Abstract
The present chapter is intended to elucidate the role of psychosocial factors such as stressful life events, adjustment issues in family, social, occupational, and academic setup, personality, and socioeconomic correlates in the individual suffering from functional aphonia/dissociative motor disorder of impairment or loss of speech which is also called as functional voice disorder (FVD). This chapter explores a study carried out by purposively selected (N=32) case files reviews of individuals with FVD who were treated with functional voice therapy. The study results indicated various stressful life events such as marital discord, adjustment difficulties with social, occupational, family, and academic stipulation, and rapidly changing personal and health conditions were significantly associated with FVD. Majority of the cases were belonging to lower socioeconomic status and depressive symptoms were observed. Presence of the persistent role of life events, adjustment issues, and depression influencing development and maintenance along with diagnosis and management techniques are discussed.
TopIntroduction
Speech is regulated by the operation of voice in humans and speech is the predominant human communication feature which differentiates human being from other creatures in our universe. Various nonorganic voice disorders with varied psychological causes are observed in day to day clinical practice. For these problems, many specialists rely on terms like “psychogenic”, “psychosomatic”, “somatoform disorder” or “somatization disorder” (Aronson, 1990; Kinz et al., 1988). But these terms were used too inconsistently and their definitions were not clear; it is useful to regard all non-organic voice disorders on a continuum, ranging from “psychogenic aphonia” at the top (i.e. where the role of psychosocial factors in the causality is greatest) via “psychogenic dysphonia” etc. to “professional dysphonia” at the bottom. The latter often stems not only from vocal misuse but also from problems of dissatisfaction at work or from conflicts in private life (Seifert, & Kollbrunner; 2005). The functional voice disorder (FVD) is formerly called as psychogenic aphonia, functional aphonia, conversional aphonia, functional dysphonia, hysterical aphonia or acute sudden voice loss. In this chapter, FVD is referred as dissociative motor disorder of impairment or loss of speech as per the ICD-10 (F44.4; World Health Organization, 1992).
The functional voice disorder is a rather rare disorder with the varying prevalence of 0.4% in general population to 0.98% in a treatment-seeking United States of America’s population (Cohen, Kim, Roy, Asche, & Courey, 2012). FVDs are rare; speech-language pathologists, ENT practitioners or general physicians as they refer the individuals who are suspected of having FVD to appropriate professionals such as psychologist, functional voice therapist or psychiatrist depending on accessibility to various setups in different countries for diagnosis and intervention, most of the FVD cases need subsequent management of FVD through therapies and interventions.
In the clinical interviews, clients disclosed that some clients have been taken to faith healers because of lack of awareness of the treatment available for the problem and such cases are more reported from the rural and semi-urban areas. Studies reported that prevalence of FVD is more in adult females than in adult males with the ratio of 5: 1 (Martins et al., 2016). The most frequently diagnosed voice disorder among adults is functional dysphonia (20.5%), acid laryngitis (12.5%), and vocal polyps (12%) (Martins et al., 2016) indicating more cases suffering from FVD among the population with voice disorders. Voice disorders are not mutually exclusive, and overlap is common. Most often FVD co-occurs with the symptoms of the depressive episode which can be elicited through a qualitative clinical interview with the client and family members.
Key Terms in this Chapter
Depression: Depression is a mood disorder. It includes persistent low mood, lack of interest in pleasurable activities, and lack of sleep and appetite.
Socioeconomic Factors: Socioeconomic factors of an individual include individual or family income, social status, education, and occupational background.
Stressful Life Event: Stressful life events are the unavoidable discrete life experiences that disrupt an individual’s usual activity, causing a substantial change and creating difficulty in readjustment to the stressors. It impacts on the mental health of the individual leading to the difficult or disordered mental state.
Functional Aphonia: Inability to speak or produce voice even though having normal structural functioning of speech production system. This might have occurred due to inability to sustain psychological stressors or overuse of the voice.
Personality: Personality is an individual’s reaction or response system for a given life situation or condition.
Adjustment Difficulty: Adjustment difficulty is the consequence of an individual’s difficulty or lack of ability to resolve or sustain the stressful life events for moving towards comfortable/contended life experience.
Psychotherapy: Psychotherapy is an application of psychological principles and techniques to help an individual to outcome the individual difficulties and increase the wellbeing of the individual. In the present chapter, functional voice therapy is one of the modules of psychotherapy approach used to manage the functional voice disorder.