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17th Annual Fall Conference of the International-Society-for-the-Study-of-Dissociation -- 36842 -- SAN ANTONIO, TX, WOS: 000225503500019, PubMed ID: 15569899, Objective: The aim of this study was to evaluate dissociative disorder and overall psychiatric comorbidity in patients with conversion disorder. Method: Thirty-eight consecutive patients previously diagnosed with conversion disorder were evaluated in two follow-up interviews. The Structured Clinical Interview for DSM-III-R, the Dissociation Questionnaire, the Somatoform Dissociation Questionnaire, and the Childhood Trauma Questionnaire were administered during the first follow-up interview. The Structured Clinical Interview for DSM-IV Dissociative Disorders was conducted in a separate evaluation. Results: At least one psychiatric diagnosis was found in 89.5% of the patients during the follow-up evaluation. Undifferentiated somatoform disorder, generalized anxiety disorder, dysthymic disorder, simple phobia, obsessive-compulsive disorder, major depression, and dissociative disorder not otherwise specified were the most prevalent psychiatric disorders. A dissociative disorder was seen in 47.4% of the patients. These patients had dysthymic disorder, major depression, somatization disorder, and borderline personality disorder more frequently than the remaining subjects. They also reported childhood emotional and sexual abuse, physical neglect, self-mutilative behavior, and suicide attempts more frequently. Conclusions: Comorbid dissociative disorder should alert clinicians for a more chronic and severe psychopathology among patients with conversion disorder., Int Soc Study Dissociat

Conversion disorder, one of the somatoform disorders, is characterized by 1) unexplained symptoms affecting voluntary motor or sensory function in ways that suggest neurological disease and 2) the presence of conflicts that play a significant role in initiating, exacerbating, and maintaining the disturbance (DSM-IV). Dating back to ancient times, conversion symptoms have been ascribed to many different mechanisms. The most influential theory perhaps was “wandering of the uterus,” from which were derived the term “hysteria” and the erroneous assumption that conversion symptoms are peculiar to females (1). The term “conversion” was first used by Freud and Breuer in reference to the substitution of a somatic symptom for a repressed idea (2). Freud then worked out his concept of talking therapy as a catharsis through which unconsciously repressed material might become conscious. In addition to the psychodynamic formulations, other etiologies have more recently been proposed; these include social and communication theories, behavioral theories, and proposed neurophysiologic deficits (3). As conversion disorder is relatively common, with some studies suggesting a lifetime prevalence of up to 33% (4), it is worthwhile isolating population-specific themes that may be helpful to both the treating psychiatrist and the referring physician. The patient in our clinical case, Ms. K (a pseudonym), was an African American woman who was seen by the adult psychiatry consultation-liaison service of a major teaching hospital. Ms. K was initially admitted to the neurological service suffering from dysarthric speech and other associated seemingly neurological symptoms. These symptoms proved to be the somatic expression of severe conflicting internal and external demands, many of which appeared to be rooted in her religious beliefs. In this clinical case conference, we will demonstrate the role of sociocultural influences in the development of Ms. K’s symptoms, describing some of the complex specific sociocultural issues that contribute to the pathogenesis of conversion disorder in devoutly religious African American Christian women. Sensitivity to the complex issues of religion, race, and gender is essential in formulating an effective biopsychosocial treatment plan for such a woman. The interdisciplinary approach presented here can be valuable to the physician, who may differ in religious background, race, and gender from the patient.

