Best practices for addressing conversion disorder in youth MAIN MESSAGES OVERVIEW

EVIDENCE IN-BRIEF
December 2011
Best practices for addressing conversion disorder in youth
MAIN MESSAGES
OVERVIEW
• Conversion reactions represent a
somatic defense against threats to
mental stability and can be
attributed to an underlying mood
disorder such as depression.
There is no proven treatment for
conversion disorder.
Conversion disorder is when an individual experiences an alteration or
loss of physical functioning that suggests a neurological or physical
condition, but the condition cannot be identified. Symptoms are not
feigned or deliberately produced; rather, they reflect the conversion of
underlying emotional distress into physical symptoms. The disorder is
likely caused by a psychological stressor or conflict.
• Research shows that cognitive
behavioural therapy appears to be
the treatment of choice for
somatoform disorders such as
conversion disorder. Data on
cognitive behavioral therapy for
conversion disorder is limited to
one small study that reported
some benefit.
• Although some research
recommends a multidisciplinary
approach to treatment, including
pharmacotherapy, psychotherapy,
physiotherapy and social worker
intervention, evidence on the
effectiveness of this approach is
lacking.
Conversion reactions represent a somatic defense against threats to
mental stability and can often be attributed to an underlying mood
disorder such as depression or anxiety. Currently, there are no strategies
with a strong evidence-base for treatment of conversion disorder.
RESEARCH RESULTS
While there is some literature on conversion disorder and more broadly
on general somatoform disorders, there is little specific to the condition
in children and youth. The research is predominantly limited to mental
health and neurology literatures, although the physiotherapy and
physical rehabilitation literature also look at conversion disorder through
the viewpoint of multi-disciplinary intervention.
FINDINGS
Research shows that there is strong evidence for the use of cognitivebehavioural therapy (CBT) in the treatment of somatoform disorders.
However, the studies that pertain specifically to conversion disorder are
very small and look only at treatments other than CBT, specifically
hypnosis and paradoxical intention.
Evidence In-Sight is a free service that responds to practice-related questions from Ontario child and youth mental health agencies. Evidence-In-Brief summarizes
those answers to provide a snapshot of available knowledge on a particular topic. The information is not exhaustive, and is intended to support – rather than
direct – evidence-informed decision making. The Ontario Centre of Excellence for Child and Youth Mental Health is pleased to offer these products as part of our
continuum of practical tools and resources designed to help agencies use evidence to strengthen care.
Addressing conversion disorder continued
Studies show that therapeutic alliance might be an important factor in therapy for conversion disorder
involving a physiotherapy component. Guidelines for working with clients include maintaining open
communication, establishing concrete measures of progress and reinforcement through positive feedback.
To date, CBT for conversion disorder has been studied only in a small pilot study and results were promising
but need further support. Preliminary findings suggest that antidepressant medication, behavioral therapy,
paradoxical intention and transcranial magnetic stimulation may be effective. Further study is needed to
confirm these results.
OTHER TREATMENT CONSIDERATIONS
While the first-line treatment strategy is psychosocial, physiotherapy can play a role in facilitating recovery
from the conversion symptoms while the underlying mental health issue is addressed. A thorough neurological
assessment is required to confirm that patients have a somatoform disorder and not an organic medical issue.
Family therapy is often necessary, as families invest heavily and devote considerable time and resources to
helping clients deal with their neurological or physical disabilities. The family has to come to terms with the
diagnosis that the disability is caused by a mental illness, and may need guidance in accepting that diagnosis
and supporting their family member through the recovery process.
To request the complete Evidence In-Sight report on best practices for addressing conversion disorder in
youth, please contact Valerie Repta. See the full list of Evidence In-Sight reports available on our website.
SUGGESTED KEYWORDS
conversion disorder in children; conversion disorder in youth; psychological disorders; conversion
hysteria; somatization disorder; somatoform conversion disorder
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