Abstract
BackgroundA 2011 survey of neurologists’ attitudes to conversion disorder found a tacit acceptance of the psychological model but significant ambivalence around its relationship to feigning. These issues are under increased scrutiny as the DSM-5 revision removed both the requirement for a psychological formulation and the exclusion of feigning from the diagnostic criteria. Whether those attitudes are shared with psychiatrists is unknown.MethodsAn online survey of the Section of Neuropsychiatry, Royal Australian and New Zealand College of Psychiatrists, and the Faculty of Neuropsychiatry, Royal College of Psychiatrists (UK), on their understanding and management of conversion disorder in February 2019. Statistical comparisons are made with our previous survey of Neurologists.ResultsA total of 52 Australian and 131 UK-based members completed the survey which revealed similarities but also clear differences from their neurological colleagues. The psychiatrists strongly endorsed a psychogenic model for conversion disorder, and the conversion model in particular, though many models were employed. They felt a psychiatric assessment was essential to the diagnosis of conversion disorder, and they often disagreed with the diagnosis in neurology referrals of putative conversion disorder. Most felt that a psychiatric formulation was supportive, and many that it was necessary to the diagnosis. They saw feigning as usually present to a degree but were more comfortable with discussing this than neurologists.ConclusionPsychiatrists use psychosocial models for conversion disorder and see an overlap with feigning. They believe psychiatrists are essential for the diagnostic process and would not usually support a diagnosis without a psychiatric formulation.
Highlights
Conversion disorder has long been a controversial disorder for clinicians.[1]
We conducted a survey of neurologists on their attitudes to understanding and managing the disorder,[5] which confirmed these impressions: though they accepted psychological models, they were uncomfortable in applying them, and there was considerable overlap with their concept of feigning
Emails were sent to the 476 members of the RANZCP Section and 4361 members of the RCPSYCH Faculty of Neuropsychiatry
Summary
A 2011 survey of neurologists’ attitudes to conversion disorder found a tacit acceptance of the psychological model but significant ambivalence around its relationship to feigning These issues are under increased scrutiny as the DSM-5 revision removed both the requirement for a psychological formulation and the exclusion of feigning from the diag nostic criteria. The psychiatrists strongly endorsed a psychogenic model for conversion disorder, and the con version model in particular, though many models were employed They felt a psychiatric assessment was essential to the diagnosis of conversion disorder, and they often disagreed with the diagnosis in neurology referrals of putative conversion disorder. Conclusion: Psychiatrists use psychosocial models for conversion disorder and see an overlap with feigning They believe psychiatrists are essential for the diagnostic process and would not usually support a diagnosis without a psychiatric formulation.
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