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Life events and escape in conversion disorder

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. Green open access

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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.

Type: Article
Title: Life events and escape in conversion disorder
Open access status: An open access version is available from UCL Discovery
DOI: 10.1017/S0033291716000714
Publisher version: https://doi.org/10.1017/S0033291716000714
Language: English
Additional information: 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.
Keywords: Conversion disorder, functional neurological disorder, life events, stress, trauma
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10063336
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