Conversion Symptoms Research Articles

La dissociation dans le DSM-5 : votre opinion S’Il Vous Plaît, Docteur Janet ?

IntroductionDSM-5 introduced a chapter on trauma- and stressor-related disorders, and modified the chapter on the dissociative disorders. ObjectiveTo review these modifications in the light of the concepts of dissociation as a division of the personality and of hysteria. MethodTo imagine how Pierre Janet might have reacted to the involved formulations in reference to his clinical and theoretical expertise and recent research findings. ResultsThere is some progress in DSM-5's conceptualization of dissociation and dissociative disorders, but much work remains to be done. DSM-5's conceptualization of dissociation is in part inconsistent and contradictory. For example, the system's conceptualization of dissociation sometimes delimits dissociation to negative symptoms, but at other places it (also) includes positive symptoms. Whereas at some places DSM-5's conceptualization involves a division of the personality, at other places the idea seems to be that dissociation can occur in the absence of such a division. Sensorimotor dissociative symptoms and disorders are basically and confusingly addressed as conversion symptoms and disorders. ConclusionDSM-5's concept of dissociation lacks clarity, consistency and specificity, hence is in need of major revision. Delimiting the concept of dissociation to a division of the personality that manifests in negative and positive cognitive-emotional and sensorimotor symptoms opens the prospect of introducing a spectrum of more and less complex trauma-related dissociative disorders in DSM-6.

Symptoms Frequencies and Stressors in the Hysterical Subjects

Hysteria is one of the oldest words, derived from Greek word meaning wondering of uterus in the body. Hysterical neurosis was eliminated from DSM-III, and its subsequent editions (DSM-IIIR, DSM-IV, and DSM-IVTR), and its replacement by "dissociation disorders" and "conversion disorders. This study was done to identify frequency of hysterical symptoms and the preceding stressors.52patients was diagnosed according to DSM-IVTR, diagnostic criteria, between July and December2007. Then all patients were assessed with a semi structured interview, using seven items, about, age, sex, marital status, educational level, occupation, stressors and residential status.81% of the patients were females while 19% were males. The most frequent presentation was with conversion symptoms in 75% of the cases. Loss of consciousness was the most frequent symptom (25%), followed by paralysis (21%). 86% of patients had a history of stressors; while 14% deny any history of stressors. Most patients had a low educational level and they were from rural areas. Hysterical patients were presenting with one or more symptoms affecting voluntary motor or sensory function, this emphasizes the need for awareness among other specialties ofthese symptoms. Stressors are present in a large proportion of these patients and identification of these stressors is important for their management.

顔面・両上肢の異常運動および失歩, 失声を呈したヒステリー児の1例

顔面・両上肢の異常運動および失歩, 失声を呈したヒステリー児の1例

転換症状と解離症状における男女差について : ロールシャッハ・テストを中心に

転換症状と解離症状における男女差について : ロールシャッハ・テストを中心に

The relationship between the First World War and neurology: 100 years of "Shell Shock".

The First World War was a global war, beginning on 28 July 1914, until 11 November 1918. Soon after the beginning of the war, there was an "epidemic" of neurological conversion symptoms. Soldiers on both sides started to present in large numbers with neurological symptoms, such as dizziness, tremor, paraplegia, tinnitus, amnesia, weakness, headache and mutism of psychosomatic origin. This condition was known as shell shock, or "war neurosis". Because medically unexplained symptoms remain a major challenge, and considering the close relationship of symptoms described in shell shock with clinical neurology, we should study their history in order to improve future care.

Conversion Disorder, Functional Neurological Symptom Disorder, and Chronic Pain: Comorbidity, Assessment, and Treatment.

This paper examines the overlap of conversion disorder with chronic pain conditions, describes ways to assess for conversion disorder, and provides an overview of evidence-based treatments for conversion disorder and chronic pain, with a focus on conversion symptoms. Conversion disorder is a significant problem that warrants further study, given that there are not many well-established guidelines. Accurate and timely assessment should help move treatment in a more fruitful direction and avoid unnecessary medical interventions. Advances in neuroimaging may also help further our understanding of conversion disorder. Creating a supportive environment and a collaborative treatment relationship and improving understanding of conversion symptoms appear to help individuals diagnosed with conversion disorder engage in appropriate treatments. Novel uses of earlier treatments, such as hypnosis and psychodynamic approaches, could potentially be beneficial and require a more vigorous and systematic study. There are treatments that produce significant improvements in functioning and reduction of physical symptoms from conversion disorder even for very severe cases. Hypnotherapy, cognitive behavioral therapy, and inpatient multidisciplinary treatment with intensive physiotherapy for severe cases have the most evidence to support reduction of symptoms. Components of treatment for conversion disorder overlap with treatments for chronic pain and can be used together to produce therapeutic effects for both conditions. Treatment needs to be tailored for each individual's specific symptoms.

