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PubMed1999

Dissociative experiences and psychopathology in conversion disorders.

The concepts of dissociation and conversion are historically linked with the first psychodynamic ideas on hysteria. However, the abolition of "hysterical neurosis" from current nosology has led to independent developments of these theoretical models. Recent studies found a high degree of somatization in dissociative disorders. However, little is known about dissociation in conversion disorders. We assessed 72 patients with conversion disorders for their dissociative and general psychopathology using the German version of the Dissociative Experience Scale (DES) and the Symptom Check List (SCL-90-R). They were compared with a control group of 96 psychiatric patients suffering from various neurotic disorders, who were matched for gender and age. Dissociative symptoms were significantly more frequent in conversion disorder patients than in controls. There were no differences in the SCL-90-R scores between the two groups. Our findings support the theory of similar psychological processes underlying conversion and dissociative disorders despite their descriptive differences.

Adult↗
PubMed1990

Conversion disorder. Camouflage for brain lesions in two cases.

We present two cases of serious central nervous system disease initially misdiagnosed as conversion disorder. In each instance, multiple medical evaluations did not uncover the underlying neurologic disorder. Skepticism on the part of psychiatric evaluators led to eventual diagnosis. Common difficulties in the clinical application of the diagnostic criteria for conversion disorder are discussed in relation to the specific pitfalls of the two cases. We make recommendations to aid in the evaluation of suspected cases of conversion disorder.

Brain Neoplasms↗
PubMedDate not supplied

[A case of conversion disorder analyzed from a psychodynamic, psychophysiologic, and morphodynamic perspective].

This paper presents a case of conversion disorder characterized by sensory paralysis that involved the right half of the body, a motor deficit consisting of permanent contracture in flexion of fingers 2-5 of the right hand (clenched fist syndrome), and a visual alteration compatible with homonymous hemianopia and amblyopia. The patient initially presented a clinical picture of depression as well as frequent gynecological disorders. The author evaluates important aspects of the psychogenesis of the clinical picture and emphasizes the identifying aspects and primary and secondary gains. Consideration is given to the distinct therapeutic strategies used (psychotherapy, autogenous training, hypnosis), and the case is analyzed from a morphodynamic point of view. The author concludes that the organic basis of the clinical picture would be localized in the posterior nuclei of the thalamus.

Adult↗
PubMed1995

The amobarbital sodium interview in conversion disorders: use of video feedback in therapy.

The prognosis in treating acute conversion disorder is good, but it demands considerable time in the form of an intensive, and often extensive, hospital stay. With the increasing trend to limiting hospital stays, the family practitioner working with a psychiatrist in the hospital setting is pressured to find new approaches in order to limit the use of inpatient units. The authors describe a case of classic conversion disorder and outline a successful approach that uses a video recording of the interview, during which the patient is under the influence of amobarbital sodium. The videotape then provides valuable feedback during future therapy sessions in the treatment of this persistent disorder.

Adult↗
PubMed2002

[A case of monoplegia from conversion disorder after spinal anesthesia].

Neurological complications related to spinal anesthesia are exceptional, but their consequences are serious. We report a case of conversion disorder, which was initially diagnosed as monoplegia caused by spinal anesthesia. The patient was a 36-year-old, 88 kg woman with a history of psychogenic aphonia. She underwent plastic surgery for both toes under spinal anesthesia. On the following day, her left leg remained paralyzed with loss of sensation below the knee level. She practiced walking according to rehabilitation program, but paralysis became worse gradually. As the hospitalization was prolonged, she refused to be discharged from the hospital and began to demand the compensation. Her symptoms had not been correlated with the correct anatomical patterns of neurological deficit. The reflexes and muscle's tonus were normal and EMG gave normal findings. The result of neurological diagnosis, confirmed the diagnosis of conversion disorder causing her monoplegia because she was under psychic stressful circumstances from her family. Conversion disorder as a cause of monoplegia after surgery under spinal anesthesia should be kept in mind.