Objective The goal of this study was to determine current and lifetime rates of DSM-III-R disorders in patients with pseudoseizures and to ascertain whether trauma is associated with the occurrence of pseudoseizures. Methods Adult pseudoseizure patients (N = 45) were interviewed regarding seizure course and life events, and they were given the Structured Clinical Interview for DSM-III-R--Patient Version, the Structured Clinical Interview for DSM-III-R Dissociative Disorders, the Dissociative Experiences Scale, and the Personality Diagnostic Questionnaire--Revised. The pseudoseizures were diagnosed in a tertiary-care video-EEG facility. Most of the subjects (78%) were female, and the mean age of the overall patient group was 37.5 years (SD = 9.7). Results The mean duration of the subjects' seizure history was 8.3 years (SD = 8.0). Common current psychiatric diagnoses included somatoform disorders (89%), dissociative disorders (91%), affective disorders (64%), personality disorders (62%), posttraumatic stress disorder (PTSD) (49%), and other anxiety disorders (47%). The lifetime occurrence of nonseizure conversion disorders was 82%. The mean Dissociative Experiences Scale score was 20.2 (SD = 18.2). Trauma was reported by 84% of the subjects: sexual abuse by 67%, physical abuse by 67%, and other traumas by 73%. Conclusions Pseudoseizure subjects have high rates of the psychiatric disorders found in traumatized groups; they closely resemble patients with dissociative disorders. Reclassification of conversion seizures with the dissociative disorders should be considered. Pseudoseizures often appear to express distress related to abuse reports. Clinicians should screen pseudoseizure patients for adult and childhood trauma, dissociative disorders, depression, and PTSD.

The authors studied case records of 27 men who had been diagnosed as having hysterical personality, although they note that the current literature assumes that the diagnosis of hysterical personality applies predominantly to women. They believe that not recognizing the hysterical personality in men is not only a common diagnostic error but antitherapeutic and counterproductive as well.

Conversion paralysis has a poor prognosis when there is evidence of nonresponse to previous treatment, long duration, and secondary atrophy of the "paralyzed" muscles. The authors present four such cases in which conversion paralysis was treated successfully by means of electromyographic (EMG) biofeedback. Each of the four patients also suffered from a chronic pain condition. Results from statistical analyses indicated that the four patients demonstrated significant improvement in the functional capacity of the "paralyzed" muscles as measured by isometric maximum voluntary contraction and EMG activity. The improvements occurred without explicit psychotherapy and suggest that behavioral modification techniques alone may be helpful in such cases.

The coexistence of epileptic and hysterical seizures in the same patient is not rare and creates problems in diagnosis and management. The authors used simultaneous video-EEG monitoring to document the diagnosis of hysterical seizures in 9 epileptic patients; clear-cut hysterical seizures were seen in all 9. The authors used individualized re-educative psychotherapy to teach patients alternative coping techniques and discharged them on minimum dosages of anticonvulsants. None of the patients had a classical hysterical personality, which suggests that conversion reaction is a more appropriate diagnosis, The etiology of "hysterical" seizures varies; the authors emphasize individualized treatment and long-term follow-up.

The authors studied the records of 84 patients who had idiopathic torsion dystonia. Thirty-seven cases had originally been misdiagnosed as primarily psychiatric illness. Only 1 patient presented with dystonic movements that were clearly part of a more general psychiatric disorder. The authors believe her to be the first reported patient whose dystonia is undeniably of psychogenic origin.

The authors describe a case of Briquet's syndrome in a man and discuss the relationship of that condition to personality features. They view Briquet's syndrome as a set of behaviors arising from personality traits and suggest that examination of the genesis and treatment of the condition be shifted to a characterological approach.

To clarify the interrelationships of conversion symptoms, hysterical personality, sexual adjustment, and cerebral organic disorders the authors studied 89 patients with classic motor conversion symptoms (group L) and compared a subgroup of 24 of these patients (group H) with 24 matched control patients (group C). They found hysterical personality in 19% of group L, 21% of group H, and none of group C and passive-immature-dependent personality in 19% of group L, 21% of group H, and none of group C. Forty-eight percent of group L, 50% of group H, and 58% of group C had some cerebral disorder. Patients with conversion symptoms who also had hysterical and passive-immature-dependent personalities were especially likely to have sexual abnormalities.

The clinical and social characteristics of criminals with conversion symptoms are noted and compared to those of other criminals. The possible association between hysteria and sociopathic personality is considered briefly.

1. This paper is part of a larger research project guided by the following questions: What is the nature of psychiatric symptoms in adolescent patients? How do the symptoms in this group compare with those of a non-patient group? What happens to the symptoms of both groups as they pass through a substantial part of their adolescence? 2. The method consists of a 5-year study of 101 adolescent outpatients and a matched control group of 101 non-patients. 3. This paper presents the results of the initial evaluation of the patient group as follows: i) Five syndromes have been defined that represent 84 of the 101 patients as follows: thinking disorder—16, psychoneurosis—38, acting-out—17, depression—7, and hysterical personality disorder—6. ii) The clinical and dynamic relationships of the 5 syndromes are presented. For example, acting-out showed more prevalence in boys, 15 or under, had an early age of onset, a long duration, and an impaired relationship with mother. iii) For several syndromes this information...

