The modern coding of hysteria: Rethinking women’s systemic conditions and treatment
-
Brooke Laufer
Private Practice, Evanston, IL 60202, USA
Abstract
There is a strikingly disproportionate female-to-male ratio in diagnoses of autoimmune, neurological, and chronic pain disorders. Although biological mechanisms—such as hormonal fluctuations, X-linked genetic factors, immune modulation, and epigenetic vulnerability—are frequently proposed, no single pathway sufficiently accounts for the magnitude of this imbalance. Across diagnostic categories, these conditions share a constellation of symptoms: persistent fatigue, cognitive slowing or “brain fog,” diffuse musculoskeletal pain, gastrointestinal disturbance, autonomic irregularities, numbness, breathlessness, and dizziness. Notably, this symptom profile echoes early twentieth-century descriptions of hysteria, a diagnosis historically applied to women whose distress manifested through bodily complaints. This article does not argue for diagnostic equivalence, but rather for conceptual continuity. It considers whether contemporary conditions such as Fibromyalgia, Celiac disease, Ehlers-Danlos syndrome, Premenstrual dysphoric disorder, and Long COVID might, in some cases, represent embodied expressions of unarticulated strain within sociocultural systems that have historically constrained female agency. Drawing on theoretical frameworks and clinical vignettes, the paper explores how trauma, chronic stress physiology, immune dysregulation, and gendered role expectations intersect. It ultimately advocates for an integrative model—medical, psychodynamic, and somatic—that treats women’s symptoms as meaningful communications shaped by both biology and lived experience, rather than as evidence of defect or fragility. This perspective seeks to shift the narrative from women's bodies as "broken" to bodies expressing deeper truths that Western medicine has yet to fully understand.
Copyright (c) 2026 Brooke Laufer
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
[1]American Psychological Association. (2020). Publication manual of the American Psychological Association, 7th Ed. Washington, DC: American Psychological Association.
[2]As-Sanie, S., Clevenger, L. A., Geisser, M. E., et al. (2014). History of abuse and its relationship to pain experience and depression in women with chronic pelvic pain. American Journal of Obstetrics and Gynecology, 210(4), 317.E1–317.E8. https://doi.org/10.1016/j.ajog.2013.12.048
[3]Ballering, A. V., Olde Hartman, T. C., Verheij, R., et al. (2023). Sex and gender differences in primary care help-seeking for common somatic symptoms: A longitudinal study. Scandinavian Journal of Primary Health Care, 41(2), 132–139. https://doi.org/10.1080/02813432.2023.2191653
[4]Barsky, A. J., Peekna, H. M., & Borus, J. F. (2001). Somatic symptom reporting in women and men. Journal of General Internal Medicine, 16(4), 266–275.
[5]Barrett, L. F. (2017). How Emotions Are Made: The Secret Life of the Brain. New York, NY: Houghton Mifflin Harcourt.
[6]Bartholomew, R. E., Wessely, S., & Rubin, G. J. (2012). Mass psychogenic illness and the social network: Is it changing the pattern of outbreaks? Journal of the Royal Society of Medicine, 105(12), 509–512. https://doi.org/10.1258/jrsm.2012.120053
[7]Bertakis, K. D., & Azari, R. (2007). Patient gender and physician practice style. Journal of Women’s Health, 16(6), 859–869.
[8]Bogousslavsky, J. (2014). Jean-Martin Charcot and his legacy. Frontiers of Neurology and Neuroscience, 35, 44–55. https://doi.org/10.1159/000359991
[9]Bussières, A., Hancock, M. J., Elklit, A., et al. (2023). Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: A systematic review and meta-analysis. European Journal of Psychotraumatology, 14(2), 2284025. https://doi.org/10.1080/20008066.2023.2284025
[10]Chaplin, T. M. (2015). Gender and emotion expression: A developmental contextual perspective. Emotion Review, 7(1), 14–21.
