"Hysteria" near the end of the twentieth century in Athens

The aim of this study was to study the frequencies of clinical manifestations traditionally associated with the concept of "hysteria", namely conversion, dissociation, and somatization in the emergency room of the Department of Psychiatry in Athens in the late 1990s, in a period of significant social change of the Greek culture towards more Western standards. We used a retrospective chart review of all new emergency room cases in a representative two-year period (1995-1997), replicating the method and the diagnostic classification of a study from our Department published 25 years ago, investigating similar changes in these symptoms in previous periods of change in the Greek social structure. Of 7424 new cases 215 (2.9%) fulfilled criteria for "hysteria", a significant reduction from the original study. Of these 28 were foreign, mostly from non-Western cultural settings. Male to female ratio (1:3) and mean age remained unchanged from the original study. Hysterical fits (pseudoseizures) were significantly less in comparison to the original study. Mental and vegetative conversion (corresponding to dissociative and somatoform disorders, respectively) remained unchanged, mixed conversion increased while changes in somatic conversion (conversion disorder) depended on the nationality of the patients. Over the last quarter century in Athens rates of patients with so called "hysterical symptoms" continue to decrease, as do the most dramatic presentations. These reductions however, are not so great to suggest a disappearance of the syndrome, while increase of the mixed forms suggest that sub-syndromes may have common underlying mechanisms. This may point towards a single disease process with multiple presentations rather than separate diagnostic categories. Culture appears to influence clinical expression of symptoms.