Psychogenic Respiratory Distress: A Case of Paradoxical Vocal Cord Dysfunction and Literature Review
Primary Care Companion J Clin Psychiatry 1999;1(2):39-46
© Copyright 2017 Physicians Postgraduate Press, Inc.
Background: Pulmonary disease such as asthma is
a psychosomatic disorder vulnerable to exacerbations precipitated
by psychological factors. A case is described in which a patient
thought to have treatment-refractory asthma was discovered to
have a conversion reaction, specifically paradoxical vocal cord
dysfunction (PVCD), characterized by abnormal vocal cord
adduction during inspiration.
Data Sources: Reports of PVCD were
located using a MEDLINE search and review of bibliographies.
MEDLINE (English language only) was searched from 1966 through
December 1998 using the terms functional asthma, functional
upper airway obstruction, laryngeal diseases, Munchausen's
stridor, paradoxical vocal cord dysfunction, psychogenic
stridor, respiratory stridor, vocal cord dysfunction, and vocal cord paralysis. A total of 170 cases of PVCD were
Study Findings: PVCD appears to be
significantly more common among females. PVCD spans all age
groups, including pediatric, adolescent, and adult patients. PVCD
was most often misdiagnosed as asthma or upper airway disease.
Because patients present with atypical and/or refractory
symptoms, several diagnostic tests are employed to evaluate
patients with PVCD; laryngoscopy is the most common. Direct
visualization of abnormal vocal cord movement is the most
definitive means of establishing the diagnosis of PVCD. A number
of psychiatric disturbances are related to PVCD, including
conversion and anxiety disorders. PVCD is associated with severe
psychosocial stress and difficulties with modulation of intense
Conclusions: Psychogenic respiratory distress
produced by PVCD can be easily misdiagnosed as severe or
refractory asthma or other pulmonary disease states. Recognition
of PVCD is important to avoid unnecessary medications and
invasive treatments. Primary care physicians can detect cases of
PVCD by attending to clinical symptoms, implementing appropriate
laboratory investigations, and examining the psychological
covariates of the disorder. Psychotherapy and speech therapy are
effective in treating most cases of PVCD.