[11]Chartier, M. J., Walker, J. R., & Naimark, B. (2009). Health risk behaviors and mental health problems as mediators of the relationship between childhood abuse and adult health. American Journal of Public Health, 99(5), 847–854. https://doi.org/10.2105/AJPH.2007.122408
[12]Cohn, M. (2015). Autoimmunity: Rationalizing possible pathways from initiation to disease. Journal of Theoretical Biology, 375, 40–51. https://doi.org/10.1016/j.jtbi.2014.05.030
[13]Conrad, N., Misra, S., Verbakel, J. Y., et al. (2023). Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: A population-based cohort study of 22 million individuals in the UK. The Lancet, 401(10391), 1878–1890. https://doi.org/10.1016/s0140-6736(23)00457-9
[14]Davidson, A., & Diamond, B. (2001). Autoimmune diseases. New England Journal of Medicine, 345(5), 340–350. https://doi.org/10.1056/NEJM200108023450506
[15]Demmler, J. C., Atkinson, M. D., Reinhold, E. J., et al. (2019). Diagnosed prevalence of Ehlers-Danlos syndrome and hypermobility spectrum disorder in Wales, UK: A national electronic cohort study and case–control comparison. BMJ Open, 9(11), e031365. https://doi.org/10.1136/bmjopen-2019-031365
[16]Dinse, G. E., Parks, C. G., Weinberg, C. R., et al. (2022). Increasing Prevalence of Antinuclear Antibodies in the United States. Arthritis Rheumatol, 74(12), 2032–2041. https://doi.org/10.1002/art.42330
[17]Dong, M., Anda, R. F., Felitti, V. J., et al. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 28(7), 771–784. https://doi.org/10.1016/j.chiabu.2004.01.008
[18]Drossman, D. A. (1995). Sexual and physical abuse and gastrointestinal illness. Scandinavian Journal of Gastroenterology, 30(sup. 208), 90–96. https://doi.org/10.3109/00365529509107768
[19]Dusenbery, M. (2018). Doing Harm: The Truth about How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. San Francisco, CA: HarperOne.
[20]Fairweather, D., Bruno, K. A., Darakjian, A. A., et al. (2023). High overlap in patients diagnosed with hypermobile Ehlers-Danlos syndrome or hypermobile spectrum disorders with fibromyalgia and 40 self-reported symptoms and comorbidities. Frontiers in Medicine, 10, 1096180. https://doi.org/10.3389/fmed.2023.1096180
[21]Freud, S. (1894). The neuro-psychoses of defense. In: Strachey, J. (editor and translator). The Standard Edition of the Complete Psychological Works of Sigmund Freud. Hogarth Press. pp. 45–61.
[22]Ganesh, R., & Munipalli, B. (2024). Long COVID and hypermobility spectrum disorders have shared pathophysiology. Frontiers in Neurology, 15, 1455498. https://doi.org/10.3389/fneur.2024.1455498
[23]Golding, J. M. (1994). Sexual assault history and physical health in randomly selected Los Angeles women. Health Psychology, 13(2), 130–138. https://doi.org/10.1037/0278-6133.13.2.130
[24]Goodwin, R. D., & Stein, M. B. (2004). Association between childhood trauma and physical disorders among adults in the United States. Psychological Medicine, 34(3), 509–520. https://doi.org/10.1017/s003329170300134x
[25]Gottfried, S. S. (2024). The Autoimmune Cure: Healing the Trauma and Other Triggers that Have Turned Your Body against You. San Francisco, CA: Harper Wave.
[26]Gracia-Ramos, A. E., Martín-Nares, E., & Hernández-Molina, G. (2021). New onset of autoimmune diseases following COVID-19 diagnosis. Cells, 10(12), 3592. https://doi.org/10.3390/cells10123592
[27]Hoffman, K. M., Trawalter, S., Axt, J. R., et al. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences, 113(16), 4296–4301.
