Formal psychological testing in patients with paradoxical vocal fold dysfunction OBJECTIVE: The etiology of paradoxical vocal fold dysfunction (PVFD) has been unclear, but it has long been hypothesized that there is a significant psychological component. The purpose of this study was to elucidate the psychological profiles of patients newly diagnosed with PVFD using psychometrically-sound psychological assessment instruments. STUDY DESIGN: Prospective cohort study of 45 adults newly diagnosed with PVFD at a tertiary university referral center. METHODS: The Minnesota Multiphasic Personality Inventory (MMPI-2) was administered to test for psychopathology. The Life Experiences Survey (LES) was administered to investigate levels of stress. Demographic, medical, and social histories were reviewed. MMPI-2 and LES scores for the PVFD cohort were compared with scores previously established for normative populations. RESULTS: The study population included 81\% female and 60\% who were age 50 or older. Compared to the normative population for the MMPI-2, significant differences were noted for both male and female PVFD patients; on average, scores were highly elevated on the hypochondriasis scale and hysteria scale and less elevated on the depression scale. This pattern was consistent with conversion disorder (P .01). In MMPI-2 subset analysis, 18 patients had a classic conversion profile while 13 others had elevated scores in the three scales of interest, but not in the classic conversion disorder pattern. Also, 11 patients had normal scores, suggesting no psychopathology. PVFD patients with a psychological history scored significantly higher on the depression and anxiety scales than PVFD patients without a psychological history. Patients with a history of asthma or gastroesophageal reflux disease (GERD) achieved significantly higher scores on the hypochondriasis scale than those without that medical history. On the LES assessment, female PVFD patients had significantly lower levels of positive stress and higher levels of negative stress than the general population; total levels of stress were not significantly different, however. Male PVFD patients had significantly lower levels of positive, negative, and total stress. For the entire cohort, asthma (65\%), GERD (51\%), and a history of abuse (38\%) were common comorbidities. CONCLUSIONS: On average, in both male and female adults, PVFD is associated with conversion disorder, representing a physical manifestation of underlying psychological difficulty. There also appears to be a subset of PVFD that is not associated with psychopathology. PVFD patients with a previous psychological history are prone to more depressive and anxious symptomatology. Patients with PVFD and a history of asthma or GERD are more likely to excessively complain about physical symptoms. Overall levels of stress are not higher in PVFD patients compared to a general population. However, females report more negative stress, and both males and females may have trouble coping with the amount of stress that they do have. PVFD is more common among women, more prevalent among older individuals, and can be comorbid with asthma, GERD, and previous abuse. These results have implications for treatment- psychotherapy directed for somatoform and conversion disorders may be added to traditional speech therapy for increased efficacy https://www.upress.umn.edu/test-division/bibliography/2000-2009/2008/husein_formal_2008 https://www.upress.umn.edu/logo.png

O.F. Husein, T.N. Husein, R. Gardner, T. Chiang, D.G. Larson, K. Obert, J. Thompson, M.D. Trudeau, D.M. Dell, and L.A. Forrest (2008)

Formal psychological testing in patients with paradoxical vocal fold dysfunction

Laryngoscope, 118(4):740-747.

Keywords

Abuse
Age
Anxiety
Anxiety Scale
Assessment instruments
Asthma
Classification
Cohort Studies
Comorbidity
Conversion
Conversion disorder
Coping
Depression
Depression and anxiety
Depression Scale
Disease
Domestic violence
Etiology
Gastroesophageal reflux
General population
Hypochondriasis
Hypochondriasis Scale
Hysteria
Hysteria Scale
Life Change Events
Life Experiences
Life Experiences Survey
Minnesota Multiphasic Personality Inventory
MMPI
MMPI 2
MMPI-2
Patients
Personality
Profile
Psychotherapy
Referral
Score
Social history
Somatoform
Speech
Speech therapy
State
Stress
Surgery
Symptoms
Test
Testing
Treatment
University
Women

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Formal psychological testing in patients with paradoxical vocal fold dysfunction