Treatment

Most patients with conversion symptoms are managed by general practitioners and do not come for psychiatric treatment. Symptoms may be minor, short lived, or self-limiting. Those who come for psychiatric treatment may be managed in several ways, of which the first is an exploration of problems and their discussion with the patient. Common-sense, exploratory, and supportive management should be combined with attention to any social circumstances that may be contributing to or promoting the symptom.

It is important to detect any accompanying illness, including depression and organic disorder, and some patients improve with treatment of those aspects alone. Brief psychotherapy may be helpful, but intensive psychodynamic psychotherapy is unlikely to be useful. A 'double-bind' approach in which the patients are misled to some extent has recently been described.(6 63) Patients are told that their symptoms may originally have been organic but persist because of a maladaptive response to the original problem. If the original symptoms were indeed organic, the maladaptive response will be removable by treatment. If they were not organic, the maladaptive response is so ingrained that it will be incurable. This approach has been reported to be therapeutically powerful in some intractable cases.

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