Hysterical Personality Research Articles

The Predictive Utility of the Orthopedic Examination in Identifying the Low Back Pain Patient with Hysterical Personality Features

NEHEMKIS, ALEXIS M. PH.D.*; CARVER, DONALD W. PH.D.**; EVANSKI, PHILIP M. M.D.†Editor(s): CRACCHIOLO, ANDREA III M.D. Author Information

The Predictive Utility of the Orthopedic Examination in Identifying the Low Back Pain Patient with Hysterical Personality Features

Physical examination of the patient with low back pain routinely includes a number of tests which are useful clinically to the orthopedist as suggestive of the presence of hysteria or malingering. These include tests of light touch differences medially and laterally in the same foot or leg, vibratory sensation in the lower extremities, forward flexion, straight-leg raising differences between the supine and sitting positions, and the Burns' bench test. The present study examined the specific predictive utility of these tests individually and as a composite battery in identifying low back pain patients with hysterical personality features. Twenty-five postoperative lumbar laminectomy and diskectomy patients were administered the MMPI and evaluated by physical examination. Silight to moderate correlations were found for each of the subtests with a Composite Hysteria Index derived from the MMPI. The predictability was improved by the use of a weighted combination of the individual tests obtained by multiple regression analysis. The results lend empirical support to: the predictive value of these clinical tests in definitively identifying 60% of those low back pain patients with hysterical personality features; decision rules for use in clinical practice were also developed.

Hysterical traits and variability of mood in normal men.

In a study of 40 normal men it was found that self-ratings on variability of mood were positively correlated with self-ratings on hysterical traits. These results are similar to those found in normal women and lend support both to the validity of the concept of hysterical personality and to the idea that men and women experience fluctuations of mood in a similar way.

Hysterical Personality. Edited by Mardi J. Horowitz, M.D. New York: Jason Aronson, Inc., 1977. 441 pp.

(1979). Hysterical Personality. Edited by Mardi J. Horowitz, M.D. New York: Jason Aronson, Inc., 1977. 441 pp. The Psychoanalytic Quarterly: Vol. 48, No. 2, pp. 308-341.

Book Review: Hysterical Personality

Book Review: Hysterical Personality

Personality, sexual adjustment, and brain lesions in patients with conversion symptoms.

To clarify the interrelationships of conversion symptoms, hysterical personality, sexual adjustment, and cerebral organic disorders the authors studied 89 patients with classic motor conversion symptoms (group L) and compared a subgroup of 24 of these patients (group H) with 24 matched control patients (group C). They found hysterical personality in 19% of group L, 21% of group H, and none of group C and passive-immature-dependent personality in 19% of group L, 21% of group H, and none of group C. Forty-eight percent of group L, 50% of group H, and 58% of group C had some cerebral disorder. Patients with conversion symptoms who also had hysterical and passive-immature-dependent personalities were especially likely to have sexual abnormalities.

The diagnosis of antisocial and hysterical personality disorders. An example of sex bias.

The author submits evidence to support the contention that antisocial and hysterical personality disorders are essentially sex-typed forms of a single condition. The features of each condition, he argues, are either common to both disorders or are related to sexual stereotypic traits. He reports on a study which indicates that mental health professionals tend to label men as antisocial personalities and women as hysterical personalities, even when these patients have identical clinical features. It is suggested that a unification of the two labels could have a beneficial effect on research and on understanding and treating the disorder and related conditions.

The hysterical personality--I. The healthy hysteric.

This paper examines the meaning and validity of 'hysterical personality disorders'. Theories and descriptions of hysterical personalities have been conflicting and often mutually incompatible, leading to a vague and imprecise nosology. No generally accepted specific inclusion criteria or follow-up studies are available; consequently, the diagnosis of 'hysterical personality disorder' has reflected adaptive as well as maladaptive traits. This paper critically examines the healthy dimension of Lazare's continuum of personality pathologies exhibiting hysterical traits. The continuum, in an attempt to reconcile the inconsistencies of this diagnosis, ranges from the relatively healthy (good, genital, true) hysteric, to the sick (bad, oral, 'so-called good') hysteric. But this paper concludes that here, too, evidence for diagnostic legitimacy is lacking. Women at the healthy end of the hysterical personality spectrum are best regarded as healthy and do not meet criteria for the diagnosis of a personality disorder.

The diagnosis of hysterical personality disorder: A study of attitudes

The concept of personality disorder must, as other psychiatric diagnoses, be evaluated in terms of reliability, utility, and validity. In recent years, there has been growing interest in such issues for personality diagnoses in general 1,2 and for obsessive-compulsive, 3–6 antisocial, 7 and hysterical personality disorders in particular. Since these diagnoses rest on the judgment that an individual is deviant in respect of traits shared to a greater or lesser degree by everyone, the diagnostic process itself, the exercise whereby that judgment is made, should receive particular study. In this way, we might learn which clinical features can be reliably recognized and, thus, used to form the basis for operational definitions of personality disorders. As an initial step in such research, a group of psychiatrists was asked to comment on several factors important in the diagnosis of hysterical personality disorder.

