In some of my research, I came across an excellent video of Dr. Rochelle Caplan from the University of California, Los Angeles. She is a child psychiatrist and was giving a talk on Conversion Disorder in children at the ADAA 2016 Conference. I think she had some excellent things to say and the way she articulated it is very helpful for those healing from Conversion Disorder and those that work with patients suffering from it.
Dr. Rochelle Caplan is Professor Emeritus of Psychiatry in the UCLA Department of Psychiatry and has directed the UCLA Pediatric Neuropsychiatry clinical program for twenty years. She completed her medical studies at the Jerusalem University Hadassah Medical School and her training in adult and child psychiatry at the Tel-Aviv University Sackler Medical School. If you would like to read a more detailed biography, check out her faculty profile.
Here are some notes that I took as I listened to the video. Please watch the video though because it puts everything in context.
What is Conversion Disorder?
- According to the DSM5, Conversion Disorder is a disorder that has medical symptoms for which there is no medical reason.
- The disorder causes significant functional disability.
- It is a rare disorder.
- There are high costs to people suffering from it including parents, friends, family and our medical system.
- It costs the medical system a great deal of money.
- Has significant impairment in the quality of life for the individual.
Symptoms Of Conversion Disorder?
- Unexplained medical symptoms.
- Neurological such as motor weakness, paralysis, psychogenic non-epileptic seizures.
- Sensory as in problems with vision and hearing.
- Respiratory symptoms such as breathing difficulties.
- Many symptoms can and often show up at one time.
- Generally multiple symptoms from many categories.
Regarded As A Psychiatric Disorder
- It is called Conversion Disorder based upon early terminology by Freud
- When a patient is faced with a conflicting situation or a stress or problem that causes negative emotions.
- These negative emotions like anger, hatred, fear, and sadness become displaced on to physical symptoms.
Recent Research on Risk Factors
- Research shows there are well defined risk factors identified.
- Anxiety and depression prior to onset of Conversion Disorder.
- Undiagnosed learning and academic issues.
- Social Problems.
- Family, parent, child relationship difficulties.
- Separation from family or parents.
- Other kinds of stresses in the family.
- Medical history where there is a high rate of family illness.
- Family history of a high rate of psychiatric disorders.
- Family history of depression and anxiety.
- Family history of conversion disorder or even epilepsy
Maladaptive Problem Solving
- Faced with stressful situations, children use maladaptive problem solving by the use of avoidance.
- Example: Child has a difficulty with learning and instead of asking for help, they don’t do their homework or projects.
- The more you avoid things, the bigger the problem gets.
- The problems do not go away.
- They become cumulative.
- Kids often try to ask parents for help but sometimes parents are critical and the kids give up on communicating they need help.
- Kids get into a predicament where there is no way out.
- This can also occur in bright children with good social skills but they have unrealistic expectations of themselves.
- Parents may have unrealistic expectations of the child in academic work, sports, or extracurricular activities.
Biggest Problem In Diagnosis
- It takes some time before the diagnosis is made.
- It is not a default diagnosis.
- There is a specific psychiatric profile.
- Conversion Disorder is more prevalent in adolescents than children.
- Conversion Disorder is found more in girls than boys.
Why So Difficult To Diagnose?
- Other than these physical symptoms, the children and parents frequently deny any other problem exists.
- Everything else outside of these symptoms is fine.
- One actually has to get through this barrier that there are no problems and everything is fine.
- There isn’t a kid that can’t complain of something, but these children deny everything.
- Their parents deny everything.
- Requires special techniques to penetrate this barrier.
Treatment Of Conversion Disorder
- Early treatment is important.
- The outcome for any type of treatment is very good for the physical symptoms.
- In over 90% of the conversion disorder patients, symptoms disappear in 12 months.
- A large percentage continue to have anxiety and depression.
- If the underlying pathology beneath the anxiety and depress is untreated, kids continue to live their lives in a very maladaptive way and problem solve through the use of their body.
- Working with psychiatric providers plus treatment of anxiety and depression is required.
- Working with parents and children in combination is extremely helpful.