Self-protective organization in children with conversion and somatoform disorders

被引:33
作者
Kozlowska, Kasia [1 ,2 ,3 ]
Williams, Leanne M. [2 ,3 ,4 ]
机构
[1] Childrens Hosp Westmead, Westmead, NSW 2145, Australia
[2] Univ Sydney, Sydney, NSW 2006, Australia
[3] Westmead Hosp, Brain Dynam Ctr, Westmead, NSW 2145, Australia
[4] Westmead Hosp, Westmead Millennium Inst, Westmead, NSW 2145, Australia
关键词
Conversion disorder; Somatoform disorder; Dissociative disorder; Dynamic-Maturational model of attachment; DMM; Emotional processing; PSYCHOGENIC URINARY RETENTION; CHRONIC PAIN PATIENTS; EVOKED-POTENTIALS; SENSORY LOSS; STRESS; ATTACHMENT; SYMPTOMS; CORTEX; BRAIN; FMRI;
D O I
10.1016/j.jpsychores.2009.03.016
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Objective: Two centuries of clinical observations have suggested that conversion symptoms are associated with strong emotions or situations that threaten the individual's physical or psychological integrity. This study tested the hypothesis that childhood conversion reactions reflect the motor-sensory components of two distinct emotional responses (one inhibitory, one excitatory) that develop as adaptations to recurring threats within intimate relationships. Method: Emotional responses to interpersonal threats were assessed in 28 children with conversion disorders using Dynamic-Maturational-Model (DMM) assessments of attachment. Attachment strategies (the inhibitory, Type A; the balanced, Type B; and the excitatory, Type C) provide information about (1) the child's behavioural (motor-sensory) organization in the face of interpersonal threats, and (2) the information processing that underpins this behavioural organization. Results: Twelve children (43%) used an inhibitory attachment strategy. Twelve (43%) used an excitatory attachment strategy. A smaller group (14%) alternated between inhibitory and excitatory strategies, their conversion symptoms reflecting the latter. Discussion: These data suggest that conversion reactions are not a single clinical entity and reflect the motor-sensory components of two distinct human emotional responses to threat. This distinction may help to account for the broad range of conversion symptoms seen in clinical practice, both those that involve loss of function and can be explained by a central inhibition hypothesis and those that involve positive symptoms and secondary gain. Crown Copyright (C) 2009 Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:223 / 233
页数:11
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