Download Conversion Disorders Among out Patients

Conversion Disorders Among out Patients
Attending Altigani Almahi Psychiatric Hospital
During (2003-2008).
SUDAN
A Thesis submitted to the University of Khartoum for Partial
fulfillment of M.A in clinical psychology
Submitted by:
Salha Mhadi Alhassan Ahmad
B.Sc. in Psychology and Pre-School Education Ahfad
University1986
Diploma in Clinical Psychology Khartoum University 2003
Supervisor: Dr. Abdelbagi Dafa Allah Ahmed
Department of Psychology - Faculty of Arts
October (2009)
Dedication
I dedicate this work to:
My Dear Mother:
Syda
My daughters
Dr.Rehab – Ferdos – Sara –Suzan and youngest sweet shemaa
My Dear husband:
Dr. Magrabi
Finally:
I would like to dedicate this work to all people who suffer the
stigma of mental (health) in Sudan.
I
Acknowledgement
First , thanks are due to Allah for help and support , There after
I would like to express my deep gratitude to ,my supervisor Dr
Abdel bagi Dafa Allh Ahmed for his inspiring advices and calm full
support ,
My thanks extended to all those who helped me in deferent
ways, particularly:
Dr. Abeer Abdu Alrhman who teach me how to think critically
and give me the technique to conduct research,
my teachers were definitely my real back support.
ƒ Dr. Rugaia Elsyed Eltaib..
ƒ Dr. Amal Ata Elseed
ƒ Dr Suliman Ali Ahmed
ƒ Dr . Yousif Safi Eldeen.
ƒ Dr. shams Eldeen.
ƒ Dr. Salah Haroon.
ƒ Dr Abd Allh Abd Alrhman
Special thanks to Altigani Almahi psychiatric hospital
members. Finally I would like to thanks Khartoum University –
Faculty of Art , Department of Psychology for giving me this
greatest chance to be a member of this department as a student of
post graduate studies – and thanks to all my teachers in all semesters
First and finally thanks to God.
II
Abstract
Salha Mhadi Alhassan Ahmad
Conversion disorder Among outpatient Attending Altigani
Almahi psychiatric hospital during (2003-2008)
This study tries to investigate the relationship between
conversion disorders and age ,gender , educational level ,socioeconomic status and marital status of outpatient attending
the
Altigani Almahi psychiatric hospital located in Omdurman
(Khartoum state ) .
The research is retrospective , the sample size include all
records of outpatient diagnosed as conversion disorders patient of
total of (100) subjects during (2003-2008) their ages range between
(11-55) years , the data was manipulated by the computer applying
the statistical package for social sciences (spss) using chi-square
tests .
The result of the study show no significant correlation between
age , marital status, educational level , gender and symptoms of
conversion disorder .
The result of the study show that there is significant positive
