The path of the conversion symptom: from Freud’s hysteria to the present day
DOI:
https://doi.org/10.25118/2763-9037.2025.v15.1505Keywords:
Hysteria, Conversion Disorder, Psychogenic Nonepileptic SeizuresAbstract
Introduction: The conversion symptom dates to Ancient Egypt and has had different interpretations over time. Under the name of Hysteria, it was studied by Charcot through hypnosis and explored by Freud, leading to the discovery of Psychoanalysis. In current version of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it falls under Conversion Disorders. Objective: Starting from a clinical illustration, we propose to describe the evolution of the conversion symptom, from Freud's hysteria until today. Methods: Narrative review of the literature, using PubMed as database and the descriptors “Conversion disorder”, “hysteria” and “psychogenic nonepileptic seizures”. As grey literature, two scientific articles and six reference books on Psychiatry and Psychoanalysis were included. Results: The conversion symptom constituted an important milestone in history of Psychiatry, bringing new possibilities for understanding emotional suffering and new perspectives on treatment. Freud found that the physical symptoms of hysteria had a psychic origin and resulted from a mechanism of conversion of psychological suffering – a symbolic expression of an unconscious representation unacceptable to the Self and, therefore, repressed. In parallel, Neurology implemented the term “psychogenic non-epileptic seizures” to differentiate them from epileptic seizures. Conclusion: Considering the psychological particularities of conversion disorder, the importance of raising awareness among health professionals regarding an empathetic approach to these patients is highlighted. To this end, we recognize the benefit of familiarizing these professionals with aspects of psychodynamic knowledge, which are useful in understanding these cases. In conclusion, the key for a patient with conversion symptoms is to have his suffering addressed.
Downloads
Metrics
References
1. Pio-Abreu JL. Pequena história da psiquiatria: os desafios das doenças mentais. Alfragide: Publicações Dom Quixote; 2021.
2. North CS. The Classification of Hysteria and Related Disorders: Historical and Phenomenological Considerations. Behav Sci. 2015;5(4):496-517. https://doi:10.3390/bs5040496 PMID: 26561836 PMCID: PMC4695775
3. Beghi M, Negrini PB, Perin C, Peroni F, Magaudda A, Cerri C, Cornaggia CM. Psychogenic non-epileptic seizures: so-called psychiatric comorbidity and underlying defense mechanisms. Neuropsychiatr Dis Treat. 2015;11:2519-27. http://dx.doi.org/10.2147/NDT.S82079 PMID: 26491330 PMCID: PMC4599147
4. Correia DT. As Raízes do sintoma e da perturbação mental. Lisboa: Lidel Edições Técnicas; 2015.
5. Gabbard GO. As bases teóricas da psiquiatria dinâmica. In: Gabbard GO. Psiquiatria psicodinâmica na prática clínica. 5a ed. Porto Alegre: Artmed Editora; 2016. p. 35-61.
6. Freud S. Estudos sobre a histeria. In: Freud S, Breuer J. Obras completas volume 2. São Paulo: Companhia das Letras; 1893-1895. p. 30-48.
7. Liga Portuguesa Contra a Epilepsia. Crises não epiléticas psicogénicas [Internet]. 2020 maio 21 [citado 2023 maio 29]. Disponível em: https://epilepsia.pt/crises-nao-epileticas-psicogenicas/
8. Feinstein A. Conversion disorder. Continuum. 2018;24(3):861-72. https://doi.org/10.1212/con.0000000000000601 PMID: 29851882
9. Popkirov S, Asadi-Pooya AA, Duncan R, Gigineishvili D, Hingray C, Kanner AM, LaFrance WC Jr, Pretorius C, Reuber M. The aetiology of psychogenic non-epileptic seizures: risk factors and comorbidities. Epileptic Disord. 2019;21(6):529-47. https://doi:10.1684/epd.2019.1107 PMID: 31843732
10. Hopp JL. Nonepileptic Episodic events. Continuum. 2019;25(2):492-507. https://doi.org/10.1212/con.0000000000000711 PMID: 30921020
11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5a ed. Arlington: American Psychiatric Association; 2013.
12. Casetto SJ. Sobre a importância de adoecer: uma visão em perspectiva da psicossomática psicanalítica no século XX. Psychê. 2006;10(17):121-42. https://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1415-11382006000100008
13. McWilliams N. Diagnóstico Psicanalítico: entendendo a estrutura da personalidade no processo clínico. 2a ed. Porto Alegre: Artmed; 2014. Capítulo 14, Personalidades histéricas (histriônicas); p. 338-87.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Mariana Assunção Maia Marques, Sofia Vilar Soares
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Debates em Psiquiatria allows the author (s) to keep their copyrights unrestricted. Allows the author (s) to retain their publication rights without restriction. Authors should ensure that the article is an original work without fabrication, fraud or plagiarism; does not infringe any copyright or right of ownership of any third party. Authors should also ensure that each one complies with the authorship requirements as recommended by the ICMJE and understand that if the article or part of it is flawed or fraudulent, each author shares responsibility.
Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) - Debates em Psiquiatria is governed by the licencse CC-By-NC
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material
The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- NonCommercial — You may not use the material for commercial purposes.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