[28]Hulme, P. A. (2004). Retrospective measurement of childhood sexual abuse: A review of instruments. Child Maltreatment, 9(2), 210–217. https://doi.org/10.1177/1077559504264264
[29]Irish, L., Kobayashi, I., & Delahanty, D. L. (2010). Long-term physical health consequences of childhood sexual abuse: A meta-analytic review. Journal of Pediatric Psychology, 35(5), 450–461. https://doi.org/10.1093/jpepsy/jsp118
[30]Jiang, Y., Greenwood-Van Meerveld, B., Johnson, A. C., et al. (2019). Role of estrogen and stress on the brain–gut axis. American Journal of Physiology-Gastrointestinal and Liver Physiology, 317(2), G203–G209. https://doi.org/10.1152/ajpgi.00144.2019
[31]Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163–190. https://doi.org/10.1007/BF00845519
[32]Klein, S. L., & Flanagan, K. L. (2016). Sex differences in immune responses. Nature Reviews Immunology, 16(10), 626–638.
[33]Kuhfuß, M., Maldei, T., Hetmanek, A., et al. (2021). Somatic experiencing—Effectiveness and key factors of a body-oriented trauma therapy: A scoping literature review. European Journal of Psychotraumatology, 12(1), 1929023. https://doi.org/10.1080/20008198.2021.1929023
[34]Levine, P. A., & Frederick, A. (1997). Waking the Tiger: Healing Trauma—The Innate Capacity to Transform Overwhelming Experiences. Berkeley, CA: North Atlantic Books.
[35]Levine, P. A. & Phillips, M. (2012). Freedom from Pain: Discover Your Body's Power to Overcome Physical Pain. New York, NY: Sounds True.
[36]Mackay, I. R. (2000). Science, medicine, and the future: Tolerance and autoimmunity. The BMJ, 321, 93–96. https://doi.org/10.1136/bmj.321.7253.93
[37]Maham, S., & Yoon, M. S. (2024). Clinical Spectrum of Long COVID: Effects on Female Reproductive Health. Viruses, 16(7), 1142. https://doi.org/10.3390/v16071142
[38]Mahroum, N., & Shoenfeld, Y. (2022). Autoimmune autonomic dysfunction syndromes: Potential involvement and pathophysiology related to complex regional pain syndrome, fibromyalgia, chronic fatigue syndrome, silicone breast implant-related symptoms and post-COVID syndrome. Pathophysiology, 29(3), 414–425. https://doi.org/10.3390/pathophysiology29030033
[39]Maté, G. (2011). In the Realm of Hungry Ghosts: Close Encounters with Addiction. Berkeley, CA: North Atlantic Books.
[40]Murray, M. (2024). A Major Health Crisis: The Alarming Rise of Autoimmune Disease. San Diego, CA: National Health Council.
[41]Najman, J. M., Nguyen, M. L., & Boyle, F. M. (2007). Sexual abuse in childhood and physical and mental health in adulthood: An Australian population study. Archives of Sexual Behavior, 36(5), 666–675. https://doi.org/10.1007/s10508-007-9180-5
[42]Nakazawa, D. J. (2008). The Autoimmune Epidemic. New York, NY: Touchstone/Simon and Schuster.
[43]Newman, M. G., Clayton, L., Zuellig, A., et al. (2000). The relationship of childhood sexual abuse and depression with somatic symptoms and medical utilization. Psychological Medicine, 30(5), 1063–1077. https://doi.org/10.1017/s003329179900272x
[44]O’Sullivan, S. (2021). The Sleeping Beauties: And Other Stories of Mystery Illness. London: Picador.
