Somatoform and Conversion Disorders
James C. Harris
Somatic symptoms often are associated with anxiety and depressive disorders, and somatic symptoms must be considered as associated with these diagnoses. For example, abdominal pain may accompany separation anxiety and be used as a reason to stay home with the parent. Children with generalized anxiety disorder may be preoccupied with medical illnesses or may present with headache or similar complaints. After bereavement, general pain complaints may be noted, and children with social phobia may feign illness to avoid social interaction. Children with mood disorders may be preoccupied with sickness and death. However, when severe somatic symptoms are the primary presentation the term somatoform disorder is used.
Somatization refers to seeking medical attention for somatic distress and symptoms where no demonstrable pathophysiology is present to account for them. Somatoform disorder refers to severe somatic symptoms that are not based on known psychopathology and that require intervention. The following categories are included: somatization disorder (multiple somatic
complaints), conversion disorder (motor or sensory symptoms suggesting a neurologic disorder), pain disorder (pain linked to psychological symptoms), hypochondriasis (excessive preoccupation with being ill), and body dysmorphic disorder (preoccupation with an imaged defect in physical appearance). This chapter focuses on the most commonly encountered of these, conversion disorder. Conversion disorder may present with or without an accompanying general medical condition.
complaints), conversion disorder (motor or sensory symptoms suggesting a neurologic disorder), pain disorder (pain linked to psychological symptoms), hypochondriasis (excessive preoccupation with being ill), and body dysmorphic disorder (preoccupation with an imaged defect in physical appearance). This chapter focuses on the most commonly encountered of these, conversion disorder. Conversion disorder may present with or without an accompanying general medical condition.
Conversion disorder should be considered when no clear-cut medical reason exists for voluntary motor or sensory symptoms that suggest a neurologic disorder or other general medical condition.
EPIDEMIOLOGY
The diagnostic criteria for conversion disorders are shown in Box 106.1. The prevalence of conversion disorders depends on the clinical setting. Conversion symptoms are reported most often on the general pediatric service, the ophthalmology service, and the neurology service. Child psychiatrists have reported a prevalence of 1% to 3% in referred outpatients. Among new outpatients at a pediatric neurology clinic, the prevalence was about 10% in school-aged referrals. Overall prevalence estimates range from 2% to 10%; the higher number is from a pediatric psychiatry inpatient consultation service. Rates are reported to be higher in children from rural poor populations than in urban children. Conversion disorder most commonly is diagnosed in children and adolescents aged 10 to 15 years. The prevalence tends to be equal for boys and girls in the prepubertal years, but a greater prevalence in girls exists in early adolescence. Symptoms frequently date from a minor illness or surgery. Many children with conversion symptoms have transient symptoms and can be treated as outpatients.
BOX 106.1 Diagnostic Criteria for Conversion Disorder
One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurologic or other general medical condition.
Psychological factors are judged to be associated with the symptom deficit, because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors.
The symptom or deficit is not produced intentionally or feigned (as in factitious disorder of malingering).
The symptom or deficit cannot, after appropriate investigation, be fully explained by a general medical condition, or by the direct effects of a substance, or as a culturally sanctioned behavior or experience.
The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
