Psychiatrists’ Understanding and Management of Conversion Disorder: A Bi-National Survey and Comparison with Neurologists, 2020, Dent et al

Andy

Andy

Retired committee member
Background: A 2011 survey of neurologists’ attitudes to conversion disorder found a tacit acceptance of the psychological model but significant ambivalence around its relationship to feigning. These issues are under increased scrutiny as the DSM-5 revision removed both the requirement for a psychological formulation and the exclusion of feigning from the diagnostic criteria. Whether those attitudes are shared with psychiatrists is unknown.

Methods: An online survey of the Section of Neuropsychiatry, Royal Australian and New Zealand College of Psychiatrists, and the Faculty of Neuropsychiatry, Royal College of Psychiatrists (UK), on their understanding and management of conversion disorder in February 2019. Statistical comparisons are made with our previous survey of Neurologists.

Results: A total of 52 Australian and 131 UK-based members completed the survey which revealed similarities but also clear differences from their neurological colleagues. The psychiatrists strongly endorsed a psychogenic model for conversion disorder, and the conversion model in particular, though many models were employed. They felt a psychiatric assessment was essential to the diagnosis of conversion disorder, and they often disagreed with the diagnosis in neurology referrals of putative conversion disorder. Most felt that a psychiatric formulation was supportive, and many that it was necessary to the diagnosis. They saw feigning as usually present to a degree but were more comfortable with discussing this than neurologists.

Conclusion: Psychiatrists use psychosocial models for conversion disorder and see an overlap with feigning. They believe psychiatrists are essential for the diagnostic process and would not usually support a diagnosis without a psychiatric formulation.
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Open acces, https://www.dovepress.com/psychiatr...n-disorder-peer-reviewed-fulltext-article-NDT
 
though many models were employed
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That is a clear sign of something that is incomplete. Nothing incomplete like this should be used in practice. I genuinely don't mind people pursuing this as a thought experiment for purely academic curiosity. But there is clearly no basis for this to be used in practice. Especially as it violates not only informed consent but clear expression of dissentn.

What these people think about this imaginary concept is not really important, but this ideology clearly has no basis to be used in the real world. The fact that the people who work in this area do not see a problem with that is itself an even larger problem, especially as it has accomplished exactly nothing, remains a bunch of "may be"s and "could be"s yet continues to receive undying support and infinite tolerance for failure and mediocrity.

That millions of lives should be subject to such a childish belief system is an absurdity in itself. Right there with imprisoning people based on their astrological sign, it's a catastrophic failure of professional obligations and presents a system too broken to continue to function.
 
I know a clinical psychologist who deals mostly with AIDS patients. He told me that when patients aren’t clinically depressed, yet need continued supportive therapy, he will sometimes use a diagnosis of conversion disorder to justify the extra sessions to insurance. The patients don’t actually have conversion disorder.

For him, a diagnosis of conversion disorder can be nothing more than an insurance billing code for ongoing therapy beyond the allotment of covered sessions.
 
Is there any unambiguous evidence that conversion disorders exist beyond the imagination of psychiatrists, psychologists and psychoanalysts and those patients they manage to convince? Did it grow out of the bizarre sexually repressed imaginations of nineteenth century Vienna as much of Freud’s thinking did (such a shame that such a brilliant mind that saw the profound limitations of psychological modelling responded by abandoning science for flights of literary fantasy) or does it correspond to some reality?

I find it hard to believe that such a widely used concept has no basis empirical reality, but in terms of my experience in relation to ME this does seem to be the case. Is there an original core of patients that unambiguously have a conversion disorder but the term is now grossly over used, or is it a total fabrication?
 
This wikipedia article says that conversion disorder is FND

https://en.wikipedia.org/wiki/Conversion_disorder#History

I would paraphrase or copy, but it is, frankly, too distressing.

Though maybe this bit

An evolutionary psychology explanation for conversion disorder is that the symptoms may have been evolutionarily advantageous during warfare. A non-combatant with these symptoms signals non-verbally, possibly to someone speaking a different language, that she or he is not dangerous as a combatant and also may be carrying some form of dangerous infectious disease. This can explain that conversion disorder may develop following a threatening situation, that there may be a group effect with many people simultaneously developing similar symptoms (as in mass psychogenic illness), and the gender difference in prevalence.[44]
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Mithriel said:
This wikipedia article says that conversion disorder is FND

https://en.wikipedia.org/wiki/Conversion_disorder#History

I would paraphrase or copy, but it is, frankly, too distressing.

Though maybe this bit
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Ah, yes, that makes perfect sense as an explanation for diseases that are largely known for LITERALLY BEING INVISIBLE! :banghead::banghead::banghead:

You can't see it. Doctors can't see it. Even the best tools of modern technology can't see it. But obviously during tribal warfare (and let's be clear here the vast majority of humanity lived as hunter-gatherers where warfare was not a thing in the modern sense, as there literally were no groups of people large enough to be considered anything more than a skirmish) people will see the invisible illness and... what? copy it?! ... make themselves appear vulnerable?

"Oh, that Mork looks in distress, spare him" is one very quick way to get shanked in the back by said Mork and his friends. Do these people ever hear the content of their words? Or do they simply never tire of hearing the sound of their voice no matter what nonsense it makes?
 
rvallee said:
That millions of lives should be subject to such a childish belief system is an absurdity in itself. Right there with imprisoning people based on their astrological sign, it's a catastrophic failure of professional obligations and presents a system too broken to continue to function.
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But there seems to me a meanness of spirit underpinning it. People are being harmed, but still this spectacle continues and encouraged and rewarded, like 19th century gentry gathering to hunt fox. It almost has the feel of perdition.
 
Conversion disorders. Psychosomatic illness.

It's just what doctors label patients with when they're too insecure in their medical knowledge and abilities to just say, "You're clearly ill, but I don't know what it is and don't know how to help you."

So they make it the patient's problem instead.

Life-destroying assholes. In the thousands. And thousands.

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