Polysymptomatic Conversion Disorder in Childhood and Adolescence in Japan

Abstract

Background: In conversion disorder in childhood and adolescence, polysymptomatic (PS) presentations are reportedly commoner than monosymptomatic (MS) ones. Somatization disorder is also associated with pseudoneurological symptoms, but is extremely rare in childhood. This occurs despite the age of onset peaking in the teens among adult somatization disorder patients. Method: We reviewed the records of 44 children and adolescents with pseudoneurological symptoms. They were categorized as MS cases (19) or PS cases (25), and their psychological backgrounds and clinical courses were compared. Results: PS patients had a poorer prognosis and more past psychiatric and family problems. While none met the DSM-IV criteria for somatization disorder, 2 PS patients met all but the sexual symptoms criteria. Conclusion: PS conversion disorder in childhood and adolescence may constitute a different entity from MS conversion disorder and may be an early manifestation or incomplete form of somatization disorder.

Culture and Conversion Disorder: Implications for DSM-5

“…Motor symptoms are a common complaint in most other studies (Chand et al, 2000;Deka et al, 2007;Deveci et al, 2007;Ercan et al, 2003;Kuloglu et al, 2003;Sar et al, 2004). Pure sensory disturbances are relatively less common and broadly comparable across studies, albeit with some exceptions (Murase et al, 2000;Tezcan et al, 2003).…”

“…A similar retrospective study of 921 children (9-17 yrs.) seen in a Japanese psychiatry outpatient clinic in Japan found that 4.7% had received a diagnosis of conversion disorder recorded in their notes (Murase, Sugiyama, Ishii, Wakako, & Ohta, 2000). In the absence of prospective assessment using DSM-IV-TR criteria, however, it is impossible to know whether the figures cited by Chand and colleagues (2000) and Murase and colleagues (2000) provide an accurate estimate of prevalence according to that taxonomy.…”

“…Loss of consciousness and/or PNES have been identified as the most frequent pseudoneurological problems in studies of conversion disorder patients from Turkey (76.9% of 52 adolescent patients studied by Ercan, Varan & Veznedaroğlu, 2003; 41.4% of 198 adult patients studied by Kuloglu, Atmaca, Tezcan, Gecici, & Bulut, 2003; 89.5% of 38 patients studied by Sar, Akyüz, Kundakçi, Kiziltan & Doğan, 2004;Deveci et al, 2007), India (50% of 30 child CD patients studied by Krishnakumar, Sumesh, & Mathews, 2006;Deka, Chaudhury, Bora, & Kalita, 2007) and the Sultanate of Oman (43.2% of 111 adult dissociative [conversion] disorder patients studied by Chand et al, 2000). In contrast, PNES were relatively rare in a small retrospective study of childhood conversion disorder from Japan (Murase et al, 2000), although a specific prevalence rate is not provided; in this study, visual disturbance was the most frequent symptom (38.6% of 44 cases), followed by motor paralysis (22.7%). Motor disturbances, particularly paralyses, pareses, and coordination disorders, were most common in a Dutch study (51.8% of 54 patients had motor symptoms only), whereas under a third of patients presented with PNES (Roelofs, Keijsers, Hoogduin, Näring, & Moene, 2002a).…”

“…Research on child and adolescent samples from several different countries suggest that the nature of these psychosocial stressors is quite consistent from one culture to the next, with school problems (Deka et al, 2007;Ghosh, Majumder, Pant, Dutta, & Bhatia, 2007;Krishnakumar et al, 2006;cf. Ercan et al, 2003), family problems (Ercan et al, 2003;Krishnakumar et al, 2006;Murase et al, 2000) and separation from parents (Ercan et al, 2003;Krishnakumar et al, 2006) all being identified as common stressors in more than one study; all of these studies are limited by small sample sizes, however. Murase and colleagues (2000) present data showing that family problems are more common in patients with multiple pseudoneurological symptoms than their mono-symptomatic counterparts, but the small numbers and retrospective nature of this study preclude firm conclusions about this question.…”

Estado actual de los trastornos somatomorfos y conversivos en niños y adolescentes

“…Los autores concluyen que la mayor expresión femenina podría entenderse desde un contexto sociocultural de inhibición y represión. Por otro lado, en 18,3% de los portadores de TC se identificó un estresor agudo participante 5 , en cambio, Murase et al 46 pesquisaron 32% de eventos estresantes gatillantes. En otra prospección en niños con TS, Bujoreanu et al corroboraron que la mayoría fueron mujeres, los principales motivos de consulta dolor y fenómenos conversivos (CPNE, alteraciones sensorio-motoras, mareo) y las comorbilidades, desórdenes ansiosos y afectivos.…”