Clinical characteristics of patients with motor disability due to conversion disorder: a prospective control group study

Abstract

Objectives-Previous studies have suggested associations between conversion and many diVerent clinical characteristics. This study investigates these findings in a prospective design including a control group. Methods-Thirty consecutive patients with a recent onset of motor disability due to a conversion disorder were compared with a control group of patients with corresponding motor symptoms due to a definite organic lesion. Both groups had a similar duration of symptoms and a comparable age and sex profile and were assessed on a prospective basis. Background information about previous somatic and psychiatric disease was collected and all patients were assessed by means of a structured clinical interview linked to the diagnostic system DSM III-R, the Hamilton rating depression scale, and a special life events inventory. Results-The conversion group had a higher degree of psychopathology with 33% of the patients fulfilling the criteria for psychiatric syndromes according to DSM-III-R axis I, whereas 50% had axis II personality disorders compared with 10% and 17% respectively in the control group. Conversion patients also had significantly higher scores according to the Hamilton rating depression scale. Although patients with known neurological disease were not included in the conversion group, a concomitant somatic disorder was found in 33% of the patients and 50% complained of benign pain. The educational background in conversion patients was poor with only 13% having dropped out of high school compared with 67% in the control group. Self reported global assessment of functioning according to the axis V on DSM IV was significantly lower in conversion patients, who also registered significantly more negative life events before the onset of symptoms than controls. Logistic regression analysis showed that low education, presence of a personality disorder, and high Hamilton depression score were significantly associated with conversion disorder. Conclusion-The importance of several previously reported predisposing and precipitating factors in conversion disorder is confirmed. The results support the notion that conversion should be treated as a symptom rather than a diagnosis and that eVorts should be made in diagnosing and treating possible underlying somatic and psychiatric conditions.

Cognitive Behavioral Therapy for Somatoform Disorders

“…Nevertheless, there is some evidence that conversion disorder is more common among women (Deveci et al, 2007;Faravelli et al, 1997), non-whites (Stefansson, et al, 1979), and individuals from lower socioeconomic classes (Folks, Ford, & Regan, 1984;Stefansson, et al, 1979). Co-morbid psychiatric distress in patients with pseudo-neurological symptoms is high; it has been estimated that 30% to 90% of patients seeking treatment for pseudo-neurological symptoms also meet criteria for at least one other psychiatric disorder, typically somatoform disorders, affective disorders, anxiety disorders, or personality disorders (Binzer, Andersen, & Kullgren, 1997;Crimlisk et al, 1998;Mokleby, Akyuz, Kundakel, Kizitlan & Dogan, 2002;Sar et al, 2004). A co-morbid personality disorder diagnosis has been found to indicate poor prognosis of conversion disorder (Mace & Trimble, 1996).…”

Aversive stimuli exacerbate defensive motor behaviour in motor conversion disorder

“…Conversion or functional symptoms are thought to be generated unconsciously, often associated with underlying psychological stressors or trauma (Scott and Anson, 2009;Vuilleumier, 2005). Psychiatric comorbidity, particularly anxiety and depressive disorders, is common (Binzer, et al, 1997;Crimlisk, et al, 1998), and negative life events predict symptom severity (Roelofs, et al, 2005); however the underlying neural mechanisms remain unclear (Vuilleumier, 2014).…”

The clinical epidemiology of hysteria: vanishingly rare, or just vanishing?

“…One was based on case register data in two countries (Stefa ' nsson et al 1976) and another on general practice surveys (Watts et al 1964). Incidence rates can also be deduced from the reports of two neurological practices (Stevens, 1989 ;Binzer et al 1997) and a psychiatric one (Karasu et al 1977). In spite of the variety of methods used, these studies yield rather similar incidence rates, with only one substantially outside the range 5-12 per 100 000 per annum.…”