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A review of the literature shows that presently held views on the relation between hypnosis and conversion disorders had their origin in the previous century. This also holds for therapeutic techniques as they are still applied today. A case report illustrates that successful symptom removal may be independent of the patient's hypnotizability and of the techniques used.
This paper outlines the successful psychoanalytic treatment of a latency-aged boy with severe conversion disorder. Details of clinical treatment are presented. As no tested treatment has yet been found that reliably treats chronic conversion in children, this case is of importance in demonstrating the usefulness of psychoanalysis as treatment for severe psychopathology. The patient's unconscious fantasy constellations that gave rise to this syndrome are highlighted.
In this prospective study, 30 patients with motor conversion disorder were assessed for key psychiatric and demographic variables. At reassessment 2 to 5 years later, 19 patients had completely recovered and 8 patients had improved, whereas only 3 were unchanged or worse. Contrary to other follow-up studies, none of the patients received a rediagnosis of neurological disease. The presence of a personality disorder and overall personality pathology, particularly within cluster C, the presence of a concomitant somatic disease, low DSM-IV Axis V score, and high score on the Becks Hopelessness Scale proved to be associated with poor outcome.
We describe a patient originally diagnosed with clinically definite multiple sclerosis whose actual diagnosis of conversion disorder was revealed when his examination was found to be fictitious, his radiological, electrophysiological, and biochemical tests were determined to be normal, and his symptoms were reversed through the use of sodium pentothal and hypnosis.
OBJECTIVES: To describe a new outbreak of "mass hysteria" or "epidemic conversion disorder" occurring in Barcelona in 1997. Based on this outbreak's features differentiating it from other similar outbreaks described in the literature or treated by the same team, to propose a change in the theoretical framework for these group somatomorphic phenomena. DESIGN: A study describing clinical epidemiological research and the interventions performed. SETTING: Urban health centre. Epidemiological research and data analysis performed by the Municipal Health Institute (MHI) of Barcelona. INTERVENTIONS AND MEASUREMENTS: The following were performed: a) Diagnostic screening of population. b) The usual epidemiological surveys of the MHI. c) Semi-structured interviews with the quarter's care professionals. d) Two group sessions with the quarter's health professionals. MHI experts analysed statistically the data provided by measurements b) and c). RESULTS: 276 people (42% of the population of the quarter) were studied. The attack rate was 10%. Data analysis noted that communication of the fantasy of the outbreak of scabies facilitated self-diagnosis and even diagnosis by health professionals. CONCLUSIONS: Given the frequency and the social and health implications of this kind of somatomorphic disorder, both in the developed countries and those "on the road to development", clinical researchers and epidemiologists should not wait to pose the possibility of hysteria until after the "organic" aetiology of an epidemic outbreak has been completely discounted. The second series of conclusions points towards the incorrectness of defining all these outbreaks as mass hysterical disorders. In reality, we should be thinking, more openly and in a more scientifically modern way, of epidemic somatomorphic disorders of various kinds. The outbreak described in the current study could be referred to as the hypochondriform variety of outbreak, whereas those described elsewhere by the same team could be understood as the conversion variety.
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This paper reports the result of a study conducted in a single family, in which members of three generations were affected by a conversion disorder. The phenotype and the age of onset were very similar in all the family members affected. The etiology is best understood in terms of a genetic condition and as the result of imitation and identification with an affected family member.
The ability to volitionally control motor imagery was investigated by comparing the chronometry of real and imagined movements in a patient (AB) with conversion disorder who presented with paralysis of the left arm and hand and in a patient (MM) with an actual injury to the left arm. Control experiments investigated voluntary control of motor imagery in a group of healthy individuals who feigned a motor impairment with one limb and in one group who were instructed to move carefully and slowly. The visually guided pointing task was used to investigate the speed for accuracy trade-offs that occur as target size is varied for both real and imagined performance. In the healthy individuals, the speed for accuracy trade-off for both real and imagined performance on the motor task conformed to Fitts' law provided both the speed and accuracy of movements was emphasised. In MM, real and imagined performance was also within normal limits despite considerable pain and discomfort. In AB and in subjects feigning a motor impairment, motor task performance with the affected limb was slow and did not conform to Fitts' law. However, although imagined performance with the affected limb was generally slower than with the unaffected limb, it did conform to Fitts' law. These results suggest subjects cannot anticipate the effects of an actual limb injury. Furthermore, while they are able to control the general duration of imagined movements they have little voluntary control over their relative timing.
The authors reviewed the occurrence in their emergency department of cases of serious neurologic problems initially thought to be conversion disorders or similar psychogenic conditions. Their aim is to indicate the significance of this issue for emergency physicians (EPs) because of its contribution to the incidence of medical errors. Although there are no national statistics, the authors estimate by extrapolation that thousands of such cases probably have occurred and large numbers may still occur each year in the United States, sometimes resulting in patient injury. They have identified ways of anticipating and attempting to prevent such occurrences. Proposed interventions focus on education regarding the difficulty of diagnosis, patient-based risk factors, and physician-based attitudes and thought processes. The authors also include suggestions for systemic "safety nets" that will help to ensure quality of care, such as appropriate imaging and consultation. Review of texts and journals readily accessible to EPs revealed little attention to this subject.
