Self-protective organization in children with conversion and somatoform disorders.
OBJECTIVE
Two centuries of clinical observations have suggested that conversion symptoms are associated with strong emotions or situations that threaten the individual's physical or psychological integrity. This study tested the hypothesis that childhood conversion reactions reflect the motor-sensory components of two distinct emotional responses (one inhibitory, one excitatory) that develop as adaptations to recurring threats within intimate relationships.


METHODS
Emotional responses to interpersonal threats were assessed in 28 children with conversion disorders using Dynamic-Maturational-Model (DMM) assessments of attachment. Attachment strategies (the inhibitory, Type A; the balanced, Type B; and the excitatory, Type C) provide information about (1) the child's behavioural (motor-sensory) organization in the face of interpersonal threats, and (2) the information processing that underpins this behavioural organization.


RESULTS
Twelve children (43%) used an inhibitory attachment strategy. Twelve (43%) used an excitatory attachment strategy. A smaller group (14%) alternated between inhibitory and excitatory strategies, their conversion symptoms reflecting the latter.


CONCLUSIONS
These data suggest that conversion reactions are not a single clinical entity and reflect the motor-sensory components of two distinct human emotional responses to threat. This distinction may help to account for the broad range of conversion symptoms seen in clinical practice, both those that involve loss of function and can be explained by a central inhibition hypothesis and those that involve positive symptoms and secondary gain.
Kozlowska
Kasia
K
Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia. kasiak@chw.edu.au
Williams
Leanne M
LM
D000223:Adaptation, Psychological; D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D015897:Comorbidity; D003291:Conversion Disorder / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation; D003674:Defense Mechanisms; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D003937:Diagnosis, Differential; D004213:Dissociative Disorders / Q000175:diagnosis / Q000523:psychology; D004644:Emotions; D005260:Female; D006801:Humans; D008016:Life Change Events; D008257:Machiavellianism; D008297:Male; D010348:Patient Care Team; D010552:Personality Assessment / Q000706:statistics & numerical data; D011594:Psychometrics; D019962:Reactive Attachment Disorder / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation; D012307:Risk Factors; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation