P-1366 - Psychopathological hand disorders: a rare somatoform reaction to psychological conflicts

Abstract

This article introduces two cases of pathological hand disorder, a rare category associated with contractures of fingers and abnormal posture of the hand. Both of these patients had history of traumatic life experiences in the past and their hand deformity could not be explained by a general medical condition. Psychopathological hand disorders including clenched fist syndrome and psychoflexed hand are somatoform conditions which represent "conversion" of emotional turmoil to physical symptoms in a symbolic manner. Prognosis seems to be poor. This fact is partly related to the interdisciplinary nature of the problem. The patient needs simultaneous psychiatric, neurologic and surgical help to reach both the proper diagnosis and management. Without considering the underlying psychological conflicts, invasive procedures are not helpful. Involvement of the key family members can be helpful for the patient to overcome the feeling of loneliness and helplessness. On the other hand, unnecessary and too much attention can be a rewarding response which keeps the situation unchanged. The patients need consistent, supportive care by their therapist to help them to get more adaptive solution for their problems. The therapist needs to know the protective role of the symptom and the patient's need to keep and maintain this posture. In some patients , the symptoms protect them from more destructive behaviors. This behavior shows the need to cope with unbearable psychological distress and to regain a sense of stability. These needs have to be addressed before any corrective intervention.