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J R Soc Med. 2004 February; 97(2): 98.
PMCID: PMC1079309

Conversion disorder in childhood

In his excellent review (September 2003 JRSM1) Professor Leary says that, in a paediatric neurology unit in the west of England, the prevalence of conversion disorder approaches 10%. In an Indian study on children and adolescents, the prevalence was 31% among inpatients and 15% among outpatients.2 This could be related to the fact that, in this culture, children with 'medical' symptoms are more readily brought for consultation than those with psychiatric symptoms alone. Moreover, conversion disorders are over-represented in the lower socio-economic groups.3 Professor Leary does not offer a reason for the higher incidence in girls than in boys. This might be related to sexual or physical abuse, a known predisposing factor.4

A common method of diagnosing conversion disorder is the resolution of symptoms in response to a placebo injection. However, this method is not advisable since it reinforces the 'medical' model for symptoms and may hamper the response to psychotherapy later.

Though these children should not be extensively investigated at presentation they do need regular follow-up. In one early series, 46% of children with conversion disorder were later found to have organic explanations for their symptoms.5

References

1. Leary PM. Conversion disorder in childhood—diagnosed too late, investigated too much? J R Soc Med 2003;96: 436-8 [PMC free article] [PubMed]
2. Srinath S, Bharat S, Girimaji S, Seshadri S. Characteristics of a child inpatient population with hysteria in India. J Am Acad Child Adolesc Psychiatry 1993;32: 822-5 [PubMed]
3. Steinhausen HC, von Aster M, Pfeiffer E, Gobel D. Comparative studies of conversion disorders in childhood and adolescence. J Child Psychol Psychiatry 1989;30: 615-21 [PubMed]
4. Roelofs K, Keijsers GP, Hoogduin KA, Naring GW, Moene FC. Childhood abuse in patients with conversion disorder. Am J Psychiatry 2002;159: 1908-13 [PubMed]
5. Lehmkuhl G, Blanz B, Lehmkuhl U, Braun-Scharm H. Conversion disorder (DSM-III 300.11): symptomatology and course in childhood and adolescence. Eur Arch Psychiatry Neurol Sci 1989;238: 155-60 [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press