The main emphasis of this paper is on a critique of the idea still current in psycho-analysis as well as in psychiatry that conversion can be seen as a purely psychogenic process. This reductionist idea is responsible for some of the difficulties clinicians encounter in their work with patients with a suspected conversion disorder; it may be a consequence of a hysterical structure of this theory. A coherent theory of the psycho-somatic phenomenon of conversion has to proceed in a non-reductionist methodology comprising psychological as well as physiological levels of description and explanation. In this paper, these hypotheses are developed in three dimensions: a) concerning clinical encounters with patients with "pseudoneurological" symptoms; b) looking at the historical development of the Freudian concept of conversion between 1894 and 1916/17, and c) theoretically, including some concepts of cognitive neuroscience.
We report on the case of a 38-year-old Malay housewife diagnosed with conversion disorder. It was believed that 'evil spirits' caused her symptoms. The patient was eventually treated by the Main Puteri, a Malay shamanistic healing ceremony, after previous treatments failed. The patient improved on the third day of the performance, which was attributed to the departure of the spirits from her body. This case documents the potential benefits of indigenous psychotherapy.
The present single case study evaluated the efficacy of a cognitive-behavioral intervention for the treatment of a patient diagnosed with globus hystericus, a conversion disorder characterized by a perceived lump in the throat. The patient was a non-mentally retarded 12-year-old female who refused to swallow solids because she thought that her throat muscles would involuntarily constrict and result in choking. She lost approximately .5 lbs. per week during the 6 months prior to treatment. Improvements in weight gain were demonstrated consequent to the implementation of behavior therapy, with weight gain being particularly pronounced after contingency contracting was added to therapy. Weight gain was maintained at 1, 6, and 10 months posttreatment.
Fifty four consecutive subjects diagnosed as Hysteria (300.1 according to ICD-9), were taken up for study, to examine the usefulness and validity of Lazare's criteria and explore its clinical utility in diagnosing conversion disorders. Lazare's validation score was computed for each subject, and the specificity, sensitivity, positive predictive validity and misclassification rates were computed for different cut off scores. A cut off score of 5 on Lazare's validation criteria gave good sensitivity (75%) but only modest specificity (41%). The individual criteria showed variation in presence between 18% and 68%, and some of these such as "disturbed sexuality" and "secondary gain" were felt to require redefining. The study of patterns of previous history of organic illness, physical findings on clinical examination, lateralization of symptoms, handedness and followup status indicated important association between hysteria and organicity.
A postal request to general practitioners in a catchment area (population 37,000) identified 18 patients fulfilling criteria for conversion disorder (age range 26-74 years; mean age of onset of first episode 38 years). There was a female preponderance, with two patients from ethnic minority groups. There was a temporal correlation with stress in 13 cases (72%) and a history of sexual abuse in 5 cases (28%). Three clinical groups were identified: acute onset with good premorbid functioning and full recovery; conversion symptoms as part of polysymptomatic presentation, with fluctuating course; and chronic, severely disturbed individuals with a past history of sexual abuse. One third of cases were referred to psychiatrists. There was no case of a missed organic disorder. The details of one case are discussed.
Numerous reports have documented the usefulness of functional electric stimulation (FES) in restoring and/or improving the function of organically diseased or paralyzed muscles. There are few reports related to the use of FES in the treatment of conversion disorder paralysis of the hysterical type. This paper presents a case of hysterically paralyzed muscles where the patient received daily treatment with FES for two weeks. Electric current was applied to a weak quadriceps and to paralyzed tibialis anterior muscles. This electrotherapeutic modality was effective in improving the function of the quadriceps and in reversing the paralysis of the tibialis anterior muscles. The improvement in the muscles' functional abilities was documented through the use of quantitative measures of muscle strength as well as computerized analysis of EMG signals. The results showed that the administration of FES resulted in a dramatic increase in motor units recruitment, increased muscle strength, and improved voluntary muscle control.
OBJECTIVE: To highlight the complications of nitrous oxide abuse. CLINICAL PICTURE: A case is presented of a myeloneuropathy in a 21-year-old woman who had been abusing nitrous oxide, obtained from whipped cream bulbs, who was referred to a psychiatric hospital with a diagnosis of conversion disorder. Nitrous oxide toxicity has been reported in medical and dental professions and a few cases of myeloneuropathy due to induced vitamin B12 deficiency have been reported. This would appear to be the first reported case of myeloneuropathy resulting from nitrous oxide abuse from whipped cream propellants as a recreational drug in the community. TREATMENT: Three doses of intramuscular hydroxy cobalamin (1000 micrograms) over the course of 1 week. OUTCOME: Her neurological symptoms and anxiety settled. CONCLUSIONS: Nitrous oxide is becoming more popular as a recreational drug; its complications should be noted and a thorough neurological examination performed if abuse is suspected.
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