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Margaret Jacobs, Leo van Biene


Patients with psychogenic voice disorder (PVD), a disorder of voice in the absence of identifiable pathology, present a particular challenge to clinicians. Although the voice can usually be restored by the use of speech therapy, recurrences can only be prevented by psychotherapeutic intervention. Psychological factors have been long recognized as playing a role in these disorders, but the nature of this contribution has been unclear. Various conceptual frameworks have been used to understand this disorder. While for much of the last century, “conversion” has been seen as the primary process that underpins this disorder, little attention has been paid to the role of dissociation in this regard. This paper explores the utility of viewing PVD through a lens of Self. In so doing, PVD can be considered as a symptomatic expression of a compromised sense of Self which has its genesis in relational trauma and maladaptative defensive maneuvers. These are underpinned by complex dissociative processes which operate largely outside of conscious awareness. A clinical vignette demonstrates the utility of treating this disorder with both speech therapy techniques and a specific mode of psychotherapy, the Conversational Model, which is focused on the fostering of a sense of Self.  It will be shown that this perspective not only provides a clear view of the genesis of this

disorder, but also describes a pathway for effective treatment.


Abuse, clinical vignette, DSM-IV, DSM-V, dysphonia, person-centered healthcare, person-centered medicine, person-centered psychiatry, personal narrative, psychogenic voice disorder, psychosocial care, psychotherapy, reflective awareness, relational trauma

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Baker, J., Ben-Tovim, D.I., Butcher, A., Esterman, A. & McLaughlin, K. (2007). Development of a modified diagnostic classification system for voice disorders with inter-rater reliability study. Logopedics Phoniatrics Vocology 32, 99-112.

Roy, N. (2003). Functional dysphonia. Current Opinion in Otolaryngology and Head and Neck Surgery 11, 144-148.

Roy, N., McGrory, J.J., Tasko, S.M., Bless, D.M., Heisey, D. & Ford, C.N. (1997). Psychological correlates of functional dysphonia: An investigation using the Minnesota multiphasic personality inventory. Journal of Voice 11 (4) 443-451.

Baker, J. (2002). Psychogenic voice disorders: Heroes or hysterics? A brief overview with questions and discussion. Logopedics Phoniatrics and Vocology 27, 84-91.

Butcher, P., Elias, A. & Raven, R. (1993). Psychogenic voice disorders and cognitive behaviour therapy. London: Whurr.

Rubin, J. & Greenberg, M. (2002). Psychogenic voice disorders in performers: A psychodynamic model. Journal of Voice 16 (4) 544-548.

Baker, J. (2003). Psychogenic voice disorders and traumatic stress experience: A discussion paper with two case reports. Journal of Voice 17 (3) 308-318.

Charcot, J.M. (1887). Lessons on the illnesses of the nervous system. Paris: Delahaye and Lecrosnie.

Janet, P. (1907). The major symptoms of hysteria. New York: McMillan.

van der Kolk, B.A. & van der Hart, O. (1989). Pierre Janet and the breakdown of adaptation in psychological trauma. American Journal of Psychiatry 146 (12) 1530-1540.

van der Kolk, B.A., McFarlane, A.C. & Weisaeth, L. (Eds.). (1996). Traumatic stress: The effects of overwhelming experience on mind, body and society. New York: Guilford Press.

van der Kolk, B., Weisaeth, L. et al. (1996). History of trauma in psychiatry. Traumatic Stress: The effects of overwhelming experience on mind, body and society. van der Kolk, B., McFarlane A.C. & Weisarth, L. (Eds.). New York: Guilford Press.

Breuer, J. & Freud, S. (1961 [1893-1895]). Studies on hysteria. The standard edition of the complete psychological works of Sigmund Freud. Vol. 2. ( J. Strachey, ed.). London, Hogarth Press.

Freud, S. (1953 [1905]). Fragment of an analysis of a case of hysteria. London: Hogarth Press and the Instutute of Psychoanalysis.

Ingals, E.F. (1890). Hysterical aphonia. Journal of the American Medical Association 15, 92-95.

Carter, A.B. (1949). The prognosis of certain hysterical symptoms. British Medical Journal 1, 1076-1079.

Bangs, J.L. & Freidinger, A. (1950). A case of hysterical dysphonia in an adult. Journal of Speech and Hearing Disorders 15, 316-323.

Milutinovic, Z. (1990). Results of vocal therapy for phononeurosis: behaviour approach. Folia Phoniatrica et Logopaedica 42, 173-177.

