title: An update in thinking about nonorganic voice disorders.
abstract: OBJECTIVE
  To describe and evaluate psychosocial factors in nonorganic voice disorders (NVDs). Nonorganic voice disorders are presumed to be the result of increased muscular tension that is caused to varying extents by vocal misuse and emotional stress. It is therefore necessary to include both of these in the diagnosis and treatment of patients with voice disorders.
  
  
  METHODS
  Clinical survey.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  To evaluate psychosocial factors in NVDs, a sample of 74 patients with NVDs was examined psychologically using the Giessen Test and Picture Frustration Test. The results were compared with a control group of 19 patients with an organic dysphonia (vocal cord paralysis).
  
  
  METHODS
  Six scales of the Giessen Test (social response, dominance, control, underlying mood, permeability, and social potency), 3 reaction types of the Picture Frustration Test (obstacle dominance, ego defense, and need persistence), and 3 aggression categories of the Picture Frustration Test (extrapunitivity, intropunitivity, and impunitivity).
  
  
  RESULTS
  The most striking significant difference between the 2 groups was that in conflict situations, patients with NVDs sought a quick solution or expected other people to provide one, which prevented them from understanding the underlying causes of the conflict.
  
  
  CONCLUSIONS
  Only if the psychosocial aspects are taken into account can patients with NVD be offered a therapy that treats the causes of the voice disorder. It must be decided individually whether and when a voice training approach or a more psychological-psychotherapeutical approach is preferable.
authors.affiliation: Division of Phoniatrics, Ear, Nose, and Throat Clinic, Head and Neck Surgery, Inselspital, University of Berne, Berne, Switzerland. eberhard.seifert@insel.ch
authors.forename: Eberhard
authors.initials: E
authors.lastname: Seifert
authors.forename: Juerg
authors.initials: J
authors.lastname: Kollbrunner
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011581:Psychological Tests; D011602:Psychophysiologic Disorders / Q000503:physiopathology; D014832:Voice Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy