EVIDENCE IN-BRIEF December 2011 Best practices for addressing conversion disorder in youth MAIN MESSAGES OVERVIEW • Conversion reactions represent a somatic defense against threats to mental stability and can be attributed to an underlying mood disorder such as depression. There is no proven treatment for conversion disorder. Conversion disorder is when an individual experiences an alteration or loss of physical functioning that suggests a neurological or physical condition, but the condition cannot be identified. Symptoms are not feigned or deliberately produced; rather, they reflect the conversion of underlying emotional distress into physical symptoms. The disorder is likely caused by a psychological stressor or conflict. • Research shows that cognitive behavioural therapy appears to be the treatment of choice for somatoform disorders such as conversion disorder. Data on cognitive behavioral therapy for conversion disorder is limited to one small study that reported some benefit. • Although some research recommends a multidisciplinary approach to treatment, including pharmacotherapy, psychotherapy, physiotherapy and social worker intervention, evidence on the effectiveness of this approach is lacking. Conversion reactions represent a somatic defense against threats to mental stability and can often be attributed to an underlying mood disorder such as depression or anxiety. Currently, there are no strategies with a strong evidence-base for treatment of conversion disorder. RESEARCH RESULTS While there is some literature on conversion disorder and more broadly on general somatoform disorders, there is little specific to the condition in children and youth. The research is predominantly limited to mental health and neurology literatures, although the physiotherapy and physical rehabilitation literature also look at conversion disorder through the viewpoint of multi-disciplinary intervention. FINDINGS Research shows that there is strong evidence for the use of cognitivebehavioural therapy (CBT) in the treatment of somatoform disorders. However, the studies that pertain specifically to conversion disorder are very small and look only at treatments other than CBT, specifically hypnosis and paradoxical intention. Evidence In-Sight is a free service that responds to practice-related questions from Ontario child and youth mental health agencies. Evidence-In-Brief summarizes those answers to provide a snapshot of available knowledge on a particular topic. The information is not exhaustive, and is intended to support – rather than direct – evidence-informed decision making. The Ontario Centre of Excellence for Child and Youth Mental Health is pleased to offer these products as part of our continuum of practical tools and resources designed to help agencies use evidence to strengthen care. Addressing conversion disorder continued Studies show that therapeutic alliance might be an important factor in therapy for conversion disorder involving a physiotherapy component. Guidelines for working with clients include maintaining open communication, establishing concrete measures of progress and reinforcement through positive feedback. To date, CBT for conversion disorder has been studied only in a small pilot study and results were promising but need further support. Preliminary findings suggest that antidepressant medication, behavioral therapy, paradoxical intention and transcranial magnetic stimulation may be effective. Further study is needed to confirm these results. OTHER TREATMENT CONSIDERATIONS While the first-line treatment strategy is psychosocial, physiotherapy can play a role in facilitating recovery from the conversion symptoms while the underlying mental health issue is addressed. A thorough neurological assessment is required to confirm that patients have a somatoform disorder and not an organic medical issue. Family therapy is often necessary, as families invest heavily and devote considerable time and resources to helping clients deal with their neurological or physical disabilities. The family has to come to terms with the diagnosis that the disability is caused by a mental illness, and may need guidance in accepting that diagnosis and supporting their family member through the recovery process. To request the complete Evidence In-Sight report on best practices for addressing conversion disorder in youth, please contact Valerie Repta. See the full list of Evidence In-Sight reports available on our website. SUGGESTED KEYWORDS conversion disorder in children; conversion disorder in youth; psychological disorders; conversion hysteria; somatization disorder; somatoform conversion disorder