CLINICAL CHARACTERISTICS OF PATIENTS WITH MOTOR DISABILITY DUE TO CONVERSION DISORDER - A PROSPECTIVE CONTROL-GROUP STUDY

Objectives-Previous studies have suggested associations between conver sion and many different clinical characteristics. This study investiga tes these findings in a prospective design including a control group. Methods-Thirty consecutive patients with a recent onset of motor disab ility due to a conversion disorder were compared with a control group of patients with corresponding motor symptoms due to a definite organi c lesion. Both groups had a similar duration of symptoms and a compara ble age and sex profile and were assessed on a prospective basis. Back ground information about previous somatic and psychiatric disease was collected and all patients were assessed by means of a structured clin ical interview linked to the diagnostic system DSM III-R, the Hamilton rating depression scale, and a special life events inventory. Results -The conversion group had a higher degree of psychopathology with 33% of the patients fulfilling the criteria for psychiatric syndromes acco rding to DSIM-III-R axis I, whereas 50% had axis II personality disord ers compared with 10% and 17% respectively in the control group. Conve rsion patients also had significantly higher scores according to the H amilton rating depression scale. Although patients with known neurolog ical disease were not included in the conversion group, a concomitant somatic disorder was found in 33% of the patients and 50% complained o f benign pain. The educational background in conversion patients was p oor with only 13% having dropped out of high school compared with 67% in the control group. Self reported global assessment of functioning a ccording to the axis V on DSM IV was significantly lower in conversion patients, who also registered significantly more negative life events before the onset of symptoms than controls. Logistic regression analy sis showed that low education, presence of a personality disorder, and high Hamilton depression score were significantly associated with con version disorder. Conclusion-The importance of several previously repo rted predisposing and precipitating factors in conversion disorder is confirmed. The results support the notion that conversion should be tr eated as a symptom rather than a diagnosis and that efforts should be made in diagnosing and treating possible underlying somatic and psychi atric conditions.