correlation between socio-economic status and symptoms of
conversion disorder .
The important recommendation of this research is to higher the
socio-economic status of the population to decrease the incidence of
conversion disorders symptoms by decreasing the predisposing
factors .
III
‫ﻣﺴﺘﺨﻠﺺ اﻟﺪراﺳﺔ‬
‫ﺻﺎﻟﺤﺔ ﻣﻬﺪي اﻟﺤﺴﻦ أﺣﻤﺪ‬
‫اﻹﺿﺮاﺑﺎت اﻟﺘﺤﻮﻟﻴﺔ وﺳﻂ اﻟﻤﺮﺿﻰ اﻟﻤﺘﺮددﻳﻦ ﻋﻠﻰ اﻟﻌﻴﺎدة اﻟﺨﺎرﺟﻴﺔ ﺑﻤﺴﺘﺸﻔﻰ‬
‫اﻟﺘﺠﺎﻧﻲ اﻟﻤﺎﺣﻲ ﺑﺈﻣﺪرﻣﺎن )وﻻﻳﺔ اﻟﺨﺮﻃﻮم( ﻓﻲ اﻟﻔﺘﺮة ﻣﺎ ﺑﻴﻦ )‪(2008-2003‬‬
‫هﺪف هﺬا اﻟﺒﺤﺚ ﻟﺪراﺳﺔ اﻟﻌﻼﻗﺔ ﺑﻴﻦ أﻋﺮاض اﻻﺿﻄﺮاب اﻟﺘﺤﻮﻟﻲ وآﻞ ﻣﻦ‬
‫اﻟﻨﻮع‪،‬اﻟﻌﻤﺮ ‪،‬اﻟﺤﺎﻟﺔ اﻻﺟﺘﻤﺎﻋﻴﺔ و اﻟﻤﺴﺘﻮى اﻻﻗﺘﺼﺎدي ‪ ،‬وﺳﻂ ﻣﺮﺿﻰ اﻻﺿﻄﺮاب‬
‫اﻟﺘﺤﻮﻟﻲ اﻟﻤﺘﺮددﻳﻦ ﻋﻠﻰ اﻟﻌﻴﺎدات اﻟﺨﺎرﺟﻴﺔ ﻟﻤﺴﺘﺸﻔﻰ اﻟﻄﺐ اﻟﻨﻔﺴﻲ ﺑﺄم درﻣﺎن ﻓﻲ‬
‫اﻟﻔﺘﺮة ﻣﻦ ﻣﺎﻳﻮ ‪ 2003‬وﺣﺘﻰ دﻳﺴﻤﺒﺮ ‪. 2008‬‬
‫اﺳﺘﺨﺪﻣﺖ‬
‫اﻟﺒﺎﺣﺜﺔ اﻟﻤﻨﻬﺞ اﻟﻮﺻﻔﻲ واﺷﺘﻤﻠﺖ ﻋﻴﻨﺔ اﻟﺪراﺳﺔ آﻞ اﻟﺴﺠﻼت اﻟﺘﻲ‬
‫ﺷﺨﺼﺖ أﻓﺮادهﺎ ﺑﺄﻧﻬﻢ ﻣﺼﺎﺑﻮن ﺑﺎﻻﺿﻄﺮاب اﻟﺘﺤﻮﻟﻲ واﻟﺬﻳﻦ ﺑﻠﻐﺖ ﺟﻤﻠﺘﻬﻢ ‪100‬‬
‫ﻣﺮﻳﺾ‪ ،‬ﺗﺮاوﺣﺖ أﻋﻤﺎرهﻢ ﻣﺎ ﺑﻴﻦ )‪ (55-11‬ﻋﺎﻣﺎ ‪ .‬ﺗﻤﺖ ﻣﻌﺎﻟﺠﺔ اﻟﺒﻴﺎﻧﺎت ﺑﺎﺳﺘﺨﺪام‬
‫اﻟﺤﺰﻣﺔ اﻹﺣﺼﺎﺋﻴﺔ ﻟﻠﻌﻠﻮم اﻻﺟﺘﻤﺎﻋﻴﺔ ‪ ،‬وذﻟﻚ ﺑﺎﺳﺘﺨﺪام اﺧﺘﺒﺎر ﻣﺮﺑﻊ آﺎي ‪ .‬وﻗﺪ‬
‫ﺗﻮﺻﻠﺖ اﻟﺪراﺳﺔ ﻟﻤﺠﻤﻮﻋﺔ ﻣﻦ اﻟﻨﺘﺎﺋﺞ اﻟﻤﻬﻤﺔ ﻣﻦ أﺑﺮزهﺎ ﺗﻮﺟﺪ ﻋﻼﻗﺔ داﻟﺔ إﺣﺼﺎﺋﻴﺔ‬
‫ﺑﻴﻦ اﻟﻤﺴﺘﻮى اﻻﻗﺘﺼﺎدي وإﻋﺮاض اﻻﺿﻄﺮاب اﻟﺘﺤﻮﻟﻲ وﺳﻂ اﻟﻤﺮﺿﻰ اﻟﻤﺘﺮددﻳﻦ‬
‫ﻋﻠﻰ اﻟﻌﻴﺎدة اﻟﺨﺎرﺟﻴﺔ ‪ .‬ﻻ ﺗﻮﺟﺪ ﻋﻼﻗﺔ داﻟﺔ إﺣﺼﺎﺋﻴﺔ ﺑﻴﻦ اﻟﺤﺎﻟﺔ اﻻﺟﺘﻤﺎﻋﻴﺔ‬
‫وإﻋﺮاض اﻻﺿﻄﺮاب اﻟﺘﺤﻮﻟﻲ وﺳﻂ اﻟﻤﺮﺿﻰ ‪ .‬ﻻ ﺗﻮﺟﺪ ﻋﻼﻗﺔ داﻟﺔ إﺣﺼﺎﺋﻴﺔ ﺑﻴﻦ‬
‫اﻟﻌﻤﺮ وإﻋﺮاض اﻻﺿﻄﺮاب اﻟﺘﺤﻮﻟﻲ ‪ .‬ﻻ ﺗﻮﺟﺪ ﻋﻼﻗﺔ داﻟﺔ إﺣﺼﺎﺋﻴﺔ ﺑﻴﻦ اﻟﻤﺴﺘﻮى‬
‫اﻟﺘﻌﻠﻴﻤﻲ وأﻋﺮاض اﻻﺿﻄﺮاب اﻟﺘﺤﻮﻟﻲ ‪ .‬ﻻ ﺗﻮﺟﺪ ﻋﻼﻗﺔ داﻟﺔ إﺣﺼﺎﺋﻴﺔ ﺑﻴﻦ اﻟﻨﻮع‬
‫وأﻋﺮاض اﻻﺿﻄﺮاب اﻟﺘﺤﻮﻟﻲ‪.‬‬
‫ﻳﻮﺻﻲ اﻟﺒﺎﺣﺚ ﺑﺮﻓﻊ اﻟﻤﺴﺘﻮى اﻻﻗﺘﺼﺎدي ﻟﻠﺴﻜﺎن ﻟﺘﻼﻓﻲ اﻟﻌﻮاﻣﻞ اﻟﻤﺴﺎﻋﺪة ﻟﻈﻬﻮر‬
‫أﻋﺮاض اﻻﺿﻄﺮاب اﻟﺘﺤﻮﻟﻲ وﻳﻮﺻﻲ ﺑﺒﺤﻮث ﻓﻲ ﻧﻔﺲ اﻟﻤﺠﺎل ﺗﻀﻢ آﻞ اﻟﻤﺴﺘﺸﻔﻴﺎت‬
‫واﻟﻤﺮاآﺰ اﻟﺼﺤﻴﺔ اﻟﺘﻲ ﺗﺘﻌﺎﻣﻞ ﻣﻊ اﻟﻤﺮﺿﻰ ذو أﻋﺮاض اﻻﺿﻄﺮاب اﻟﺘﺤﻮﻟﻲ‬
‫‪IV‬‬
List of Contents
Subject
Page
- Dedication
i
- Acknowledgement
ii
- Abstract in English
iii
- Abstract in Arabic
iv
- List of content
v
viii
- List of tables
Chapter One
1
1.1 Introduction
1
2
1.2 Objective
2
1.3 General objective
2
2
1.4 Specific objectives
2
1.5 Hypothesis of the research
1.6 Study limitation
3
3
1.7 Study area
3
1.8 Study time
3
1.9 Terminology definition
3
5
Chapter Two
V
Literature review
5
Etiology of conversion disorders
6
Pathophysiology
7
Diagnostic of conversion disorders and risk factors
11
Childhood traumatization
13
Psychiatric co-morbidity
16
Management
19
Prognosis and course
21
Previous Studies
22
Chapter Three
29
Methodology and procedures
29
Study area
29
Study population
30
Sampling
30
Study design
31
Material and methods
32
Procedures
32
Chapter Four
33
Results and discussion
33
Chapter Five
37
Discussion
37
Chapter Six
43
VI
43
- The conclusion
44
- Recommendation
-
References
& Appendix
45
VII
List of tables :
Table (1) socio demographic profile of subject
