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Psychogenic Voice Disorders Presented by Sara Panian ASC 823C April 17, 2003.
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Transcript of Psychogenic Voice Disorders Presented by Sara Panian ASC 823C April 17, 2003.
Psychogenic Voice Disorders
Presented bySara PanianASC 823C
April 17, 2003
“Psychogenic” vs. “Functional”
Boone & McFarlane use the term “functional”
Rationale: Most patients experience a total return of functional voice in 1-3 voice therapy sessions.
Aronson and others prefer the term “psychogenic”
Rationale: Most cases are traced to a psychological cause (anxiety, depression, etc.)
The term “functional” is ambiguous
Conversion Reactions
Definition: Any loss of voluntary control over normal striated muscle or over the general or special senses as a consequence of environmental stress or interpersonal conflict.
Psychogenic voice disorders originate from this psychoneurosis.
(Aronson, p. 141)
Psychogenic Causes of Voice Problems
Chronic anxiety states
Stress
Depression
Intrapersonal & interpersonal problems
Trauma
Qualifications for Psychogenic Voice Disorders
One of the previous factors or causes listed must be presentVoice must be affected fairly consistentlyNo organic cause can account for the disorder
Types of Psychogenic Voice Disorders
Conversion Aphonia
Conversion Dysphonia
Puberphonia/Mutational Falsetto
Conversion Muteness
Conversion Aphonia
Involuntary whispering despite a normal larynx
Gradual or sudden onsetCan be triggered by an organic disorderPsychotherapy often recommended
Approximately 80% of patients with conversion aphonia are female (Aronson, p. 144)
Conversion Dysphonia
Characterized by an unreliable voiceUnpredictable pitch, amplitude, etc.Examples:
breathy normal qualityhigh low pitchloud soft voice
Many of these patients have adjusted to their anxiety or depression
Some may prefer to continue as they are without voice therapyOthers truly want a better voice
Personality and Conversion Dysphonia
According to one study, the majority of individuals with vocal nodules are extroverts, while the majority of individuals with functional dysphonia are introverts.
(Roy et al., 2000)
Puberphonia/Mutational Falsetto
Failure to change from higher-pitched voice of preadolescence to lower-pitched voice of adolescence and adulthood (Aronson, p. 146)
Characteristics:WeakThinBreathy HoarseMonopitched
Laryngeal capability of producing normal low-pitched voice is present
Conversion Mutism/Muteness
Most severe of conversion voice disorders
Patient makes no attempt to phonate or articulate, or may articulate without exhalation
Characteristics:Indifference to the symptom
Chronic stress
Depression (mild to moderate)
Suppressed anger
Immaturity and dependency
Conversion Mutism, cont’d
Common themes in patient history:Wanting, but not allowing oneself, to express an emotion verbally (such as fear, anger, or remorse)
A breakdown in communication with someone of importance to the patient
Shame or fear getting in the way of expressing feelings through normal speech and language
Identification of Psychogenic Voice Disorders
A complete medical examination should be completed to rule out any possible organic or neurologic cause for the disorder.
Flexible endoscopic evaluation reveals vocal folds adduct during coughing, laughing, etc., but not during communicative speech.
Identification of Psychogenic Voice Disorders, cont’d
Client is unaware that the mechanisms used for non-speech actions (coughing, throat-clearing, etc.) are the same as those used for speaking.
Case History
After diagnosis has been made…
Clinician will want to carefully probe deeper than during a regular case history.
Attempt to determine “cause” of disorderLet client know that stresses or conflict in her life may be affecting her voice
Ask if there’s anything happening in her life that might be important for you to know
Referrals?
Immediate mental health referral may not be most effective
Client may reject referral to psychologist or psychiatrist
SLP: Lead gradually to this area and educate the client regarding the need for professional counseling
(Aronson, 1990)
Therapy Considerations
Avoid telling the client, “You could talk if you wanted to!”
Instead, explain what is physically wrong
“…keeping vocal folds apart…”
Experiencing an inability to “get them started”
Therapy Techniques
The steps to normal communication:Coughing, throat-clearing, etc.Prolongation to phonated vowels with coughProduction of all vowelsMonosyllabic wordsAny wordSimple phrases Oral readingSimple conversationConversation with anyone about anything in the clinic settingGeneralization to everyday communication
Iatrogenic Factor
Definition: Any illness induced by the actions of the clinician
Never tell a client with a voice disorder (organic, or especially psychogenic) to whisper or not use their voice for days or weeks!
Creates anxiety Secondary voice disorder
Failure to use voice Flaccidity of nonuse of vocal folds Another dysphonia
(Aronson, p. 151)
Deep thoughts…
“If the eyes are the mirror
of the human
soul, then the voice
is the barometer of
human emotion.”
Kerry Erie, M.Cl.Sc,
Resources
Aronson, A.E. (1985). Clinical voice disorders: An interdisciplinary approach (2nd edition). New York: Thieme Inc.Boone, D.R. & McFarlane, S.C. (2000). The voice and voice therapy (6th edition). Boston: Allyn and Bacon.Case, J.L. (2002). Clinical management of voice disorders (4th
edition). Austin, TX: Pro-ed.Psychogenic voice disorders (1999, April 22).Retrieved April 6,
2003, from http://www.geocities.com/Tokyo/2961/FYV-psy-disorders.htm
Stemple, J.C., Glaze, L.E., & Klaben, B.G. (2000). Clinical voice pathology: Theory and management (3rd edition). San Diego, CA: Singular Publishing.
Voice of emotion: The speech-language pathologist’s role in managing stress related voice disorders (2003). Retrieved April 6, 2003, from http://www.londonspeech.com/article7.htm