A case study published in May 2015 suggests a new approach for the treatment of conversion disorder, especially in children.
Conversion disorder is characterized by the psychological experience of symptoms associated with an illness or injury, despite the fact that no physical signs are present. For example, a person may experience paralysis of a body part after falling from a ladder, even though physical examinations reveal no injuries. Conversion disorder affects anywhere between 0.5 and 10 percent of the population, but is considered especially rare in children.
The case study, published in the Journal of Health Psychology, was conducted on a 5-year old girl, referred to as “H” for the purposes of anonymity. According to the research team, H suffered from frequent and random spells of falling down and losing consciousness.
The typical diagnostic process for individuals with unexplained symptoms like H’s involves physical examinations and medical testing, any in many cases, admission to the hospital. Historically, the chances of successfully identifying and treating conversion disorder are low for adults, and somewhat higher for children. The research team reported that H was subjected to all the usual diagnostic methods—including hospitalization—but brain tests showed no abnormalities or conditions.
Doctors looked into H’s history for answers and found that she and her twin brother were born prematurely (at 34 weeks). H did not begin speaking until age 3; her father abandoned the family after the birth; her mother suffered from depression, anxiety and alexithymia; and H was kept home from preschool because of her episodes. H was spending all her time with her mother, even sleeping in her bed, which may have led to unhealthy attachment. Researchers point to the mother’s mental health issues as a large factor in H’s conversion disorder.
“Due to [the mother’s] untreated depression, she had failed to provide an emotionally secure environment for her children,” said Dr. Georgios Boulas, cardiologist at Attikon University Hospital in Athens and corresponding author.
The team hypothesizes that H may have developed her condition as a way to subconsciously get a break from her mother’s suffocating behavior; to “leave the scene and inscribe a possibility of separation.”
H’s treatment was multidisciplinary and involved her entire family. First they received psychoeducation—information to help explain H’s condition and the issues that led to it. Each family member also received individual and group psychotherapy; H’s mother received medication to treat her own conditions; and the father was encouraged to establish a regular relationship with his children.
H’s symptoms stopped almost immediately. She had two episodes early on in treatment, but the team attributed them to stressful situations, including fights between family members. H was free of symptoms for four years at the time of the study.
Boulas believes the case presents strong evidence for a multidisciplinary approach to treating conversion disorder.
“A psychological and a family assessment at an early stage may be extremely helpful by providing an explanatory bio-psycho-social model for the symptoms,” Boulas said.
