What is Dissociative Anesthesia?
Dissociative anesthesia or loss of sensory perception is a sensory disorder, characterized by a violation of one of the types of sensitivity, but not based on objectively recorded lesions of the nervous system. Sensory dissociative disorders include hyperesthesia, paresthesia, anesthesia, blindness, deafness and tunnel vision. The main differences of these disorders from organic diseases are that their prevalence does not correspond to innervation, the severity of these disorders is variable, and the symptoms of the disorder may decrease with suggestion and self-suggestion. The areas of skin anesthesia often have such boundaries, that it becomes clear that they reflect the patient’s ideas about bodily functions rather than being in accordance with medical knowledge. The loss of sensory perception may be accompanied by complaints of paresthesias. Loss of vision in dissociative disorders is seldom total and in cases of visual impairment it is more often a question of loss of visual acuity, its general ambiguity or “narrowing of the field of visual perception.” Contrary to complaints of vision loss, the patient’s overall mobility and motor performance are often surprisingly well preserved. Much less frequently than loss of sensation or vision, dissociative deafness and anosmia occur.
Symptoms of Dissociative Anesthesia
Anesthesia, paresthesia and hyperesthesia are not appropriate innervation; symptoms more often noted in the extremities. Patients with paresthesia and hyperesthesia are usually described as feeling pain or burning. For example, one can observe characteristic paresthesia of the limbs of the “stocking” and “socks” type; hemianesthesia with a border of sensitivity that passes exactly along the median line. Dissociative deafness, blindness and tunnel vision can be unilateral or bilateral. However, the neurological examination reveals the integrity of the sensory pathways. With convertible blindness, for example, patients can move without help, pupils respond well to light.
Diagnosis of Dissociative Anesthesia
For a reliable diagnosis should be both of the following criteria:
- the absence of a physical disorder that could explain the symptoms that characterize this disorder (but there may be physical disorders that give rise to other symptoms);
- the presence of a convincing link in time between the onset of symptoms of the disorder and stressful events, problems or needs;
and any of the two:
- partial or complete loss of some or all types of skin sensitivity of the area or the whole body (touch, pinprick, vibration, cold-heat);
- partial or complete loss of vision, hearing, or smell.
Treatment of Dissociative Anesthesia
The main role in the treatment belongs to psychotherapy, including cognitive-behavioral techniques, training of social skills, relaxation techniques and auto-training. Pharmacotherapy is used to create the prerequisites and opportunities for subsequent psychotherapy, it is used in the form of short courses using tranquilizers, antidepressants, neuroleptics, mood stabilizers.