Milutinovic, Z. (1991). Inflammatory changes as a risk factor in the development of phononeurosis. Folia Phoniatrica et Logopaedica 43, 177-180.

Greene, J.S. (1938). Psychiatric therapy for dysphonia, aphonia, psychophonasthenia, falsetto. Archives of Otolaryngology 28, 213-221.

Smurthwaite, H. (1919). War neuroses of the larynx and speech mechanism. Journal of Laryngology and Otology 34 (1) 13-20.

Sokolowsky, R.R. & Junkermann, M.E.B. (1944). War aphonia. Journal of Speech and Hearing Disorders 9, 193-208.

Brown, R.J., Cardena, E., Nijenhuis, E., Sar, V. & van der Hart, O. (2007). Should conversion disorder be reclassified as a dissociative disorder in DSM–V? Psychosomatics 48 (5) 369-378.

Butcher, A., Elias, A. & Cavalli, L. (2007). Understanding and treating psychogenic voice disorder. West Sussex: John Wiley & Son Ltd.

Oates, J.M. (2004). The evidence base for the management of individuals with voice disorders. In: Evidence-based practice in speech pathology, pp. 110-139. (S. Reilly, J. Douglas & J. Oates, eds.). London: Whurr Publishers.

Oates, J. &Winkworth, A. (2008). Current knowledge, controversies and future directions in hyperfunctional voice disorders. International Journal of Speech - Language Pathology 10 (4) 267-277.

Verdolini, K., Rosen, C.A. & Branski, R.C. (Eds.). (2006). Classification manual for voice disorders-I. New Jersey: Laurence Erlbaum and Associates Inc.

Aronson, A.E. (1990). Editorial: Importance of the psychosocial interview in the diagnosis and treatment of "functional" voice disorders. Journal of Voice 4 (4) 287-289.

Rosen, D.C. & Sataloff, R.T. (1997). Psychological aspects of voice disorders. In: Professional voice: The science and art of clinical care. (R. T. Sataloff, ed.). San Diego: Singular Publishing Group Inc.

Wilson, J.A., Deary, I.J., Scott, S. & MacKenzie, K. (1995). Functional dysphonia. British Medical Journal 21, 1039-1040.

Aronson, A.E. (1973). Psychogenic voice disorders. Philadelphia: PA, Saunders.

Aronson, A.E. (1990). Clinical voice disorders: an interdisciplinary approach. New York: Thieme.

House, A.O. & Andrews, C.A. (1987). The psychiatric and social characteristics of patients with functional dysphonia. Journal of Psychosomatic Research 31 (4) 483-490.

Roy, N., Bless, D.M. & Heisey, D. (2000). Personality and voice disorders: A multitrait-multidisorder analysis. Journal of Voice 14 (4) 521-548.

Baker, J. (2008). The role of psychogenic and psychosocial factors in the development of functional voice disorders. International Journal of Speech-Language Pathology 10 (4) 210-230.

Baker, J. & Lane, R.D. (2009). Emotion processing deficits in functional voice disorders. In: Emotions in the human voice, pp. 105-135. (K. Izdebski, ed.). San Diego, CA: Plural Publishing.

van Mersbergen, M. (2011). Voice disorders and personality: Understanding their interactions. Perspectives on Voice and Voice Disorders 21, 31-38.

Morrison, M.D. & Rammage , L.A. (1993). Muscle misuse voice disorders: Description and classification. Acta Oto-laryngologica 113, 428-434.

Dietrich, M. & Verdolini Abbott, K. (2012). Vocal function in introverts and extraverts during a psychological stress reactivity protocol. Journal of Speech, Language, and Hearing Research 55, 973-987.

Gerritsma, E.J. (1991). An investigation into some personality characteristics of patients with psychogenic aphonia and dysphonia. Folia Phoniatrica et Logopaedica 43, 13-20.

Butcher, P., Elias, A., Raven, R., Yeatman, J. & Littlejohns, D. (1987). Psychogenic voice disorder unresponsive to speech therapy: Psychological characteristics and cognitive-behavior therapy. British Journal of Disorders of Communication 22, 81-92.

Baker, J., Ben-Tovim, D.I., Butcher, A., Esterman, A. & McLaughlin, K. (2013). Psychosocial risk factors which may differentiate between women with functional voice disorder, organic voice disorder and a control group. International Journal of Speech & Language Pathology 15 (6) 547-563.

