Hysteria in Children

There are few terms in psychiatry which have come to cover such a diversity of conditions as the term ‘hysteria’. At the one extreme are fits, fugues, and dream states which result from serious dissociation and are akin to psychosis; at the other minor physical symptoms like headache or constipation which may result from transient anxiety over, say, an examination. Between these extremes are a great variety of psychogenic conditions of all degrees of severity, and probably of at least two different pathologies. On the one hand are bodily dysfunctions arising directly from anxiety and having no specific psychological significance. To this group belong many cases of tachycardia, giddiness, diarrhoea and indigestion. Chronic anxiety, presumably as a result of sympathetic overstimulation, has interfered with the natural functions. On the other hand, are bodily symptoms which have symbolical significance and serve a definite psychological purpose. To this group belong most cases of paralysis, blindness, and many functional pains. It is probably only the latter group which ought to be termed hysteria. The former, although it includes functional somatic symptoms, is best considered as a part of the Anxiety State.

Before puberty genuine and prolonged hysterical symptoms are probably as rare as minor and transient anxiety symptoms are common. At present in this country children are only very seldom sent to a child-guidance clinic suffering from neurotic symptoms like paralysis or blindness, or from major hysterical attacks. On the other hand, cases with minor functional symptoms, such as pains, constipation, or lack of appetite, are extremely common. True hysteria seems only to become common after puberty and then approximates to the usual adult forms.

Although it is convenient to divide hysterical symptoms into two major categories, (1) physical, which may be either sensory or motor, and (2) quasi-psychotic, it must not be forgotten that the physical symptom is