180 Chapter 21
The family
The family seems normal in most instances; only about a fifth are grossly
abnormal. They are usually convinced that the disorder is organic, wanting
further physical assessment and resisting psychiatric referral. There is often
a family history of physical or psychiatric disorder.
The context and outcome
The child or adolescent is often stuck in an intolerable predicament,
ranging from undisclosed sexual abuse to unsustainably high expectations.
The disorder may be precipitated by an adverse life event or by a minor
physical illness, although there is sometimes no clear antecedent. In 80%
of cases it is possible to identify a model for the symptoms that are enacted:
similar illnesses in the family or the wider social circle, or illnesses that the
individual has previously had. Most conversion disorders recover fully, but
a minority run a very chronic course.
Treatment
Physical investigations need to stop. An initial focus on the symptoms
rather than on possible psychological stressors may help the family engage.
This is a process that may be slow and cannot easily be hurried. A mixture
of physical rehabilitation and training in ‘mind over matter’ techniques
provides the child or adolescent with a way out with honour. The affected
individual needs to obtain greater rewards by getting better than by staying
sick. This can sometimes be done by altering the family’s behaviour, but
may sometimes need an in-patient admission. When a child or adolescent
is stuck in an intolerable predicament, this needs to be recognised and
addressed. In the longer term, the individual needs to learn more adaptive
ways of dealing with stresses.
Subject review
Husain Ket al.(2007) A review of psychological models and interventions
for medically unexplained symptoms in children.Children and Adolescents
and Adolescent Mental Health 12 ,2–7.
Sandberg S, Stevenson J. (2008) Psychiatric aspects of somatic disease.
In: Rutter Met al.(eds)Rutter’s Child and Adolescent Psychiatry,5thedn.
Wiley-Blackwell, Chichester, pp. 930–944.
Further reading
Chalder Tet al. (2003) Epidemiology of chronic fatigue syndrome and self
reported myalgic encephalomyelitis in 5–15-year-olds: cross-sectional
study.BMJ 327 , 654–655.