Baker, J. (2010). Women's voices: Lost or mislaid, stolen or strayed? International Journal of Advances in Speech & Language Pathology 12 (2) 94-106.

House, A.O. & Andrews, H.B. (1988). Life Events and difficulties Preceding the Onset of Functional Dysphonia. Journal of Psychosomatic Research 32 (3) 311-319.

Andersson, K. & Schalen, L. (1998). Etiology of psychogenic voice disorder: Results of a follow-up study of thirty patients. Journal of Voice 12 (1) 96-106.

Lane, R.D. & Schwartz, G.E. (1987). Levels of emotional awareness: A cognitive-developmental theory and its application to psychopathology. American Journal of Psychiatry 144, 133-143.

Hatcher, S. & House, A. (2003). Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study. Psychological Medicine 33, 1185-1192.

Andrews, H.B. & House, A. (1989). Functional dysphonia. In: Life events and illness. (G.W. Brown & T.O. Harris, eds.). New York: The Guilford Press

Baker, J. (1998). Psychogenic dysphonia: Peeling back the layers. Journal of Voice 12 (4) 527-535.

Sudhir, P.M., Chandra, P.S., Shivashankar, N. & Yamini, B.K. (2009). Comprehensive management of psychogenic dysphonia: A case illustration. Journal of Communication Disorders 42, 305-312.

Miles, A. & Asbridge, J.E. (2014). Clarifying the concepts, epistemology and lexicon of person-centeredness: an essential pre-requisite for the effective operationalization of PCH within modern healthcare systems. European Journal for Person Centered Healthcare 2 (1) 1-15.

Aronson, A.E., Peterson, H.W. Jr. & Litin, E.M. (1966). Psychiatric symptomotology in functional dysphonia and aphonia. Journal of Speech and Hearing Disorders 31, 115-127.

Jung, C.G. (1951). Aion: Researches into the Phenomenology of the Self (Collected Works Vol. 9 Part 2). Princeton, NJ: Bollingen.

Kohut, H. (1971). The analysis of self. New York: International University Press.

Meares, R. (2000). Intimacy and alienation: Memory, trauma and personal being. London: Routledge.

Meares, R. (2004). The Conversational Model: An outline. American Journal of Psychotherapy 58 (1) 51-66.

Meares, R. (2005). The Metaphor of Play: Origin and Breakdown of Personal Being. London: Routledge.

Meares, R. (2012). A dissociation model of borderline personality disorder. New York: W.W. Norton & Company Inc.

James, W. (1892). Psychology: Briefer course. London: Macmillan.

Meares, R. (1999). The contribution of Hughlings Jackson to an understanding of dissociation. American Journal of Psychiatry 156 (12) 1850-1855.

Meares, R. (1999). Value, trauma and personal reality. Bulletin of the Menninger Clinic 63, 443-458.

Hobson, R.F. (1985). Forms of Feeling: The Heart of Psychotherapy. London: Routledge.

Graham, P. & van Biene, L. (2007). Hierarchy of Engagement. In: Self in Conversation, pp. 177-196. Sydney: ANZAP Books.

Westen, D., Moses, M. J. et al. (1992). Quality of depressive experience in borderline personality disorder and major depression: When depression is not just depression. Journal of Personality Disorders 6, 382-393.

Stevenson, J., Meares, R. & D’Angelo, R. (2005). Five-year outcome of outpatient psychotherapy with borderline patients. Psychological Medicine 35 (1) 79-87.

Korner, A., Gerull, F., Meares, R. & Stevenson, J. (2006). Borderline personality disorder treated with the conversational model: a replication study. Comprehensive Psychiatry 47 (5) 406-411.

Colton, R.H. & Casper, J.K. (1990). Understanding voice problems: A physiological perspective for diagnosis and treatment. Baltimore: Williams & Wilkins.

Waller, N., Putnam, F.W. et al. (1996). Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences. Psychological Methods 1 (3) 300-321.

Brandchaft, B. (1994). To free the spirit from its cell. In: The intersubjective perspective, pp. 57-76. (R.D. Stolorow, G.E. Atwood & B. Brandchaft, eds.). Lanham, MD: Jason Aronson.

Jackson, J.H. (1931). Selected writings of John Hughlings Jackson. London: Hodder.

Brandchaft, B. (2007). Systems of pathological accommodation and change in analysis. Psychoanalytic Psychology 24 (4) 667-687.



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