Conversion disorders: Clinical presentation, assessment, psychoeducation, and intervention

Conversion disorders include nonepileptic seizures and sensory or motor dysfunction (gait disturbance, loss of strength and paralysis, speech disorders) without organic medical cause. In terms of classification, etiology and therapy, they take an intermediate position between somatoform and dissociative disorders. On the basis of high rates of psychopathological vulnerability and comorbidity, they can be triggered by traumatic experiences, acute stress factors, and challenging developmental tasks that cannot be coped with successfully. A typical constellation is an emotionally invalidating family climate that inhibits the authentic and direct expression of needs and feelings in the child. Manifestation of conversion symptomsmay, on the one hand, reduce stress experience and provide social reinforcement, but it also creates new stress factors such as functional disability, restriction of social and educational participation, health anxiety about an unrecognized underlying disease and fear of stigmatization as a malingerer or mentally ill. According to a conceptual model presented in this paper, guidelines for psychological exploration, history taking, case conceptualization, and communicating the diagnosis are provided. As part of psychoeducation, patient-oriented metaphors are used in order to enhance patient and parent understanding of how symptoms develop despite intact neurological functioning. The psychotherapeutic intervention starts with a gradual resumption of age-appropriate activities and roles. Physiotherapy is initiated which provides the patient with a ritual to allow recovery without loss of face. Psychotherapeutic strategies in the strict sense utilize the existing dissociation of consciousness from physical symptoms. Adapted to the child's developmental level, one part of the personality is conceived that wishes to overcome the symptoms while another part of personality represents the conversion symptoms and their wishes. Together with the child, the therapist develops solutions that may allow the two parts of the personality to be reintegrated again and, thus, remove the dissociation of consciousness from physical functioning.