Hysterical?

Since I ended up not elaborating on hysteria elsewhere on the forum, I might as well do it here. I copied below excepts from this article by Carol S. North : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695775/#!po=67.7778

The relationships among dissociative, somatoform, and conversion disorders have long been uncertain and uneasy in the history of efforts to classify and understand them. The current classification of these disorders has evolved over centuries from common historical roots in a syndrome previously known as hysteria that has been interlinked in some periods with spiritual maladies.

In the first half of the twentieth century, attention to dissociative disorders dwindled to the point of near extinction of the syndrome. Dissociative syndromes were conceptually subsumed into hysteria, the forerunner of the modern diagnosis of somatization disorder

In 1697, the English physician Thomas Sydenham conceived of hysteria as an emotional condition rather than as a physical disorder, moving the source of the disorder from the uterus to the central nervous system [5,18]. Sydenham referred to hysteria as “Proteus,” acknowledging this disorder’s proclivity to simulate almost any disease

Freud is credited with having first introduced the concept of hysterical conversion, and he originally coined this term [29,34]. Freud emphasized psychological origins to hysterical conversion phenomena, in which ideas or memories too unpleasant for conscious awareness are repressed into the unconscious and “converted” into physical symptoms to solve unbearable psychological conflicts

At this point in history, dissociation and conversion were clearly still embedded within a unified concept of hysteria.

Later in that century [...] The Washington University group adopted the name “Briquet’s syndrome” to replace the older term “hysteria,” which had long since become heavily laden with pejorative connotations

After DSM-II, [...] the term “somatoform” was originally established to refer to physical symptom complaints without a medical basis, reminiscent of those represented in the older concepts of hysteria and Briquet’s syndrome.

the basis of psychodynamic theory in the formulation of criteria for psychiatric disorders was formally abandoned 35 years ago beginning with the third edition of the Diagnostic and Statistical Manual

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [...] Somatization disorder was removed entirely. [...] Conversion disorder was retained in DSM-5

The degree of overlap among dissociative, somatoform, and conversion phenomena within patients has complicated efforts throughout history to categorize these disorders. Additional psychiatric comorbidities demonstrated in association with these disorders, especially borderline personality disorder, have further confused efforts to categorize these disorders.

An extensive review of multiple personality disorder by North et al. [14] demonstrated abundant evidence of comorbidity with somatization disorder (33%–100%), conversion disorder (generally > 50%), and borderline personality disorder (about 50%–70%), with three or four comorbid disorders on average.

In the Epidemiologic Catchment Area (ECA) household study of the prevalence of psychiatric disorders in America [92], 100% of individuals diagnosed with somatization disorder also met criteria for another psychiatric disorder.

Comorbidity of somatization disorder and conversion disorder with borderline personality disorder is well documented [14]. Borderline personality disorder is characterized in current diagnostic criteria as a pattern of instability in interpersonal relationships, self-image, and emotional regulation, with marked impulsivity [64]. Studies of patients with borderline personality disorder [96,97,98] have found that 96%–100% of these patients have psychiatric comorbidities, with a mean of 3.4–5.1 comorbid disorders [96,98]. In one of these studies [96], nearly two-thirds (62%) of the patients also met diagnostic criteria for Briquet’s syndrome; additionally, the comorbidity with somatization disorder was higher using DSM-IV criteria than with DSM-III criteria.

Hudziak’s group [96] was impressed by the similarities in the criteria for borderline personality disorder and descriptions of the characteristics of patients with Briquet’s syndrome, leading them to consider the possibility that Briquet’s syndrome might actually constitute a subset of borderline personality disorder.

MMPI evidence suggests that somatization disorder, dissociative identity disorder, and borderline personality disorder share much of their psychopathological material in common.

Because the classification of disorders formerly conceptualized as hysterical involves two main categories of somatoform and psychoform symptoms, a new term, “oForm,” is suggested to refer to these categories of psychopathology. This term is descriptive and circumvents the longstanding pejorative term “hysteria” formerly previously used as the name for the psychopathology of these syndromes [39,41,42,43] and which has also been used to describe many different syndromes.

In a nutshell, hysteria is an outdated term with a pejorative connotation.

But the psychodynamic and psychoanalytic schools didn't get the memo - they associate hysteria with hpd which, frankly, is a huge departure from the historical concepts of hysteria per this article.

The terms hysteria and hysterical haven't appeared in the DSM since DSM-III in 1980, I believe. The DSM allegedly embrace an atheoretical approach, moving away from schools' dogmas.

And hysteria's modern incarnations (conversion and somatization), are heavily correlated with BPD.

P.S. Histrionic PD is still in the DSM-V, my mistake ...

On a personal level, my own perception of personality disorders has changed. What I mean is...

Here is one definition, though not the only definition, of 'personality' - https://en.wikipedia.org/wiki/Personality

"Personality is a set of individual differences that are affected by the development of an individual: values, attitudes, personal memories, social relationships, habits, and skills."

Key point being we as people struggle defining what 'personality' is, and even more so, what is 'normal'. Without those basics, it's no surprise that trying to categorize 'disorders' has remained contentious, redefined over time, and also often not said, but I think key to ask, what is the cultural background of those doing the categorizing?