Adult↗
PubMed1989

Comparative studies of conversion disorders in childhood and adolescence.

In a syndrome validation study, four groups of patients suffering from conversion disorders, anxiety states, obsessive-compulsive disorder and emotional disorders, as well as a healthy control group, were compared. The following findings emerged: besides female preponderance and greater age, a higher rate of low SES subjects and social migration patients suffering from conversion disorders displayed a greater proportion of psychiatric and medical diseases in their parental heritage.

Adolescent↗
PubMed2002

Misdiagnosis of conversion disorders.

Five cases are presented describing the clinical features for which they were referred and admitted to a rehabilitation unit and later identified as having been misdiagnosed as having a conversion disorder. The diagnoses were sarcoma-induced osteomalacia, cerebellar medulloblastoma, Huntington's chorea, transverse myelitis, and lower extremity dystonia. A perceived history of psychological difficulties, an unusual neurologic presentation, and normal initial diagnostic testing in a female patient were associated with a misdiagnosis of conversion disorders; unfortunately, these factors also characterize actual conversion disorders.

Adult↗
PubMed1993

Conversion disorder revisited: severe parasomnia discovered.

In light of recently described and reviewed disorders of movement and behaviour during sleep, the long standing diagnosis of conversion disorder in a forty-nine year old Vietnam veteran was reappraised. Polysomnographic studies showed that the nocturnal component of his "pseudoseizures" was due to physical disorder, a severe mixed parasomnia comprising the recently described REM behaviour disorder and a non-REM parasomnia. His sleep architecture was also deranged, featuring reduced REM latency and increased REM density. An association between these abnormalities and psychological trauma is recognised in the literature. Treatment with clonazepam has abolished the nocturnal behavioural disturbance. His daytime pseudoseizures occur less frequently and his general well being is improved. The case is a reminder that physical disorder may underlie and act as prototype to the psychologically-driven symptom. Before attributing behavioural disturbance at night to psychological causes alone, polysomnographic studies should be done to exclude a treatable parasomnia.

Arousal↗
PubMed1988

ECT in a Patient with Conversion Disorder.

A 61-year-old man with a severe conversion disorder with paralysis of his hand and consequent disuse atrophy was successfully treated with electroconvulsive therapy (ECT) when he was threatened with the loss of his hand. The experience of ECT in patients with conversion disorder is reviewed.

Journal Article↗
PubMed2002

Frustration and fulfillment of needs in dissociative and conversion disorders.

We reviewed all patients with dissociative disorders (nine patients with dissociative amnesia or dissociative fugue) and conversion disorders (10 patients) who were admitted and treated during the past 15 years. Needs frustrated at the appearance of the symptoms and those fulfilled at discharge were studied in both groups using Maslow's hierarchy of needs. The patients of both groups who encountered troubles in their life events were found to have frustrated needs. These symptoms tended to be accompanied more often by frustrations regarding a 'need for love' in the dissociative disorders group and by frustration in the need for 'self-esteem and self-actualization' in the conversion disorders group. In addition, needs of lower orders were already threatened at onset in many patients. The symptoms disappeared in patients in whom the situation completely improved (needs were fulfilled), but the symptoms were alleviated or unchanged in those in whom the problems remained unresolved.

Adult↗
PubMed1984

The validity of broadly defined hysteria and DSM-III conversion disorder: outcome, family history, and mortality.

Patients who fail to meet criteria for Briquet's syndrome (or somatization disorder) despite a chart diagnosis of hysteria have been shown previously to resemble patients with primary depression in terms of familial psychopathology. The same patients are shown here to have excess mortality which also resembles that seen in patients with primary depression. The isolation of patients meeting DSM-III criteria for conversion disorder yielded very similar results. Outcome and mortality data clearly separated conversion disorder from Briquet's syndrome patients; family history data suggested substantial diagnostic heterogeneity. Until the validity of this diagnosis is established, the label "conversion disorder" is recommended as a descriptive alternative to the label "undiagnosed."