Incidence of dissociative stupor and possession in a private psychiatry clinic

IntroductionDissociative and conversion disorders are reported to have a present incidence of about 85–100per 1000 by different studies, which are very few. The present research is a part of a longitudinal study of 15 years but here; only 3 years are represented, which could be briefly analyzed.ObjectiveLatest reports suggest a decline in incidence of hysteria (conversion and dissociation) and this research just tries to reconfirm.MethodsAll new patients attending a private psychiatry OPD in a small township of India at Lakhimpur Kheri in Uttar Pradesh, were screened to identify cases of dissociative disorder according to ICD 10, F44.2 and F44.3 from the 1st of January 2016 to 31st of October 2016 (10 months). These screened cases, only those presenting with fits of unconsciousness and possession, were analyzed and compared with the previous years for the same period.ResultsOut of a total of 3671 patients seen, (2122 males and 1549 females) a total of 319 presented with the above mentioned symptoms (58 males and 261 females) about 87 per 1000 of psychiatric patients.ConclusionThe results, when compared with two previous years for the same period were quite similar, 2015 getting incidence of 97 per 1000 and 2014, an incidence of 89 per 1000. The inference thus is that there does not seem to be any decline of incidence and the figure would be much higher if both conversion and dissociative symptoms are included – a really serious situation.Disclosure of InterestThe authors have not supplied their declaration of competing interest.

A systematic report review of Ganser syndrome: 118 years of case studies

IntroductionGanser syndrome was first described by a German psychiatrist Ganser in 1898, in a patient who showed a peculiar twilight state. Ganser syndrome is defined as the presence of approximate answers, somatic conversion symptoms, clouding of consciousness, and pseudo-hallucinations. The etiology of this disease remains a subject of debate. While the DSM-IV-TR classifies Ganser syndrome under the heading of dissociative disorder, it is not listed as a diagnosis in the DSM-V.Objectives and aimsThe purpose of this paper is to review available literature on Ganser syndrome, published in Dutch, English, German, and French for examining the etiological debate, in order to gain insight into the etiology of this disorder.MethodsThe study design was a retrospective case series of all published cases since 1898. For this purpose we used the electronic databases PubMed and Embase.ResultsOver a period of 118 years, we found 79 papers, describing 117 case reports on Ganser syndrome. It generally occurs in patients who are exposed to somatic disorders or to psychological stress, however, often in absence of a psychiatric disorder.ConclusionsGanser syndrome remains a controversial disorder in terms of its etiology. Ganser syndrome has been associated with organic disorders, as well as with stressful and intolerable life events. Based on this report, it is noteworthy that this syndrome predominantly occurs in the absence of co-morbid psychiatric disorders and is often associated with stress factors and underlying somatic diseases.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Dissociation and conversion symptoms in dermatology

Dissociation and conversion (defined as the somatic component of dissociation) can play an important mediating role in the exacerbation of the stress-reactive dermatoses (eg, psoriasis, idiopathic urticaria, atopic dermatitis), dermatoses that are exacerbated by excessive scratching (eg, lichen simplex chronicus, prurigo nodularis) and koebnerization, and the self-induced dermatoses (dermatitis artefacta, acne excoriée, skin picking disorder, trichotillomania, onychotillomania/onychophagia). Dissociative symptoms often coexist with obsessive-compulsive symptoms in the more severe cases of the self-induced dermatoses.Dissociation can play an important role in cutaneous sensory disorder (eg, scalp dysesthesia syndrome, stomatodynia/glossodynia, vulvodynia/scrotodynia, medically unexplained anesthesia). Dissociation typically occurs in the context of extreme psychosocial stress and a history of severe abuse/neglect during early life. Dissociative patients may experience a sense of detachment from their body and present in a state of extreme self-neglect, including denial of serious skin disorders. Amnesia is one of the core symptoms of dissociation; therefore, patients, who self-induce their skin lesions during a dissociative episode often deny self-inducing their lesions; it is important to recognize that this is distinct from malingering, and the lesions are not intentionally induced. Dissociation and conversion symptoms are typically present in the complex dermatology patient and should be assessed using a comprehensive biopsychosocial approach.

