Supportive psychotherapy emphasizes reassurance and education. For Miss T, that would mean reassurance that her paralysis will improve, with education about conversion disorder and how difficult life events can cause similar symptoms.
Sociocultural considerations. Cultural beliefs inhibit some people’s emotions and may predispose them to conversion symptoms.
No empirical evidence indicates that medication improves conversion disorder. Anecdotal reports cite positive response to older antipsychotics, lithium, and electroconvulsive therapy.6
Patients with conversion disorder, however, tend to develop mood and/or anxiety symptoms later, and psychotropics may help treat these comorbidities. Follow the patient while symptoms are present.7 Comorbid symptoms’ severity, response, and presentation dictate follow-up frequency.
Prognosis. Children with conversion disorder generally have good outcomes,5 particularly those with good premorbid function who are diagnosed early.7 Time from symptom onset to diagnosis ranges from weeks to 1 year, and most cases resolve within 3 months of diagnosis. Symptom recurrence is rare but may indicate emerging polysymptomatic somatization disorder.5
Treatment: Reassurance and support
Miss T responded well to supportive psychotherapy and reassurance from hospital staff. No psychiatric screening tests were done, but child psychiatrists saw Miss T several times daily, and she exhibited no other psychiatric symptoms. We have no information on follow-up treatment, which occurred outside the hospital.
Related resources
- Academy of Psychosomatic Medicine. www.apm.org
- Weiner J, Dulcan M. Textbook of child and adolescent psychiatry (3rd ed). Washington, DC: American Psychiatric Publishing, 2003.