Psychogenic Voice Disorders
Presented by
Sara Panian
ASC 823C
April 17, 2003
“Psychogenic” vs. “Functional”
Boone & McFarlane use the term
“functional”
Rationale: Most patients experience a total
return of functional voice in 1-3 voice therapy
sessions.
Aronson and others prefer the term
“psychogenic”
Rationale: Most cases are traced to a
psychological cause (anxiety, depression, etc.)
The term “functional” is ambiguous
Conversion Reactions
Definition: Any loss of voluntary
control over normal striated muscle or
over the general or special senses as
a consequence of environmental
stress or interpersonal conflict.
Psychogenic voice disorders originate
from this psychoneurosis.
(Aronson, p. 141)
Psychogenic Causes of Voice
Problems
Chronic anxiety
states
Stress
Depression
Intrapersonal &
interpersonal
problems
Trauma
Qualifications for Psychogenic
Voice Disorders
One of the
previous factors or
causes listed must
be present
Voice must be
affected fairly
consistently
No organic cause
can account for the
disorder
Types of Psychogenic Voice
Disorders
Conversion Aphonia
Conversion Dysphonia
Puberphonia/Mutational Falsetto
Conversion Muteness
Conversion Aphonia
Involuntary whispering despite a
normal larynx
Gradual or sudden onset
Can be triggered by an organic disorder
Psychotherapy often recommended
Approximately 80% of patients with
conversion aphonia are female (Aronson,
p. 144)
Conversion Dysphonia
Characterized by an unreliable voice
Unpredictable pitch, amplitude, etc.
Examples:
breathy  normal quality
high  low pitch
loud  soft voice
Many of these patients have adjusted to
their anxiety or depression
Some may prefer to continue as they are
without voice therapy
Others truly want a better voice
Personality and Conversion
Dysphonia
According to one study, the majority
of individuals with vocal nodules are
extroverts, while the majority of
individuals with functional dysphonia
are introverts.
(Roy et al., 2000)
Puberphonia/Mutational
Falsetto
Failure to change from higher-pitched voice
of preadolescence to lower-pitched voice of
adolescence and adulthood (Aronson, p. 146)
Characteristics:
Weak
Thin
Breathy
Hoarse
Monopitched
Laryngeal capability of producing normal lowpitched voice is present
Conversion Mutism/Muteness
Most severe of conversion voice disorders
Patient makes no attempt to phonate or
articulate, or may articulate without
exhalation
Characteristics:
Indifference to the symptom
Chronic stress
Depression (mild to moderate)
Suppressed anger
Immaturity and dependency
Conversion Mutism, cont’d
Common themes in patient history:
Wanting, but not allowing oneself, to
express an emotion verbally (such as
fear, anger, or remorse)
A breakdown in communication with
someone of importance to the patient
Shame or fear getting in the way of
expressing feelings through normal
speech and language
Identification of Psychogenic
Voice Disorders
A complete medical examination should be
completed to rule out any possible organic
or neurologic cause for the disorder.
Flexible endoscopic evaluation reveals
vocal folds adduct during coughing,
laughing, etc., but not during
communicative speech.
Identification of Psychogenic Voice
Disorders, cont’d
Client is unaware that the mechanisms
used for non-speech actions (coughing,
throat-clearing, etc.) are the same as those
used for speaking.
Case History
After diagnosis has been made…
Clinician will want to carefully probe
deeper than during a regular case
history.
Attempt to determine “cause” of disorder
Let client know that stresses or conflict in
her life may be affecting her voice
Ask if there’s anything happening in her life
that might be important for you to know
Referrals?
Immediate mental
health referral may not
be most effective
Client may reject
referral to psychologist
or psychiatrist
SLP: Lead gradually to
this area and educate
the client regarding the
need for professional
counseling
(Aronson, 1990)
Therapy Considerations
Avoid telling the client, “You could talk
if you wanted to!”
Instead, explain what is physically
wrong
“…keeping vocal folds apart…”
Experiencing an inability to “get them
started”
Therapy Techniques
The steps to normal communication:
Coughing, throat-clearing, etc.
Prolongation to phonated vowels with cough
Production of all vowels
Monosyllabic words
Any word
Simple phrases
Oral reading
Simple conversation
Conversation with anyone about anything in the
clinic setting
Generalization to everyday communication
Iatrogenic Factor
Definition: Any illness induced by the
actions of the clinician
Never tell a client with a voice disorder
(organic, or especially psychogenic) to
whisper or not use their voice for days or
weeks!
Creates anxiety  Secondary voice disorder
Failure to use voice  Flaccidity of nonuse of
vocal folds  Another dysphonia
(Aronson, p. 151)
Deep thoughts…
“If the eyes are the mirror
of the human
soul, then the voice
is the barometer of
human emotion.”
Kerry Erie, M.Cl.Sc,
Resources
Aronson, A.E. (1985). Clinical voice disorders: An
interdisciplinary approach (2nd edition). New York: Thieme
Inc.
Boone, D.R. & McFarlane, S.C. (2000). The voice and voice
therapy (6th edition). Boston: Allyn and Bacon.
Case, J.L. (2002). Clinical management of voice disorders (4th
edition). Austin, TX: Pro-ed.
Psychogenic voice disorders (1999, April 22).Retrieved April 6,
2003, from http://www.geocities.com/Tokyo/2961/FYVpsy-disorders.htm
Stemple, J.C., Glaze, L.E., & Klaben, B.G. (2000). Clinical voice
pathology: Theory and management (3rd edition). San
Diego, CA: Singular Publishing.
Voice of emotion: The speech-language pathologist’s role in
managing stress related voice disorders (2003). Retrieved
April 6, 2003, from
http://www.londonspeech.com/article7.htm