Conversion disorder is largely managed by neurologists, for whom it presents
great challenges to understanding and management. This study aimed to
quantify these challenges, examining how neurologists understand conversion
disorder, and what they tell their patients.
A postal survey of all consultant neurologists in the UK registered with the
Association of British Neurologists.
349 of 591 practising consultant neurologists completed the survey. They saw
conversion disorder commonly. While they endorsed psychological models for
conversion, they diagnosed it according to features of the clinical
presentation, most importantly inconsistency and abnormal illness behaviour.
Most of the respondents saw feigning as entangled with conversion disorder,
with a minority seeing one as a variant of the other. They were quite
willing to discuss psychological factors as long as the patient was
receptive but were generally unwilling to discuss feigning even though they
saw it as their responsibility. Those who favoured models in terms of
feigning were older, while younger, female neurologists preferred
psychological models, believed conversion would one day be understood
neurologically and found communicating with their conversion patients easier
than it had been in the past.
Neurologists accept psychological models for conversion disorder but do not
employ them in their diagnosis; they do not see conversion as clearly
different from feigning. This may be changing as younger, female
neurologists endorse psychological views more clearly and find it easier to
discuss with their patients.