Psychological characteristics of dissociation in general population

Dissociation is defined as the separation of those processes that should be accessible, considering that both somatoform and conversion symptoms may be understood as dissociative. In recent decades, psychological variables have been related to dissociation, such as suggestibility, fantasy, alexithymia, abnormal emotional processes, and also a particular personality profile. The aim of this paper is to study the profile associated with psychoform and somatoform dissociation. The sample consisted of 355 participants. University students employed the snowball sampling. The following instruments were used: the Dissociative Experiences Scale-II (DES-II), the Questionnaire Somatoform Dissociation (SDQ-20), the Inventory Suggestibility (IS), the Alexithymia Scale Toronto (TAS-20), the Scale Difficulties in Emotion Regulation (DERS), the revised NEO Personality Inventory (NEO-PI), and some ad hoc questions to evaluate sleep-related experiences. The results indicated that high dissociators showed higher scores on suggestibility, alexithymia, sleep- related experiences, neuroticism, openness to experience, and lower conscientiousness than low dissociators, the results being similar to those obtained by high somatizers. As a conclusion, the profile found in both types of dissociation indicated their existing relationship, and pointed out possible lines of future research and treatment.

Seizure as a conversion symptom, a case report

IntroductionPatients with conversive disorder could show atypical clinical presentations with neurological symptoms that are not frequently seen currently.Case ReportA 21-year-old female who was diagnosed of conversive disorder was admitted into a short-stay psychiatric unit for two weeks to introduce treatment and receiving a diagnosis. She presented few seconds long seizures in members without bitting her tongue and keeping control of sphincters, always surrounded by relatives. A neurological study was made with CT scan and electroencephalography and no evidences of neurological abnormalities were found. Various treatments were used but seizures went worse. Venlafaxine (150 mg/day) was prescribed after hipothymc reactive symptoms were observed, which together with pshycotherapy achieved clinical improvement in the two months follow-up.DiscussionPatients with conversive disorder don’t respond appropriately to pharmacologic treatment. In order for patients to understand the situation it is important to keep themupdated in an empathic manner. It is important to exclude other causes.ConclusionsA detailed psychopathological exploration should be made in all conversive patients, to explore symptoms and comorbidities that could reveal new therapeutic treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Conversion disorder in adolescents: A review and case report

IntroductionConversion disorder (CD) is an uncommon but highly disabling condition. Affected children and adolescents are often severely impaired and at risk of serious long-term physical and psychosocial complications. Despite the enormous personal suffering and health resource implications of CD, little research has been done.ObjectivesTo update our knowledge about CD in adolescents, with a comprehensive review of the literature with special focus in prevalence, psychosocial factors, diagnosis, treatment and outcome.AimsTo present the most relevant data of our review with a clinical illustration that provides a practical vision of this disorder.MethodsA systematic literature review was performed in MEDLINE, with particular interest in papers published in the last 10 years. Clinical illustration is provided by a case selected from an outpatient child and adolescent mental health service.ResultsFew reliable prevalence data are available; the range goes from 0.2 in a German study to 31% in non-western clinical settings. Diagnosis is based on a constellation of features and treatment should involve several heath care professionals. CD has a favourable outcome in children and adolescents. However, mood and/or anxiety disorders are encountered at a considerable rate even after recovery from conversion symptoms. Long clinical follow-up seems appropriate.ConclusionsThe expression of emotional distress in the form of physical complaints is common in children. Nevertheless, the most severe presentation of physical symptoms is not a common topic in literature. More research should be done to improve our understanding of this disabling disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Evidências de validade da Escala de Experiências Dissociativas em amostra não clínica

Validity evidence of the Dissociative Experiences Scale in a nonclinical sample The aim of this paper is to present the psychometric properties, factor structure and evidence of convergent validity of the Brazilian version of the Dissociative Experiences Scale (DES) in a non-clinical sample. The study included 1,450 respondents (67.9% male), 18 and older (M=29.32; SD=11.27), from several Brazilian states, who joined an online survey about the role of dissociative experiences in religious practices and their relation to sociodemographic and psychopathological variables. The exploratory factor analysis indicated that the best solution would be tri-factorial. The factors were named as absorption, depersonalization/derealization and amnesia. The Brazilian DES denoted satisfactory internal consistency. The DES also correlated positively with expected variables, as measures of somatization and conversion symptoms, and reports of religious experiences. Participants with a score greater than or equal to 30 in the DES presented significantly higher scores in emotional abuse, physical abuse and sexual abuse.