In my perception now, our personalities are meaningless in a vacuum. If it was just us, on a deserted island, there'd be no question, and no need to define what is normal vs what is disordered. Personalities and social norms are not separable in my mind.

So that leaves me no closer to any answers either, but ... labels aside, it's still understandable that in the context of a society and culture, others may perceive someone as being far above average emotional, dramatic, choose whatever outward appearances here (e.g., withdrawn, aggressive, sensitive, etc.) that relative to others, is far outside the norm.

Here is what is also maybe misleading....

Many of us in western culture feel there is something wrong with us because we don't feel good about ourselves, and here is another factor that may be relevant too - we are surrounded by media images of over-the-top personalities that seemingly have way over-the-top self-esteem. Some of these image are pure fictional characters; some are real people, but we see only selective slices of their lives (well, until those same characters have a falling out in life). Yet not all societies are so self obsessed. Hopefully others can already see where I am going with this. How much of today's current personality disorders are only disorders in the context of a society/culture that places too much emphasis on artificial/fictional levels of self-esteem?

These are good points xdude.

My thought here is also to be careful of the politics involved with developing labels or classifying disorders. And it is political , with input coming from different people as time goes by. The DSM has undergone so many changes and there have been professional outspoken critics of those changes. Oftentimes it is the appearance of who wants to be right, rather then what is right. A huge difference. We are taking about emotional health here, so it is important to make this distinction.

I think for the OP and EE, if ones finds relief in a particular school of thought, or a set of clues that leads ones down a better path, whose to say it is wrong? After all it is their life and the path to a better one can take various twists and turns.

This is an HPD to HPD support forum, so I will bow out.

Good luck to inspired and EE.

mark1958 wrote:...Oftentimes it is the appearance of who wants to be right, rather then what is right. A huge difference. We are taking about emotional health here, so it is important to make this distinction.

I think for the OP and EE, if ones finds relief in a particular school of thought, or a set of clues that leads ones down a better path, whose to say it is wrong? ...

Much agreement Mark.

Someone asked me once, "Do you want to be right, or do you want to be happy?"

Definitely something to that. It's a mental shift, but I think a valuable one, that mental health professionals (and those who are struggling) focus on what works to feel better over what is 'right'.

@xdude (first post)

There's a lot of self-defeating and self-sabotaging aspects to a personality disorder that we can't possibly ignore, I mean a PD is not just a series of traits that "normal" people consider outside of their range ...

I completely agree with your last paragraph though.

@mark

mark1958 wrote:I think for the OP and EE, if ones finds relief in a particular school of thought, or a set of clues that leads ones down a better path, whose to say it is wrong?

I'm not sure who you're referring to here ?

Because I, for one, never wrote in this thread or elsewhere that it is wrong to draw personal relief from studying a particular school of thought.

As a matter of fact, I read a lot of psychoanalytic works, and drew many tips from rubbing shoulders with them. In fact, I love psychoanalysis.

Having said that, there are also more modern approach to recovery, that can help you get straighter to a goal. Which is why I encourage people to think critically and get acquainted with as many angles of approach as they can regarding their mental health.

Isn't that the purpose of a thread, presenting OP with various conclusions ?

@CastleOf -

I think the key thing to question is one to self. When we perceive someone else as being self-defeating, is that their perception of their lives or ours; what we think they should be? (and if so why does it bug us but not them enough to pursue change?).

By the way, even 'disordered' types can be perceived as having some above average successful traits, depending on context. Likewise neurotic types...

https://www.psychologytoday.com/blog/fu ... sm-paradox
https://en.wikipedia.org/wiki/Neurotici ... psychology

"One man's trash is another man's treasure." applies; our personal sense of what 'success' means and what is important to us, not necessarily so for others, etc.

xdude wrote:I think the key thing to question is one to self. When we perceive someone else as being self-defeating, is that their perception of their lives or ours; what we think they should be? (and if so why does it bug us but not them enough to pursue change?).

Yes but I'm hoping that you agree with me that giving people access to info in case they want to change without trying to control the outcome is a bit more of a noble goal ?

xdude wrote:By the way, even 'disordered' types can be perceived as having some above average successful traits, depending on context.

On the short term, some disordered traits can give us an edge over normies, but there is always a long term cost to this as well, and very often the long term cost is meaningful interactions in the case of disordered traits. So when we shield people from realities entirely, we also obstruct their motivation to implement change in a way.

Our disorders and traits' function was to protect us from harsh realities as children, and as adults we keep defending against those realities. Regarding the first article, my main take away is that neuroticism makes you prone to face those "depressive realities". Which they justly call a "hidden advantage". But I think what they didn't state clearly but is implied in the conclusion, is that in doing so, you become a little less neurotic at a time.

So it matters little to me that people share my definition of what is a treasure and what is trash, but it matters more to me that they're being given the opportunity to define their version of a treasure and a trash in the first place.

Thank you for the information and the food for thought. I hope OP is reading as well.

