Attitudes on Mind Over Matter: Physician Views on the Role of Placebo in Psychogenic Disorders

Abstract

Psychogenic movement disorders (PMD) mimic known movement disorders, yet cannot be attributed to an underlying neurological substrate. PMD has been reported to affect up to 15–25% of patients who visit specialized movement disorder clinics. The lack of mechanistic understanding of this disorder contributes to the hesitation of physicians to give a diagnosis of PMD, and patients often experience inordinate health care costs and multiple referrals between psychiatrists and neurologists who have differing views on the diagnosis and terminology of PMD. Given that the prognosis for PMD is poor, that the success of standard treatment for PMD is highly dependent on the patient's belief in the diagnosis and treatment regimen, and that case studies suggest the efficacy of placebo for PMD, placebo therapy has recently been advocated for PMD. Recent surveys report a high percentage of physicians administering placebo therapy. Therefore, perhaps the ethical question in PMD should be, “Are we harming patients by withholding placebo treatment?” In order to determine whether placebo therapy would be a viable option for PMD, we must first rigorously assess the factors contributing to the medical contexts in which placebos are offered. We conducted in-depth interviews with neurologists and psychiatrists to assess the attitudes that contribute to ethical norms and to assess physician attitudes and practices surrounding placebo therapy to psychogenic patients. These data will serve to inform the future treatment of patients with PMD, to make recommendations for clinician training and healthcare policy, and to reframe and deepen our discussion of the value of placebo therapies.