Ganser syndrome: Review and case report

IntroductionFirst described by Sigbert Ganser in 1987, Ganser syndrome consists in a rare condition, characterized by the following four clinical features: approximate answers, dulling of consciousness, conversion symptoms and hallucinations.ObjectivesTo present a case suggestive of Ganser Syndrome and to review the literature with particular regard to the aetiology of this condition.MethodsLiterature review, using computerized databases (MEDLINE®, Medscape®). Articles were selected based on the content of their abstract and their relevance.ResultsA 58-year-old woman was admitted to a Psychiatric Unit of a General Hospital for presenting behavioural abnormalities of acute onset. During hospitalization, the patient displayed indifference, incoherent speech with approximate answers, motor abnormalities and auditory psedudohallucinations. The patient was evaluated by a neurologist and various exams were performed (blood tests, CT, MRI, EEG) that showed no significant abnormalities. Pharmacological treatment consisted of antidepressant and antipsychotic medications. During the follow-up, there was a slow but gradual improvement of symptoms. Six months after hospitalization the patient decide to end up the follow-up.ConclusionsLittle is still known about Ganser Syndrome. The four aetiological perspectives consider: hysterical origin, malingering or factitious disorder, psychotic origin and organic origin. The lack of reports and information about Ganser syndrome made it worthwhile reporting this case.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Le trouble de conversion en médecine interne : 37 observations

ObjectivesTo describe the clinical characteristics of a series of patients presenting conversion disorder in a general internal medicine ward and outpatient clinic, the arguments retained by the physicians in favour of the diagnosis, the somatic and psychiatric co-morbidities, the management and the outcome of the disorder. MethodsWe report the study of 37 patients diagnosed with conversion disorder in an internal medicine department of a French university hospital over a period of 14 years. We retrospectively reviewed the charts of the patients and contacted their primary care physicians to obtain follow-up data. No structured instrument was used for the diagnosis of conversion disorder or for the assessment of psychiatric comorbidities. ResultsAs expected, patients were mostly young females, although a great variety of age, gender, and socio-cultural background was observed. Motor symptoms predominated (62%). A relevant psychogenic factor was explicitly mentioned in only 43% of the cases. In many cases, organic disease was also present, and an organic cause for the symptom initially considered as conversion was suspected in 3 cases. Depressive and anxious disorders were present respectively in 38% and 35% of cases. A pain complaint was associated in half of the cases. Among patients for whom follow-up data is available, conversion symptoms persisted or recurred in 70% of cases and were associated with a poor quality of life. ConclusionThis case series confirms that the DSM-IV-TR criterion of “psychogenicity” (later abandoned in DSM-5) is highly problematic in clinical practice. It suggests a close relationship between conversion disorder and unexplained chronic pain.

Relationships among depression, anxiety, anxiety sensitivity, and perceived social support in adolescents with conversion disorder

Objective: This study aimed to assess the relationships of depression, anxiety, anxiety sensitivity, and perceived social support with conversion symptoms in adolescents with conversion disorder (CD). Methods: Fifty outpatients, aged 8–18 years, who had been diagnosed with CD and members of a control group were assessed using the psychological questionnaires. Results: Compared with controls, adolescents with CD scored higher on the Child Depression Inventory (CDI), Screen for Child Anxiety-related Emotional Disorders (SCARED), Childhood Anxiety Sensitivity Index (CASI) total, CASI physical and cognitive subscales, and Multidimensional Scale of Perceived Social Support family subscale. Multiple regression analysis showed that CDI, CASI total, and CASI cognitive scores predicted the Somatoform Dissociation Questionnaire (SDQ) scores and that CDI and CASI total scores predicted the Children's Somatization Inventory (CSI) scores of subjects. Conclusions: This study suggest that adolescents with CD had poor psychosocial well-being, and depression, global anxiety sensitivity and anxiety sensitivity cognitive concerns are related to conversion symptoms.

