Conversion Disorder

Psychodynamic Theory: psychological gains (2)

1. Primary gain- CD symptoms block the person's awareness of the internal conflict 2. Secondary gain - CD symptoms excuse the person from responsibilities and help person attract sympathy and attention

Comorbid disorders

1. Anxiety, 2. Depression 3. Substance abuse

Treatments for CD (4)

1. Insight: Psychodynamic therapy to help the patient work through the conflict in the conscious mind so there is no longer a need to convert the symptoms into a physical problem 2. Suggestion: Offers emotional support, tells them as persuasively as possible from someone with authority, with or without hypnosis. 3. Reinforcement: Removal of rewards for the client's sick behavior and increases rewards for healthy behavior. 4. Confrontation: Attempts to force the patient out of the sick role by telling them their symptoms have no medical basis All but confrontation work well. Important to allow the patient to save face.

Two diagnostic issues

1. Often difficult to differentiate between true neurological disorders and conversion disorder (problem is that technology cannot always detect abnormalities; neurological nonsense when symptoms directly contradict biology) 2. Need to differentiate conversion disorder from malingering (faking a problem in order to avoid responsibility). La belle indifference: lack of concern displayed by some patients toward their physical symptoms, seen in 1/3 of cases.

Psychodynamic Theory: Freud's 3-step process

1. Person experiences unacceptable unconscious conflict 2. Person represses conflict 3. Anxiety continues to increase and threatens to emerge into conscious mind so it is converted into conscious, physical symptoms to avoid dealing directly with the conflict

Conversion disorder (definition)

Characterized by a significant alteration or loss of one or two areas of functioning that is actually an expression of a psychological conflict or need. (Formerly known as hysteria)

Symptoms (suggest neurological disease)

Possible Symptoms include: 1. Paralysis, 2. Seizures, 3. Paresthesia, 4. Anesthesia, 5. Visual problems 6. Aphonia, 7. Anosmia, 8. False pregnancy Symptoms are NOT faked, but they are not supported by the medical evidence. Could be viewed as involuntary responses.

Prevalence/Gender differences/Onset

Prevalence: >1%, Diagnosed 2x as often in women than men. Onset: late adolescence or early adult. Onset is sudden, usually at times of extreme stress.

Sociocultural Theory:

a. Decrease in prevalence in the last century b. Possible reasons for decrease? i. Increased medical sophistication ii. Increased psychological sophistication iii. More common in people from lower socioeconomic classes, undeveloped countries, rural areas, and the uneducated.

Behavioral Theory:

a. Symptoms bring the sufferer rewards (very similar to psychodynamic view of secondary gain) b. Behaviorists view the primary gain as the cause of the disorder c. Research evidence? Little support from empirical research

Cognitive Theory:

a. Symptoms may be forms of communication b. Purpose of symptoms: communicate a distressing emotion in a physical symptom that is more comfortable for the patient c. People who have difficulty expressing emotion would therefore be candidates for developing conversion disorder i. Especially true of children