Conversion disorder in childhood

Abstract

In his excellent review (September 2003 JRSM1) Professor Leary says that, in a paediatric neurology unit in the west of England, the prevalence of conversion disorder approaches 10%. In an Indian study on children and adolescents, the prevalence was 31% among inpatients and 15% among outpatients.2 This could be related to the fact that, in this culture, children with 'medical' symptoms are more readily brought for consultation than those with psychiatric symptoms alone. Moreover, conversion disorders are over-represented in the lower socio-economic groups.3 Professor Leary does not offer a reason for the higher incidence in girls than in boys. This might be related to sexual or physical abuse, a known predisposing factor.4 A common method of diagnosing conversion disorder is the resolution of symptoms in response to a placebo injection. However, this method is not advisable since it reinforces the 'medical' model for symptoms and may hamper the response to psychotherapy later. Though these children should not be extensively investigated at presentation they do need regular follow-up. In one early series, 46% of children with conversion disorder were later found to have organic explanations for their symptoms.5