Delusional Disorder in a Patient with Corpus Callosum Agenesis

Agenesis of corpus callosum is rare and associated neuropsychiatric abnormalities reported are epilepsy, Asperger's syndrome, learning problems, depression, schizophrenia, conduct disorder and conversion symptoms. Schizophrenia is the most common psychiatric disorder reported among corpus callosum agenesis. We report a rare case of delusional disorder with corpus callosum agenesis and seizure disorder. The patient presented with delusions of persecution towards younger brother and mother, disturbed sleep and reduced appetite. She had a history of seizure disorder of ten years duration, which was controlled with carbamazepine and levetiracetam. Neurological examination was normal. On MRI, corpus callosum agenesis was detected. She was put on an atypical antipsychotic quetiapine to which her psychiatric symptoms responded completely.

Conversion Disorders and Dissociative Disorders - Together They are Strong!

The diagnosis of conversion disorder (CD) requires one or more symptoms of altered voluntary motor or sensory function; clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions, and the symptom or deficit is not better explained by another medical or mental disorder. Both patients with conversion disorder and dissociative disorder (DD) frequently have psychiatric comorbidities. Conversive symptoms are observed in non-Western societies frequently. Childhood traumas and abuse are often seen both dissociative disorders and conversion disorder. It could be expected that these disorders might be seen much more in Western socities because of immigration linked different reasons.

Chapter 13 - Stress, childhood trauma, and cognitive functions in functional neurologic disorders

Conversion disorder (CD) has traditionally been ascribed to psychologic factors such as trauma, stress, or emotional conflict. Although reference to the psychologic origin of CD has been removed from the criteria list in DSM-5, many theories still incorporate CD as originating from adverse events. This chapter provides a critical review of the literature on stressful life events in CD and discusses current cognitive and neurobiologic models linking psychologic stressors with conversion symptomatology. In addition, we propose a neurobiologic stress model integrating those cognitive models with neuroendocrine stress research and propose that stress and stress-induced changes in hypothalamus-pituitary-adrenal (HPA) axis function may result in cognitive alterations, that in turn contribute to experiencing conversion symptoms. Experimental studies indeed suggest that basal as well as stress-induced changes in HPA axis responding lead to alterations in attentional processing in CD. Although those changes are stronger in traumatized patients, similar patterns have been observed in patients who do not report a history of traumatic events. We conclude that, whereas adverse events may play an important role in many cases of CD, a substantial proportion of patients do not report a history of traumatization or recent stressful events. Studies integrating effects of stress on cognitive functioning in CD are scarce. We propose that, instead of focusing research on defining etiologic events in terms of symptom-eliciting events, future research should work towards an integrated mechanistic account, assessing alterations in cognitive and biologic stress systems in an integrated manner in patients with CD. Such an account may not only serve early symptom detection, it might also provide a starting point for better-targeted interventions.

Excitatory and inhibitory conversive experiences: neurobiological features involving positive and negative conversion symptoms.

Previous reviews have focused on neurobiological and physiological mechanisms underlying conversion disorder, but they do not usually distinguish between negative and positive conversion symptoms. Some authors have proposed that different phenomena should underlie both situations and that diverse emotion regulation strategies (under- vs. overregulation of affect) should be related to different internal experiences (excitatory experiences with hyperarousal manifestations vs. inhibitory experiences coexisting with hypoarousal states, respectively). After a careful review of the literature, we conclude that there is not a unique theory comprising all findings. Nevertheless, we have also collected some replicated findings that should be salient. Patients manifesting positive conversion symptoms tended to present with limbic hyperfunction, not sufficiently counteracted by prefrontal control. This leads to underregulation of affect mechanisms, increased emotional reactivity and autonomic hyperarousal. The opposite pattern (with a prefrontal overfunction working as a cognitive brake over the limbic system) has been described during negative conversion manifestations. We also highlight the influence of fronto-limbic circuits over cortico-striato-thalamo-cortical circuits' regulation, whose horizontal and vertical synchronization has been at the spotlight of the genesis of conversion and dissociative disorders.