I. Hysterical psychotic disorder (dissociative disorder) The pre-morbid personality of hysterical patients is often abnormal, and the onset of the disease is related to psychiatric factors. The symptoms exhibited by the patient may be similar to those of a physical illness or mental disorder suffered by their close relatives or friends. In a minority, the symptoms form a repeatedly recurring pattern, always with the appearance of these disorders as a response to stress. It often gives the impression that episodes of illness are conducive to the patient’s ability to get out of trouble, vent emotions, and gain sympathy and support from others. The main manifestations are episodes of narrowed range of consciousness, acute emotional outbursts with venting characteristics, selective amnesia, or impairment of self-identification. Recurrent episodes can often develop by recalling and associating situations related to past trauma. The common types are as follows: 1. Emotional outbursts: Often occur suddenly when arguing with others, and manifesting as venting, crying, chest pounding, head banging and rolling. The attack is especially violent when surrounded by many people. 2, hysterical disorders of consciousness: the main performance of the scope of consciousness is reduced. The onset is sudden, and the speech, movement and expression reflect the content of psychological trauma. 3. Hysterical wandering: In addition to all the characteristics of hysterical amnesia, it also occurs during daytime awakening, leaving home or workplace, making apparently purposeful trips, retaining the ability of self-care (such as eating, grooming, etc.) during the trip, and being able to carry out simple social interactions with strangers (such as buying tickets, asking for directions, ordering food). Some cases even adopt a new identity, usually lasting only a few days. Their arranged trips may be to places that are known and have emotional significance. Hysterical wandering begins and ends abruptly. The patient has a reduced range of consciousness at this point and may have self-identification deficits and amnesia afterwards. Nevertheless, to an uninformed bystander, the patient’s behavior during this time appears normal. 4.Hysterical identity disorder: It is a transient mental disorder with acute onset. The patient temporarily loses the ability to recognize his or her own identity and is fully aware of his or her surroundings. In some cases, the patient acts as if he or she has been replaced by another personality, spirit, fairy, or outside force. The patient’s attention and awareness are focused on only one or two aspects of the environment with which he or she is in close contact. There is often a limited and repetitive series of movements, postures, and articulations. Some patients exhibit two or more distinctly different personalities, alternating (called dual and multiple personalities, respectively), but only one of them is prominent at a given time. Each personality involved is intact, with its own memories, behaviors, and preferences, and can be in complete opposition to that patient’s premorbid personality. The transition from one personality to the other usually starts abruptly and is closely related to a traumatic event; later, the transition usually occurs only when a stressful event is encountered or when the patient receives treatment such as relaxation, hypnosis, or venting, when the patient lacks full awareness of his or her surroundings. 5.Hysterical amnesia: The patient has no organic brain damage, and selective amnesia is the main manifestation. The time or event that is forgotten is often related to psychological trauma. 6.Hysterical pseudo-dementia: The patient suddenly appears severe mental impairment after psychological trauma, but no organic brain lesion or other psychiatric illness exists. If the patient can understand the question, but gives approximate answer, giving the impression of deliberate artifice, it is called Ganser syndrome. If, after a psychological trauma, childishness, speech, expressions and movements like those of a child suddenly appear and the patient refers to himself as a toddler, it is called child-like dementia. 7.Hysterical psychosis: sudden onset after severe psychological trauma, with variable symptoms, mainly manifesting obvious behavioral disorders, crying and laughing erratically, performing ornamental actions, childish and confused behaviors, transient hallucinations, delusions and thought disorders, and personality disintegration. The duration of the disorder rarely exceeds 3 weeks, and it can be cured suddenly without sequelae, but it can recur. Hysterical somatic disorders (conversion disorder) include motor disorders, sensory disorders, and somatization symptoms. In these disorders there is motor loss or impairment, or sensory loss (often cutaneous sensation). Although no somatic disorder can be found to explain the symptoms, and there is no corresponding organic damage on physical and neurological examination, or laboratory tests, the patient’s presentation does appear to be suffering from a somatic disorder. The symptoms seen often reflect the patient’s perceptions and concepts of somatic disorders that are inconsistent with physiological and anatomical principles. In addition, an assessment of the patient’s mental state and social situation often reveals that the disability due to functional loss helps the patient to escape unpleasant conflicts or indirectly reflects dependency or resentment. Although the problems and conflicts are clearly visible to others, the patient denies them and blames all suffering on the symptoms and their resulting disability. The degree of disability due to each symptom varies from time to time, depending on the number and type of people present and the emotional state of the patient. This means that in addition to the core manifestation of motor or sensory impairment, there are a variable number of attention-seeking behaviors. The specific breakdown is as follows: 1) Sensory impairment: (1) Sensory hypersensitivity: manifested by a particular part of the skin that is particularly sensitive to touch, without actual neuropathy. (2) Sensory loss: local or generalized skin sensory loss, which can be hemianesthesia or glove or garter type sensory loss, the scope of which is not consistent with the distribution of nerves. (3) Hysterical visual impairment: it can be manifested as amblyopia, blindness or tube-spotting. It usually occurs suddenly and can be treated with a sudden and complete return to normal. (4) Hysterical auditory disorder: most of them show sudden loss of hearing, but the auditory evoked potentials are normal. (5) Plum nucleus (hysterical ball): Patients often feel a foreign body or obstruction in the pharynx, but there is no abnormality in the examination of the pharynx. 2, hysterical movement disorder: (1) hysterical spasmodic seizure; often due to psychological factors or by implication, sudden seizure, showing slow collapse, generalized rigidity or corkscrew. Sometimes the limbs are irregularly shaking, shortness of breath, and the call is not answered. There is usually no trauma or fecal incontinence. The seizure usually lasts for tens of minutes, and after the seizure is over, the eyes are drowsy or closed, and the seizure can occur several times a day. (2) Hysterical paralysis: It can be hemiplegia, paraplegia or monoplegia. There is often significant resistance to passive activities and no organic damage to the nervous system on examination, but chronic cases may have disuse muscle atrophy. (3) Hysterical aphasia or mutism: The patient does not have any organic lesion of the lips, tongue and palate or vocal cords, but cannot make a sound when he wants to speak or talks with a very low and hoarse pronunciation, which is called aphasia. If the patient does not use words to answer questions, but uses gestures or writing to express the meaning of conversation, it is called mutism. (4) Somatization disorder: dominated by a variety of frequently changing somatic symptoms, which can involve any system or part of the body. The most common are gastrointestinal sensations (pain, hiccups, acid reflux, vomiting, nausea, etc.), abnormal skin sensations (itching, burning, tingling, numbness, soreness, etc.), skin spots; sexual and menstrual complaints are also common. Significant depression and anxiety are often present. The patient builds on this with further nonspecific features, i.e., additional subjectivity regarding the symptom complaints, often insisting on attributing symptoms to a specific organ or system, while physical and laboratory examinations fail to reveal organic lesions of that organ or system.