eprintid: 10063336 rev_number: 16 eprint_status: archive userid: 608 dir: disk0/10/06/33/36 datestamp: 2018-12-05 11:26:31 lastmod: 2021-10-01 23:37:38 status_changed: 2018-12-05 11:26:31 type: article metadata_visibility: show creators_name: Nicholson, TR creators_name: Aybek, S creators_name: Craig, T creators_name: Harris, T creators_name: Wojcik, W creators_name: David, AS creators_name: Kanaan, RA title: Life events and escape in conversion disorder ispublished: pub divisions: UCL divisions: B02 divisions: C07 divisions: D79 keywords: Conversion disorder, functional neurological disorder, life events, stress, trauma note: This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use,distribution, and reproduction in any medium, provided the original work is properly cited. abstract: BACKGROUND: Psychological models of conversion disorder (CD) traditionally assume that psychosocial stressors are identifiable around symptom onset. In the face of limited supportive evidence such models are being challenged. METHODS: Forty-three motor CD patients, 28 depression patients and 28 healthy controls were assessed using the Life Events and Difficulties Schedule in the year before symptom onset. A novel ‘escape’ rating for events was developed to test the Freudian theory that physical symptoms of CD could provide escape from stressors, a form of ‘secondary gain’. RESULTS: CD patients had significantly more severe life events and ‘escape’ events than controls. In the month before symptom onset at least one severe event was identified in 56% of CD patients – significantly more than 21% of depression patients [odds ratio (OR) 4.63, 95% confidence interval (CI) 1.56–13.70] and healthy controls (OR 5.81, 95% CI 1.86–18.2). In the same time period 53% of CD patients had at least one ‘high escape’ event – again significantly higher than 14% in depression patients (OR 6.90, 95% CI 2.05–23.6) and 0% in healthy controls. Previous sexual abuse was more commonly reported in CD than controls, and in one third of female patients was contextually relevant to life events at symptom onset. The majority (88%) of life events of potential aetiological relevance were not identified by routine clinical assessments. Nine per cent of CD patients had no identifiable severe life events. CONCLUSIONS: Evidence was found supporting the psychological model of CD, the Freudian notion of escape and the potential aetiological relevance of childhood traumas in some patients. Uncovering stressors of potential aetiological relevance requires thorough psychosocial evaluation. date: 2016-09 date_type: published publisher: CAMBRIDGE UNIV PRESS official_url: https://doi.org/10.1017/S0033291716000714 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green article_type_text: Article verified: verified_manual elements_id: 1594984 doi: 10.1017/S0033291716000714 language_elements: English lyricists_name: David, Anthony lyricists_id: ADDAV87 actors_name: David, Anthony actors_id: ADDAV87 actors_role: owner full_text_status: public publication: Psychological Medicine volume: 46 number: 12 pagerange: 2617-2626 pages: 10 issn: 1469-8978 citation: Nicholson, TR; Aybek, S; Craig, T; Harris, T; Wojcik, W; David, AS; Kanaan, RA; (2016) Life events and escape in conversion disorder. Psychological Medicine , 46 (12) pp. 2617-2626. 10.1017/S0033291716000714 <https://doi.org/10.1017/S0033291716000714>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10063336/1/Life%20events%20and%20escape%20in%20conversion%20disorder.pdf