Forty-seven patients suffering from personality disorders manifested through somatic symptoms or behavioral crises were treated by short-term hospitalization on a ward reserved primarily for acute psychotic disorders. The patients had been refractory to previous treatment approaches. The average hospitalization lasted 16 days and consisted of a highly structured program designed to restore the patient to social functioning and to provide a setting and a vocabulary for converting somatic and behavioral expression into verbal expression. Family members were involved in the treatment. In most of the cases there was a complete loss of presenting symptoms and disturbance at the time of discharge. A follow-up study 18-30 months after discharge revealed that the gains persisted in 2/3 of the group evaluated. The results are attributed to specific social, psychological, and educational processes requiring a particular kind of ward structure and staff attitude for successful results.

The authors present a study of 56 student naval aviators who developed conversion reactions during training. Clinical information and results obtained from a questionnaire, MMPI, and psychiatric interview are described.

Electroencephalography was performed in 92 military and selective service convulsive and non-convulsive problems. Of 20 subjects with a history of convulsion during military service observed by other than medical personnel, the EEG was abnormal in 10 (50%), doubtful in 2 (10%) and normal in 8 (40%). Of 41 subjects with a self-claimed history of rare convulsions months to years ago, the EEG was abnormal in 18 (43.9%), doubtful in 1 (2.4%) and normal in 22 (53.4%). Of 9 subjects with a history of "fainting attack" in the military service, the EEG was abnormal in 5 (55.6%) and normal in 4 (44.4%) Of 12 subjects with episodes of faintness with retention of consciousness, the EEG was abnormal in 1 (8.3%), doubtful in 1 (8.3%) and normal in 10 (83.4%). Of 10 subjects considered malingerers with vague "nervousness" or vague fainting spells, the EEG was abnormal in none, doubtful in 1 (10%) and normal in 9 (90%). From this study it was concluded that the electroencephalogram was of assisting value in the neuropsy...

1. The galvanic skin response (GSR) elicited by pin prick and light touch was tested in seven patients with organic (traumatic) interruption of the peripheral sensory pathway; in one patient with complete (traumatic) transsection of the spinal cord and in seven patients with hysterical anesthesias. 2. A new method, of recording the GSR with the Grass electroencephalograph, as suggested by Luther Mays, is described and used. 3. In patients with organic anesthesias due to complete peripheral nerve and complete cord lesions no GSR could be obtained on stimulation of the anesthetic zone by pin prick and light touch. 4. In all hysterical patients the GSR elicited by stimulation of the anesthetic zone by pin prick and light touch was normal. 5. Thus the described test offers an objective method of differential diagnosis between organic and functional anesthesias. 6. The results of this investigation support the thesis that functional anesthesia is a result of inattention to the sensory input from the anesthetic...

The hypnotized subject still retains some power to defend himself. The explanation of many of the hysteroid aspects of hypnotic behavior is found in terms of ego defense. The hypnotized subject tends to act in a way which he believes a hypnotized person does act. This tendency may be further elaborated into a purposeful hysteric defense.

A case of hysterical monocular anaurosis in a young woman is reported. The present illness, past history, and course in the hospital is presented. There is a discussion of possible psychodynamics underlying the symptomatology.

A patient with conversion reaction who demonstrated typical symptoms for this illness (la belle indifference, spells of aphonia, paralysis, anesthesia and many other unexplained symptoms) is presented. This case illustrates that successful suicide in a patient with conversion reaction, although rare, does occur. This case also suggests two dangers in the management of conversion reaction patients. The first danger is that the physician may be so impressed with the multiple hysterical symptoms that he may not pay enough attention to depressive symptoms and underlying depression. The second danger is that these patients may intend to make only a suicide gesture and in so doing commit unintentional but successful suicide as may have occurred in the above case.