A New Classification System for Psychogenic Voice Disorders

Peter Butcher, Lesley Cavalli, Annie Elias

Psychogenic voice disorder (PVD) is defined as a dysphonia or aphonia where the causative or perpetuating factors are largely of psychological or emotional conflict (Butcher, Elias, Cavalli, 2007). A new model of classification for psychogenic voice disorder is presented. This model describes three types of psychogenic voice disorder, distinct from a muscle misuse voice disorder. The aetiological features of the voice disorder, the psychological processes and the patient’s coping mechanism determine the type of PVD. The model has some common ground with previous classification systems (Aronson, 1990; Butcher, Elias and Raven, 1993; Morrison and Rammage, 1993), and it has drawn on Freud’s concept of conversion i.e. the view that a psychological conflict is converted into a physical symptom. However, this model is firmly grounded in a cognitive behavioural framework. It reformulates Freud’s concept of conversion to take into account the common aetiological features found in this population and it is supported by the current psychiatric criteria for conversion disorder (DSM-IV-TR). The evidence has been derived from the authors’ review of a wide body of voice research in combination with their own detailed clinical explorations together as SLTs and cognitive behaviour therapist.
Furthermore, since the model has implications for speech and language therapists’ (SLT) clinical practice, important considerations for both assessment and treatment, which are underpinned by an understanding of cognitive behaviour therapy (CBT), are outlined. The classification helps the SLT determine when a symptomatic versus psychological therapeutic approach is best and it advocates CBT as the psychological treatment of choice.

Peter Butcher, Consultant Clinical Psychologist in CBT
East London and City Mental Health Trust, London, UK
Lesley Cavalli, Specialist Speech and Language Therapist at Great Ormond Hospital for Sick Children, London, UK and Lecturer in Voice, Department of Human Communication Science, University College London
Annie Elias, Specialist Speech and Language Therapist
Kentand Canterbury Hospital, UK

References
Aronson, A.E. (1990) Clinical Voice Disorders, 3^rd edn. New York: Thieme.
Butcher P, Elias A and Cavalli L (2007 Understanding and Treating Psychogenic Voice Disorder a CBT framework. Chichester-Wiley
Butcher P, Elias A and Raven R (1993) Psychogenic Voice Disorders and Cognitive-behaviour Therapy. London: Whurr
DSM-IV-TR, (American Psychiatric Association 2000)
Morrison MD and Rammage LA (1993) Muscle misuse voice disorders: Description and classification. Acta Otolaryngology 113, 428-34
Freud S (1962) The aetiology of hysteria. In Complete Psychological Works. London: Hogarth Press.