Psychogenic Dysphonia - A Comprehensive Review

Introduction:

In the field of voice disorders, psychogenic dysphonia stands as a perplexing condition, challenging for both patients and clinicians. This condition is usually misunderstood and misdiagnosed. It manifests as a voice-production disruption without any organic or physical dysfunctionalities. This disorder involves the intricate connection between the mind and body, emphasizing the profound connection between psychological factors and vocal function.

This article discusses the mysteries surrounding psychogenic dysphonia, understanding its symptoms, causes, diagnostic methods, and treatment approaches.

What Is Psychogenic Dysphonia?

Psychogenic dysphonia refers to loss of voice where there is inadequate structural or neurological pathology that contributes to the nature and severity of the dysphonia and where the loss of voluntary control over phonation seems to be associated with psychological processes like depression, anxiety, conversion reaction, or personality disorder. Such dysphonias might lead to the development of post-viral infection with laryngitis and often occurs in association with proximity to emotionally or psychologically exhausting experiences.

In certain rare instances, severe and persistent psychogenic dysphonia may develop under harmless circumstances. However, with time, it may be traced back to traumatic stress experiences that occurred months or years before the onset of the voice disorder.

Unlike organic voice disorders, which originate from physical anomalies or injuries to the vocal mechanism, this disorder arises mainly from emotional factors. Patients with this condition generally show various symptoms, including whispering, hoarseness, voice breaks, or even complete loss of voice, all of which cannot be attributed to structural abnormalities.

What Are the Causes?

The etiology of psychogenic dysphonia remains complex, including a number of psychological, environmental, and social factors contributing to its onset and exacerbation.

The primary causes of psychogenic dysphonia include:

• Stress.

• Anxiety.

• Depression.

• Trauma.

• Unresolved emotional conflicts.

• Personality traits like perfectionism have also been identified as triggers for this disorder.

Further, individuals who depend mainly on their voices for professional or personal reasons, such as singers or public speakers, are more susceptible to the development of psychogenic dysphonia as they experience heightened performance pressure and vocal strain. Anderson and Schalen (1998) believed that psychogenic voice disorders are generally multifaceted and primarily result from psychosocial stress and are triggered by emotional distress.

The inability to express emotion is a common characteristic of psychogenic voice disorders. Anderson and Schalen (1998) documented the importance of family and work stresses as major contributory factors. Rather than a specific life event acting as a trigger, their subjects reveal that the long-term effects of conflicts and frustrations finally give rise to the problem. Butcher et al. (1987) stated that the stressful situations for these patients can be classified into three groups:

• Family and interpersonal difficulties.

• Stressful factors associated with work.

• The burden of responsibility.

What Are the Symptoms?

The symptoms of psychogenic dysphonia include:

• The patient requires efforts to produce voice.

• The patient feels vocal fatigue and vocal tract discomfort.

• In cases where coexisting laryngeal pathology exists, the voice might become worse than its appearance suggests.

• The symptoms are not always consistent. A typical vocal note might be heard in vegetative behaviors like throat clearing, coughing, yawning, or laughing. However, not when the voice is being used for communication.

• The voice ranges according to the subject matter, social context, and the patient's mood during the conversation.

• The history and presentation might be inconsistent with any known condition.

• Several therapeutic methods lead to normal voices.

• The voice disorder might be episodic.

• Abnormal voice or aphonia occurs with periods of normal voice.

• The patient describes a history of stressful events or prolonged stress.

How Is Psychogenic Dysphonia Diagnosed?

Diagnosis of psychogenic dysphonia is challenging for healthcare professionals because of its complex nature and overlap with other voice disorders. Differential diagnosis is usually necessary to rule out organic causes through complete clinical evaluation, imaging studies, laryngeal examination, and voice assessments. However, the absence of physical abnormalities does not always validate a psychogenic origin, emphasizing the need for a comprehensive psychosocial assessment to discover the underlying psychological factors contributing to voice dysfunction.

How Is Psychogenic Dysphonia Treated?

Proper management of psychogenic dysphonia requires incorporating a multidisciplinary approach involving psychological interventions, speech therapy, and holistic wellness techniques. Speech therapy techniques focus on retraining vocal habits, improving breath support, and enhancing vocal resonance through phonation, relaxation, and articulation exercises.

Psychotherapy methods for treating psychogenic dysphonia include

• Cognitive-behavioral therapy (a type of talking therapy that is commonly used for the treatment of a variety of mental health problems).

• Psychodynamic therapy (unconscious processes seen in the client's present behavior).

• Mindfulness-based interventions address underlying emotional issues.

• Maladaptive coping mechanisms.

• Stress management strategies.

Further, holistic therapies like relaxation techniques, mindfulness practices, lifestyle modifications, and vocal hygiene education are essential in restoring vocal health and overall well-being. Cumulative efforts among otolaryngologists (a medical specialty focused on the ears, nose, and throat), speech-language pathologists, psychologists, and other healthcare professionals ensure a comprehensive treatment plan customized to each individual's unique needs and challenges.

What Is the Prognosis?

Psychogenic dysphonia poses a range of challenges in clinical management despite advancements in diagnostic and treatment methods. The challenges include relapse, patient resistance, and coexisting psychological comorbidities. Patients might show a range of insight into their condition, varying from denial and resistance to acceptance and engagement in treatment. Further, dealing with the underlying psychological issues and modifying maladaptive behaviors needs time, patience, and ongoing support from clinicians and patients.

The prognosis of psychogenic dysphonia differs depending on individual factors like severity of symptoms, duration of the condition, and response to therapy. While specific individuals might experience significant enhancement and restoration of normal voice function with proper intervention, some might face continuous challenges and need long-term management techniques to decrease the intensity of the symptoms and enhance the quality of life.

Conclusion:

In the intricate tapestry of voice disorders, psychogenic dysphonia emerges as a poignant reminder of the complicated connection between mind, body, and voice. By investigating its complexities and incorporating a holistic approach to diagnosis and treatment, healthcare professionals can help individuals facing this problem reclaim their voices and embark on a journey toward vocal health and emotional well-being. Through collaboration, compassion, and comprehensive care, the mysteries of psychogenic dysphonia can be deciphered, offering hope and healing to those in need.