The seductive patient.

Women referred to as hysterical personalities comprise the largest group of seductive patients. We will discuss (1) how to recognize them, (2) how they behave with physicians, (3) the reactions evoked by them, (4) what brings them to physicians, (5) what they are really seeking, and (6) how to cope with them. To supplement information obtained from patients seen in psychiatric practice, information was gathered from 15 practitioners representing surgical as well as medical specialties.

Relationships between psychoanalytic personality pattern, death anxiety, and self-actualization.

The present study explored relationships between psychoanalytic personaliry pattern, i.e., oral, obsessive, and hysterical personality, the personality dimension of self-actualization, and the construct of death anxiety. Subjects were 114 graduate srudents (44 males, 70 females) enrolled predominantly in education courses at several colleges in the Boston area. Subjects were all volunteers who were told to respond anonymously to a personality questionnaire. The Lazare-Klerman Trait Scales were used to measure the psychoanalytic personality variables of oral, obsessive, and hysterical personality ( 1 ). The Personal Orientation Inventory was used to measure self-actualizing values, attitudes, and behaviors ( 4 ) . The Death Anxiety Scale was used to measure the degree of conscious verbalized death anxiery ( 5 ) . With the permission of the test author the items comprising the Death Anxiety Scale were randomly embedded in the Lazare-Klerman Traic Scales. None of three psychoanalytic personaliry variables significantly related to death anxiety. The three psychoanalytic personality variables related negatively to seven of the 12 self-actualitation variables, i t . , Time Competence, Inner-directedness, Existentiality, Spontaneiry, Self-regard, Self-acceptance, and Capacity for Intimate Contact. Correlations ranged from .42 ( p 6 .001) to .16 ( p 6 .05). Death anxiety was significantly related to only one of the 12 self-actualization variables, i.e., Time Competence; however, the correlation of -.25 ( f i A .05) between death anxiety and Time Competence was of low magnitude. The results were interpreted as offering support for psychoanalytic theorizing that pregenital character types represent expressions of psychological irnmaturicy ( 2 ) . The results were, however, inconsistent with some previous research which has suggested that conscious verbalized death anxiety often reflects neurotic concerns and/or some degree of emotional immaturity (3). Finally the finding that only one of 12 self-actualization variables was significantly related to the death anxiety is specifically at d d s with the report of Wesch (6), who found several significant negative relationships between self-actualization variables as measured by the Personal Orientation Inventory and death anxiety as measured by the Death Anxiety Scale.

Briquet's syndrome, hysterical personality, and the MMPI

The authors compared the MMPI scores of 29 inpatients diagnosed by other authors as having hysterical personality and 21 outpatients diagnosed by the authors as having Briquet's syndrome. The two groups of patients differed significantly in age, on the MMPI lie scale, and on the MMPI hypochondriasis scale but not on any of the other MMPI scales. The authors discuss the implications of these findings for further defining the differences and similarities between hysterical personality and Briquet's syndrome.

The Psychotherapy of Character Disorder

Patients suffering from character disorder are often rejected as unsuitable for psychotherapy. Those with anxiety and depression often seek help, and should be assessed for their potential to be helped by a carefully structured long term psychotherapeutic relationship controlled by the therapist to reduce acting out behaviour. The therapist acts throughout as a model for the patient. As the patient develops basic trust in the therapist, identification develops and a major sustained improvement can occur. The therapy described is current-behaviour orientated and the importance of clear, unambiguous communication, particularly verbal communications, is stressed. The principles of therapy are applicable to all contacts with character-disordered patients. Briefly described is the long term therapy of two patients with hysterical personality disorders and acting-out behaviour, as examples of one type of the wide variety of character disorders that can be treated, and where the nine year follow up was adequate to ensure that improvement was sustained.

Variability of mood and hysterical traits in normal women

PERSONALITY is described in terms of traits shared, to a greater or lesser degree, by everyone. The clinical diagnosis of personality disorder rests on the judgment that several of these traits are present to a quantitatively deviant degree. How reliable and valid is that judgment? The issue of reliability has recently been examined by PRESLEY and WALTON~ in relation to categorical and dimensional classifications of personality disorder. They point to three sources of disagreement among clinicians which lower the reliability of categorical diagnoses: (1) rater bias resulting in varying attention to certain aspects of the patient’s personality; (2) several meanings being attached to the same term; and (3) inadequate definition as to the limits of normal trait variation. Less study has been given the question of validity. SLAVNEY and MCHUGH~ were unable to validate clinical diagnoses of hysterical personality disorder with the Minnesota Multiphasic Personality Inventory (MMPT). They had hoped that such a self-rating instrument might avoid the above-mentioned potential causes of low reliability, and hence low validity, that are inherent in clinical judgments. Most of their patients with diagnoses of hysterical personality disorder were depressed, however, and had an MMPI mean profile which closely resembled that of depressed controls. The authors concluded that the MMPI accurately reflected the similar moods of depressed index patients and controls, but that it failed to assess the traits which physicians apparently recognized when assigning the diagnosis of hysterical personality disorder to one group and not to the other. Emotional lability is one of the traits said to characterize the hysterical personality and it can be directly assessed by serial self-ratings of mood. Such self-ratings have been related to other subjective phenomena,3s5 to endocrine changes-s and to mental illnesses.s-12 We report the use of techniques suggested by some of these studies to examine the hypothesis that self-ratings on variability of mood are positively correlated with self-ratings on hysterical traits. In this way, we hope to demonstrate empirically one aspect of the validity of the concept hysterical personality.

A Phenomenology of the Hysteric Personality

A Phenomenology of the Hysteric Personality

Intrapair difference in personality traits, and emotional and social adjustment in monozygotic twins.

During the last decade, there has been a growing interest in the advantages that MZ twin pairs offer for studying the effect of environmental factors on the development of emotional disturbances. Much of this research has been aimed at investigating the relationship between childhood differences and later discordance with regard to schizophrenia in MZ twin pairs. A few studies have used similar methodology to investigate the development of neurotic reactions. There has been very little work dealing with the causes of discordance in the normal personality development of MZ twin pairs. The paper presents some of the results from a larger twin project which show the relationship between childhood differences and differences in adulthood. The study examined differences in oral, obsessive, and hysterical personality traits, as well as differences in phobic fears, general neurotic symptomatology, occupational and marriage adjustment in 50 relatively unselected MZ twin pairs. The results show that many of the same childhood differences which have been reported to be associated with the discordance found in regard to schizophrenia and neuroses, are also related to differences in personality structure, emotional and social adjustment in less disturbed MZ twin pairs. Other childhood differences, however, seem to be more specifically related either to neurotic or to normal personality development, pointing to the importance of studying the relationship between specific intrapair differences in childhood and differences in various areas of later personality development.

Classification of the MMPI profiles of two alcoholic groups

Ninety-two per cent of the MMPI CODES OF 60 ALCOHOLICS IN THE Link Society and institutional groups of the present study were classified according to a mixed typological-dimensional model. The study applied reciprocal two-digit high-point codes and also five different spiked codes and two different codes which include more than two scales in predominant position. Related codes suggesting different diagnostic descriptions were, however, separated from each other. The present study also used new interpretations of some MMPI scales, detailed descriptions of the other scales and applied some critically examined measurements of certain authors. Of special interest is a detailed interpretation of codes opathic deviate) scale as a measurement of hysterical personality. The above methods gave a more exact identification of the MMPI codes than a previous study of the present author and suggest that it is possible to give a more refined description of different personality disorders in particular but also of other psycho-pathological and behavioural characteristics of the alcoholic patients in the Link Society and institutional groups. The different typal dimensions measured by the MMPI high-point codes seem to be of theoretical value but also seem to be useful for a more differentiated and adequate treatment of alcoholics. In further corroborative studies there is a need for more case history descriptions in order to correct for local departures. It is also possible that these descriptions may aid in giving a clearer identification of the codes, including scale 5, not classified in the present study.

Personality and Symptom Pattern in Depression

This paper reports relationships between symptoms and premorbid personality in a varied sample of depressed patients. Symptoms were rated by a psychiatrist at clinical interview; personality was rated by patients on a self-report after clinical improvement, using the Maudsley Personality Inventory and an inventory of obsessive, hysterical and oral personality. Additional ratings on the latter were obtained at interview with a relative. The most prominent finding was that patients with premorbid neuroticism also showed a neurotic rather than an endogenous symptom pattern. Additional relationships were relatively weak but consistent with previous studies. Depressives with neurotic rather than endogenous symptom pattern showed more evidence of oral dependent personality and less obsessionality. Patients with hysterical personalities tended to be less severely ill and to show a pattern characterized by mixed depression and hostility with less evidence of anxiety.

Short versus long hospitalization: a prospective controlled study. V. One-year follow-up results for nonschizophrenie patients.

The authors studied the effect of long-term versus short-term hospitalization on a group of 74 patients with the diagnoses of affective disorder, neurosis and personality disorder, and hysterical personality one year after their admission to the hospital. Although they had found in an earlier study that short-term patients seemed to integrate more rapidly in the hospital, the results reported in this study showed no statistically reliable differences between the long-term and short-term groups. In contrast to the author's results for schizophrenic patients, their findings for nonschizophrenic patients do not support extended hospitalization.

The hysterical personality and the feminine character: A study of Scarlett O'Hara

The hysterical personality and the feminine character: A study of Scarlett O'Hara