Patients with conversion disorder present loss or diminution of one or several neurological functions, with no apparent organic cause. Their symptoms cannot be explained by a physical illness, which causes anxiety and difficulty to perform tasks. Nonorganic hearing loss is a condition in which there is audiometric discrepancy between the real hearing threshold and the measured threshold of the patient, in the absence of any organic disease. The following is a case of a patient with conversion disorder, who responded to a treatment of hypnosis and suggestion techniques.
A 21 year old unmarried labourer visited – visited our ophthalmology outpatient department (OPD) and subsequently ENT OPD along with his mother. The patient reported partial sight loss and hearing difficulty from 9 a.m. to 4 p.m. every day. He had difficulty in seeing people and objects along with difficulty in hearing what people said or what instructions were given to him. The ophthalmologist and otorhinolaryngologist examined him, and ruled out organicity by visual charts, ophthalmoscopic examination, slit-lamp examination and tuning fork tests, otoscopic examination, pure tone audiometry, respectively, and then referred the patient to psychiatry. The patient showed willingness to collaborate and eagerness to tell his story on interviewing. Premorbidly, he was well adjusted, very good at work, and had good interpersonal relationships. He was a cook at a local shop for the past 3–4 years and had no problems at work. However, for the past 3 months, he reported that he had haziness in seeing the food items he prepared. He would make mistakes either by cooking more or less or sometimes overcooking the food items and had difficulty in identifying the color of the food. He also made mistakes while returning money to customers and used to give more amounts due to confusion in color of currency notes. Even at home, he could not recognize the food prepared by his mother. Such symptoms gradually started around 9 a.m., worsened as day progressed, with a full recovery at 4 p.m. every day.
He also seemed to have difficulty in hearing along with vision problems as he frequently made mistakes in hearing the orders placed by his customers and served wrong orders.
He corroborated his blindness and deafness, and he reported that this fact bothered him. He expressed – difficulty in seeing people and objects, difficulty in hearing what people said or what instructions were given to him, excessive thoughts and worries about his impairment, and occasional death wishes due to the same. No psychotic symptoms were present. He affirmed to be a nervous, eager, and hardworking person and did not remain absent from work. His relatives described him as self-demanding person, eager and responsible to his work. He was also concerned about illnesses. No positive family, medical, and substance history was reported.
Patient was admitted and started on low-dose anxiolytics (tablet clonazepam 1.5 mg in divided doses for 3 days) without much improvement. Hence hypnotherapy was considered.
Hypnotic induction was initiated through the visualization of a door that opened to a staircase, leading down to the beach. As the patient visualized descending each stair, he became more relaxed and went deeper into the hypnotic state and was unable to control his muscles or open his eyes, even if wanted. Once the state of suggestibility was reached, the patient was told that soon his eyes would recover and see colors again. Through this technique, more collaboration for the suggestion was obtained from the patient. The posthypnotic order was that his eyes would heal overnight so when he opened them in the morning he would not only see but also hear normally. The process lasted for 90 min in a quiet atmosphere, without any interruptions. A week later, the patient was asymptomatic, had recovered vision completely, was able to see colors, and was ready to go, and did not have hearing loss. He was discharged. We followed up the patient on OPD basis and put him on tablet escitalopram 10 mg for anxiety and depressive symptoms. Since then, the patient has been coming for regular follow-ups and is well maintained on the above mentioned medication, reporting to have continued the same job as he used to do initially with no impairment.
Laria et al. published the case of conversion blindness in a 9-year-old female child who was treated with psychotherapy for 6 months until she fully recovered her vision. Ziegler and Schlemmer reported on the case of three family members with conversion blindness, who got better with the use of suggestion. One case of color blindness recovering in 24 h following one hypnosis session has been reported, which is similar to our finding. This case describes the use of hypnosis in the treatment of a man, Wilson, who, after sustaining injury to his face and eyes in the explosion of a coach car battery, suffered from both the conversion disorder of blindness and posttraumatic stress disorder (PTSD). He avoided going to sleep and closing his eyes, worrying that he would lose the little vision that remained. After some initial stabilization, hypnosis was used in adjunction with cognitive and behavior therapy (CBT). Through the use of hypnosis, his symptoms of PTSD were reduced and his visual ability was largely restored. Conversion disorder usually develops abruptly and lasts a relatively short time. Spontaneous recovery is found in approximately 95% of cases, usually within 2 weeks. In a group of patients with sudden deafness, 2.5% were diagnosed with psychogenic sudden deafness. The results showed distinctive features for each group with regard to audiologic, psychiatric, and clinical characteristics. Patients with psychogenic hearing loss had a history of psychological problems or had a temporal relationship between a preceding psychological stress factor with the development and exacerbation of the hearing loss.
Good prognosis for recovery following hypnosis in conversion disorder is the presence of an identifiable stressor in life, male gender, short interval between onset of symptoms, acute in onset, and lack of physical/psychiatric illness. Paralysis, weakness, blindness, and deafness have good prognosis, whereas seizure and tremors have bad prognosis. Recurrence is seen in ¼th of individuals within 1 year after first episode.
An important role of the concept of suggestion in the management of functional neurologic symptoms is to raise awareness of how interactions with clinicians and wider clinical contexts can alter expectancies and beliefs of patients in ways that influence the onset, course, and remission of symptoms. Antidepressants and anti-anxiety medications can be used to relieve anxiety or depression. Psychotherapy and family therapy may be helpful in younger patients having family dysfunctions. Group therapy may be helpful in adolescents to learn social skills and coping strategies to decrease their dependencies. Cognitive behavior therapy may be used to improve cognition regarding illness. Hypnotherapy can be useful to relieve anxiety.
In the case discussed here, the efficacy of hypnosis in the treatment of the pathology was evident. It is important that psychiatric residency should involve basic training in relaxation and hypnosis techniques as proposed in some hospitals.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
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