Adult↗
PubMedDate not supplied

Metaphor and meaning in conversion disorder: a brief active therapy.

The concept of conversion disorder as a change in somatic function that symbolically represents an unconscious conflict is currently challenged in the literature. In this article, the author elaborates on the psychodynamic concept of conversion and defines its characteristics and mode of diagnosis. The usefulness of this approach is demonstrated in a detailed case presentation of a brief, active psychodynamic psychotherapy of six sessions that led to the rapid disappearance of symptoms. In particular, the metaphoric meanings of the physical symptoms were interpreted and followed by an immediate disappearance of symptoms. The logic of this therapeutic approach and its implications as a transference cure are discussed in detail.

Aged↗
PubMed1996

Ten-year prognosis of conversion disorder.

BACKGROUND: Previous work suggests neurological disease commonly supervenes in cases of conversion disorder but has not identified clear predisposing factors. Patients' subsequent use of services has been neglected. METHOD: Clinical outcomes for 73 patients investigated for pseudoneurological symptoms at a neurological hospital 10 years earlier were compared with findings on presentation. Fifty-six patients complied with a structured interview concerning use of services. RESULTS: Thirty patients had no relief from their original symptom at follow-up. They had been older, with more chronic symptoms, and different auxiliary psychiatric diagnoses. In 11 patients a clear neurological diagnosis was subsequently made for the original symptom. Provisional neurological diagnoses at presentation had been disproportionately common among these 11. Small numbers of patients with poor outcomes made most use of hospital and community services. High attenders met screening criteria for somatisation disorder at follow-up. CONCLUSIONS: The prognosis for chronic symptoms remains poor, but subsequent rediagnosis of neurological disease is less frequent than commonly supposed. Somatisation disorder may develop if hospital contact does not lead to diagnosis of another disease.

Adaptation, Psychological↗
PubMed2001

Treating adolescent conversion disorders: are hypnotic techniques reusable?

When treating disabling conversion disorders in hospitalized adolescents, clinicians must act to restore function as rapidly as possible. After attempting to rule out physical causes for the symptoms and trying to find persuasive psychological reasons that the patient will accept and use to resolve the condition, the inpatient staff of a multidisciplinary therapeutic milieu must seek additional approaches to the care of these seriously ill individuals. This clinical forum reports the author's experience treating 2 young patients, a 12-year-old girl and a 15-year-old boy, with hypnosis. Therapists of every experience level find hypnotic techniques that work for them in a variety of patients, but are hypnotic techniques really reusable? The author reports what he learned once again.

Adolescent↗
PubMed1982

[Organic versus functional factors in the diagnosis of conversion disorders (author's transl)].

Conversion symptoms involving conspicous pseudoneurological signs of the motor system are very seldom today. To differentiate in these cases between organic and functional disturbances is highly difficult. Two patients are described. A 25 year old soldier with the symptomatology of a repetitive transverse lesion of the spinal cord and a 70 year old pensioner with a blepharospasm. They both showed an accompanying depression. Diagnostic criteria, psychodynamic models and especially the organic background of conversion symptoms are discussed.

Adult↗
PubMed1989

Visual conversion disorder: a case analysis of the influence of visual information.

We examined the influence of visual information on a decision task that was administered to an individual with monocular visual conversion disorder. Findings indicated that his performance was influenced by the visual information and by motivation instructions. The findings are discussed in terms of a model of hysterical blindness that recognizes the interplay of cognitive and motivational processes.

Adult↗
PubMed1983

The differentiation of vomiting/weight loss as a conversion disorder from anorexia nervosa.

The authors studied patients with weight loss and vomiting, distinguishing by means of objective criteria those who had what they feel is a conversion disorder from those with anorexia nervosa. The group of patients with conversion disorder were quite different from those with anorexia nervosa and could be considered as suffering from less pervasive psychological deficits. Medical and psychotherapeutic intervention must take into account the differences between these two groups for treatment to achieve maximal benefit.

Anorexia Nervosa↗