The Impact of Early Trauma and Recent Life-Events on Symptom Severity in Patients With Conversion Disorder

Abstract

Abstract:Although the presence of psychological stress factors in the evolution of conversion symptoms forms an important criterion for the DSM-IV diagnosis of conversion disorder, little is known about the nature and timing of these stress factors. Fifty-four patients with conversion disorder and 50 control patients with an affective disorder were screened for life events experienced in the year before the symptom onset. Conversion patients did not differ from control patients in the number or severity of life events, but showed a significant relation between the recent life events and the severity of conversion symptoms. Especially life events with respect to work and relationships contributed to this effect. These results remained when controlling for the previously found effects of childhood traumatization on the severity of conversion symptoms. The findings imply that conversion symptoms may be elicited by a complex of early and later negative life events and that traditional unifactorial trauma-theories of conversion disorder should be replaced by multifactorial stress models.

Aversive stimuli exacerbate defensive motor behaviour in motor conversion disorder

“…The presentation of unpleasant images could possibly engage associations stored in long-term memory (Henke, 2010), tagging stimuli with threat-related information or personal relevance. This could result from past history of psychosocial stressors, which are thought to promote functional symptoms (Roelofs, et al, 2005), as also proposed for pathological anxiety (Rosen and Schulkin, 1998). Kanaan et al (2007) also reported increased activity in hippocampus in a single patient with functional paralysis when exposed to trauma-related narratives.…”

“…Conversion or functional symptoms are thought to be generated unconsciously, often associated with underlying psychological stressors or trauma (Scott and Anson, 2009;Vuilleumier, 2005). Psychiatric comorbidity, particularly anxiety and depressive disorders, is common (Binzer, et al, 1997;Crimlisk, et al, 1998), and negative life events predict symptom severity (Roelofs, et al, 2005); however the underlying neural mechanisms remain unclear (Vuilleumier, 2014).…”

Misverstand: de behandeling van dissociatieve stoornissen moet zich richten op het verwerken van traumatische gebeurtenissen uit het verleden

“…De invloed van factoren uit het 'hier en nu', zoals alledaagse stress of gebeurtenissen in het gezin, is pas heel recent voor het eerst in het kader van dissociatieve ervaringen bestudeerd (Roelofs, Spinhoven, Sandijck, Moene, & Hoogduin, 2005;Spinhoven et al, 2004). Dit onderzoek toonde dat bij patie¨nten met conversiestoornissen -officieel geen dissociatieve stoornis, maar als somatoforme dissociatie toch beschouwd als verwant -belangrijke invloed uitgaat van actuele stressoren.…”

“…Wij voerden zelf een onderzoek uit waarin we, in overeenstemming met de bevindingen van Roelofs et al (2005) het verband konden aantonen tussen alledaagse stress (FAD-N en APL) en dissociatieve verschijnselen (DIS-Q) .…”

Psychological traumatization and adverse life events in patients with organic and functional vestibular symptoms

“…In their comprehensive review, Roelofs and Spinhoven [52] not only found increased rates of lifetime trauma in patients with medically unexplained symptoms but also an association between trauma and symptom severity. This modulating effect of posttraumatic stress symptoms on somatic symptoms as well as overall functioning and health-related quality of life has been described for different conditions such as conversion disorder, behavioural spells and chronic pain [39,50,53].Moreover, from the vantage point of traumatization, McFarlane et al [44] found that patients suffering from posttraumatic stress disorder (PTSD) report more somatic symptoms than non-PTSD subjects. Although somatoform symptoms often appear to be unspecific and involve multiple organ systems [17], Wahlstrom et al [65] report that pseudoneurological symptoms including dizziness, mental fatigue, clumsiness and headaches are more strongly associated with exposure…”