Seems to be taking a philosophical turn, which I think is good. Science, research, straight facts is also good, but when it comes to psychoanalysis (and PD), veering towards the abstract seems inevitable.

I agree with the idea that PD is mainly about how we relate to others. Are our relationships satisfying and are we able to have healthy relationships, etc.? Because that seems to be one of the roots of the human experience, what makes life fulfilling, the relationships we have and positive emotions therein.

This might be what separates Axis 1 from Axis 2. Many people with Axis 1 can still have relationships, they may need to be managed more carefully, but the dysfunction is not in how they relate to others...its more in how they relate to reality, but the ability to trust and be intimate with another is not the core of the dysfunction.

For PDs there is dysfunction in the ability to connect and seek solace and comfort and safety in other people.

Just passing thoughts. Haven't developed them more at this point.

I've gotten off track too, so...

Mark had written something in SOFF a while back that really struck a chord with me, not because I had never pondered it, but he put it so well that it's had a change on my emotional state ever since. Essentially he wrote, I didn't really love her, I loved what I was trying to change her into. A big epiphany fell out of that for me -

I also felt my ?ex? was far too dramatic, emotional, etc., but what I was in denial about is that while others may or may not have thought the same, in their roles, her personality does have a place in their life that they approve of, at least at times. For various reasons they got something out of her personality too, and so did she. She did have relationships that worked in some contexts, and it was me thinking there is something wrong with her, not her thinking there is something wrong with herself.

The realization that she really meant it, "I am not going to change" (though she has), because she is essentially content with who she is, as-is. Really accepting this, and that it was about me trying to change her, not her being uncomfortable with what I perceived as excessive emotions/drama, like REALLY accepting, has made a world of difference for me too.

Point being that often it's others who perceive a PD as problematic, and then only in some contexts.

So yea, info is good, but still nothing happens until/if the person with the PD reaches their own epiphany, I need/want to change.

--

Oh, and I'm reminded of something that ties in. I grew up a mult-thousand student high school. Sort of a little microcosm of society. I'd say the vast majority would have fit the 'preppy' persona. Smile, dress a certain way, social manners, studious, happy? Of course there were plenty of cliques and groups, the stoners, the hippies, the jocks, the goths, etc.

I bring this up only because while the majority believed the sub-groups had social issues, the sub-groups thought the very same in reverse. Oh, and sure the goths appeared 'unhappy', but were they?, or were they happy to be part of a smaller group who shared similar personalities? In their perception it could be they are thinking exactly what they said, others are living fake happiness, out of touch with their darker side, a shallow way to live, etc.

Of course I am not saying PDs are entirely equivalent to smaller/isolated social groups, just that our perception of who is discontent with who they are is not the same as their perception, and... that some people are content to be discontent; it's their sense of identity, but it doesn't necessarily mean they live entirely alone (or feel lonely) either. Similarly, someone with a PD may express much including 'negative' emotions, and it's understandable we react to that, but sometimes that is the point. It's habit, their identity, and it has worked for them in some ways, ways they are not ready to give up.

Short version - Outward appearances can be deceiving. Our perception of others is not the same as their perception of self, and as always, others change when/if they really want to.

@ xdude ...oh I see what you're saying now. (As for getting off track, personally its not a problem for me at all. I am finding this conversation very enlightening.)

Yes, I think the theory is that most PDs are ego syntonic and the person is happy with who they are and don't want to change.

So as you said its getting into fuzzy territory; are we evaluating someone else based on our own values? What if that person is happy the way they are? Who are we to change them? etc...I think these are really good points.

Not that its out of line to present alternatives, or to challenge a person, as Castle suggested.

But the need or desire to change another person can become unhealthy. I guess, when it becomes about that person's own needs, and not necessarily about the "disordered" person. It can be a fine line sometimes, I think. It can be hard to untangle, who is showing the disordered behavior, who here really needs to change, what are the real issues, etc.? And it gets tied up in culture, values, personal preference, etc.

My longest relationship lasted 5 years and this person was very controlling and tried to change me. The first thing he did was demand I stop using all substances. I was a drinker and smoke marijuana and had to quit that overnight once we got together. Then he demanded I cut contact with all of my exes. I stayed in touch with them and would occasionally have a phone call, just to exchange news. I had to stop this. Then he disapproved of some life long friends, thought they were a bad influence (they weren't). Tried to convert me to some extreme form of Christianity (which he didn't even follow himself). Would randomly demand to see my phone and if he saw a number he didn't recognize, would demand to know who it is, sometimes calling it to find out who it was. Hacked into my email and intercepted emails from my own father. Waited outside of my house when I didn't answer the phone. So things progressively escalated that way.

I stayed with him for 5 years though, even though it was on and off. I don't know what this means. I must have gotten something out of someone trying to control me. It was very stressful for both of us though. I am sure for him it was about me being a "project," he didn't accept me as I was, but had some mirage or illusion of who I could be, and thought that person could be the perfect partner for him. But it was impossible for me to change into that. I didn't want to give up the relationship, but it was also impossible to become who he wanted. So that is just my experience.

I don't think he's a bad person. Apparently he has had other normal relationships. It was something about me that caused him to act that way, it seems.