lack of concern ('ta-belle"infterence about those symptoms which may actually provide secondary gains by winning sympathy 2 Dissoclative disorder -

('ta-belle"infterence about those symptoms which may actually provide secondary gains by winning sympathy 2 Dissoclative disorder - (Hysierlcal neurosis, dtssociative type) Here alterations may occur In the patients state of conaclousness or In his identify to produce such symptoms as amnesia ambullism fugue and multiple personality Etiology Tnere is sufficienavidence to suggest that the symptoms ara psychogenic and that the environmental factors are the important etiologcal faclors 1 Age - The peak Incidence is balween the ages of 20 to 35 years 2 Sex - incidence is higher in females 3 Intellgence - People with low intelligence more Iikely 4 Personality - Commonest is histrionic: personality (characteristcs • dramatizing and exhibitionistic, attention seeking, immature. having shallow andsuperticial emotional relationships] 5 Maritalstatus - Mora comrnon In unmarried widowed and divorcees 6 Socio-cultural factors - More common in primitive, developing and less sophisticated or cultured societies 7 Psychoanalytical theories - Hysterical symptoms are viewed as symbolic representations and distorted expressions of unresolved intrapsychic conflicts about one's sexual drive (libido) When the libidinal energy manifesis itself as somatic symptoms through the ego-defence mechanism of conversion, the resulting disorder is known as conversion disorder When the libidinal energy marifests as psychological symptome through the defense mechanism of disociation, the resulting disorder is labelled dissociaiive disorder Clincal manifestations 1 SYMPTOMS OF CONVERSION DISORDER - These ariee because of the involvement of voluntary neuromuscular system (a) Motor symptoms - These are of two types (i) Akinesia e. g. paresie or paralysis involving a part of the body monoplegia, hemiplegia, paraplegia, etc (ii) Hyperkinesia and dyskinesia e. g .tremors, tortcollis, convulons or fits (b) Sensory symptoms These can be in the form of anaesthesia, hypaaesthesia. hyperaesthesia and paraesesthesia This dtsturbance can affect all the general sensations Special organs of sense, like those for sight, hearingr smell andtastecanalso be disturbed resulting in blindness. deafness. etc (c) Visceral symptoms - Common ones are hiccoughs vomiting, dyspnoea, dysphagia, aphonia, etc 2 SYMPTOMS OF DISSOCIATION DISORDER - (a) Somnambulism and sormiloquy. (b) Amnesia • cicunscribed and covers up the psychologically traumatic event (c) Trance -An altered state of consciousness lasting for a few minutes to a few hours, during which the patientappears to be oblivious of tne surroundings (d) Fugue-An altered state of conslousness wherein the patient travels long distances over a period of days and subsequently has amnesia for the entire episode (e) Multiple parsonalities like those of Dr Jakyl and Mr Hyde (f) Ganser'ssyndrome,a rare disordercharacrisedby giving of "approximate answers", somatic or paychological hysterical symptoms, hallucinations and an apparent clouding of consciousness Characteistics of hysterical symotoms- 1 Absence of organic basis for symptoms 2 Theyserve both primary gain (resolution of intrapsychic confficts) and secondary gain (obtaining sympathy and attention) 3 In conversion disorder - (a) Symptoms seldom occur when patient is alone, on the other hand, symptoms are exaggerated in presence of other persons