[45]Overstreet, D. S., Strath, L. J., Jordan, M., et al. (2023). A brief overview: Sex differences in prevalent chronic musculoskeletal conditions. International Journal of Environmental Research and Public Health, 20(5), 4521. https://doi.org/10.3390/ijerph20054521
[46]Panahi, F., & Faramarzi, M. (2016). The effects of mindfulness-based cognitive therapy on depression and anxiety in women with premenstrual syndrome. Depression Research and Treatment, 2016, 9816481. https://doi.org/10.1155/2016/9816481
[47]Payne, P., Levine, P. A., & Crane-Godreau, M. A. (2015). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 6, 93, 1–18. https://doi.org/10.3389/fpsyg.2015.00093
[48]Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York, NY: W. W. Norton & Company.
[49]Salmon, P., Skaife, K., & Rhodes, J. (2003). Abuse, dissociation, and somatization in irritable bowel syndrome: Toward an explanatory model. Journal of Behavioral Medicine, 26(1), 1–18. https://doi.org/10.1023/a:1021718304633
[50]Samulowitz, A., Gremyr, I., Eriksson, E., et al. (2018). "Brave men" and "emotional women": A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Research and Management, 2018(1), 6358624. https://doi.org/10.1155/2018/6358624
[51]Scull, A. (2009). Hysteria: The Biography. Oxford: Oxford University Press.
[52]Showalter, E. (1985). The Female Malady: Women, Madness, and English Culture, 1830–1980. New York, NY: Pantheon Books.
[53]Showalter, E. (1997). Hystories: Hysterical Epidemics and Modern Media. New York, NY: Columbia University Press.
[54]Slavich, G. M., & Irwin, M. R. (2014). From stress to inflammation and major depressive disorder: A social signal transduction theory of depression. Psychological Bulletin, 140(3), 774–815.
[55]Somers, E. C., Thomas, S. L., Smeeth, L., et al. (2009). Autoimmune diseases: A leading cause of death among young and middle-aged women in the United States. Clinical Immunology, 132(3), 256–264.
[56]Song, B., Yeh, P., Nguyen, D., et al. (2020). Ehlers-Danlos syndrome: An analysis of the current treatment options. Pain Physician, 23(4), 429–438.
[57]Stone, J., & Carson, A. (2011). Functional neurological symptoms: Assessment and management. Neurologic Clinics, 29(1), 1–18.
[58]Stone, J., Smyth, R., Carson, A., et al. (2005). Systematic review of misdiagnosis of conversion symptoms and “hysteria.” The BMJ, 331, 989. https://doi.org/10.1136/bmj.38628.466898.55
[59]Tasca, C., Rapetti, M., Carta, M. G., et al. (2012). Women and hysteria in the history of mental health. Clinical Practice & Epidemiology in Mental Health, 8, 110–119. https://doi.org/10.2174/1745017901208010110
[60]Taub, R., Agmon-Levin, N., Frumer, L., et al. (2024). Mindfulness-based stress reduction (MBSR) for fibromyalgia patients: The role of pain cognitions as mechanisms of change. Complementary Therapies in Clinical Practice, 56, 101860. https://doi.org/10.1016/j.ctcp.2024.101860
[61]Taylor, S. E., Klein, L. C., Lewis, B. P., et al. (2000). Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight. Psychological Review, 107(3), 411–429. https://doi.org/10.1037/0033-295X.107.3.411
[62]van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Viking.
[63]Walker, E. A., Gelfand, A., Katon, W. J., et al. (1999). Adult health status of women with histories of childhood abuse and neglect. American Journal of Medicine, 107(4), 332–339. https://doi.org/10.1016/s0002-9343(99)00235-1
[64]Wendell, S. (1996). The Rejected Body: Feminist Philosophical Reflections on Disability. New York, NY: Routledge.
[65]Yamin, J. B., Meints, S. M., Pester, B. D., et al. (2025). Childhood abuse and health outcomes in patients with fibromyalgia: A cross-sectional exploratory study of the moderating effects of pain catastrophizing and mindfulness. BMC Musculoskeletal Disorders, 26(1), 195. https://doi.org/10.1186/s12891-025-08449-7
