complains of abdominal pain with crying, and sometimes while crying from displeasure or unwillingness to complete some task, the child begins to hiccup often, then there is an urge to vomit. In such cases, parents usually change their anger to mercy.

It is a common property of hysteria to take on the forms of other organic diseases, mimicking those diseases.

Hysterical affects are of an inadequate nature; do not correspond to the content of the experience or the situation that has arisen. They are usually pronounced, outwardly brightly decorated, theatrical and may be accompanied by peculiar postures, sobs, wringing of hands, deep sighs, etc. Similar conditions can occur on the eve of a hysterical seizure, accompany it, or occur in the interval between attacks. In most cases, they are accompanied by vegetative, sensory and other disorders. Often, at a certain stage in the development of hysteria, they can manifest themselves exclusively as emotional-affective disorders, which in most cases are joined by other disorders.

Other disorders. Among other hysterical disorders, aphonia and mutism should be noted. Aphonia - the absence of sonority of the voice while maintaining whispered speech. It is predominantly laryngeal or true in nature, occurs in organic, including inflammatory, diseases (laryngitis), with organic lesions of the nervous system with impaired innervation of the vocal cords, although it can be psychogenic (functional), which in some cases occurs with hysteria . Such children speak in a whisper, sometimes straining their face to give the impression that normal verbal communication is impossible. In some cases, psychogenic aphonia occurs only in a certain situation, for example, in kindergarten when communicating with a teacher or in school lessons, while when talking with peers, speech is louder, and at home it is not disturbed. Consequently, there is a speech defect only for a certain situation, something objectionable to the child, in the form of a peculiar form of protest.

A more pronounced form of speech pathology is mutism - the complete absence of speech with the preservation of the speech apparatus. It can occur with organic diseases of the brain (usually in combination with paresis or paralysis of the limbs), severe mental illness (for example, with schizophrenia), and also with hysteria (hysterical mutism). The latter can be total, i.e. noted constantly in various conditions, or selective (elective) - occurs only in a certain situation, for example, when talking on certain topics or in relation to specific persons. Total psychogenic mutism is often accompanied by expressive facial expressions and (or) concomitant movements of the head, torso, limbs (pantomime).

Total hysterical mutism in childhood is extremely rare. Separate casuistic cases of it in adults are described. The mechanism of this syndrome is unknown. The previously generally accepted position that hysterical mutism is due to inhibition of the speech-motor apparatus does not contain any concretization. According to V. V. Kovalev (1979), elective mutism usually develops in children with speech and intellectual insufficiency and traits of increased inhibition in character with increased requirements for speech and intellectual activity while attending kindergarten (less often) or school (more often). This may occur in children at the beginning of their stay in a psychiatric hospital, when they are silent in class, but come into verbal contact with other children. The mechanism of the occurrence of this syndrome is explained by the “conditional desirability of silence”, which protects the individual from a traumatic situation, for example, making contact with a teacher who did not like it, responding to lessons, etc.

If a child has total mutism, a thorough neurological examination should always be carried out in order to exclude an organic disease of the nervous system.