page 31
Table (2) gender and conversion disorders symptoms
page 33
Table (3) economic status and conversion disorders symptoms page 34
Table (4) age group and conversion disorders symptoms
page 34
Table (5) marital status and conversion disorders symptoms
page 35
Table (6) education levels and conversion disorders symptoms page 35
Table (7) total number of psychiatric patients attending Altigani Almahi
psychiatric hospital during 2007
page 41
VIII
CHAPTER ONE
1-1 Introduction:
The research
problem statement is the relationship
between conversion disorder and (age, gender ,educational
and socio-economical status, marital status )
considering
levels
the
interest, magnitude ,measurement of concepts ,level of expertise,
relevance, availability of data and ethical issues.
Mental health is an important part of public health, which is
not so considered or talked. The researcher like to highlight on
conversion disorders here in the Sudan particularly in Khartoum
where The researcher didn't found enough data or research in that
area.
Socio-demographic profile is any features related to person
social character like age, sex, address, and so on.
This kind of information are so important to describe any disease
and to know which are the risk groups and to give idea about disease
predisposing factors . Moreover, in order to do research in any field
researchers need to have preliminary data. That the researchers are
intending to do here in this study, to give general idea about sociodemographic character of conversion disorders patients here in
Sudan. Although this study has its limitation being hospital record
based and only including the statement of one center but that will
open a door for more comprehensive studies to answer some
questions :
1.
In which age it is more common?
1
2. Is there
any relationship between socio-economic status
and conversion disorders?
3. Is there any relationship between the educational level and
conversion disorders
4. Which sex is affected more?
5.
Is symptoms more common among married or unmarried
subjects?
1-2 Objectives:
1-3 General Objective:
To determine the socio- demographic profile (age ,gender,
martial status, education level..etc) of patient of conversion disorders
attending Altigani Almahi psychiatric hospital during a period from
January 2003 to December 2008.
1-4 Specific Objectives:
- To Identify which sex affected more .
- To determine the relationship between the educational level and
conversion disorders.
-
To detect in which age it is more common.
- To determine the relationship between socio-economic status
and conversion disorders .
- To determine the relationship between martial status and
conversion disorders.
1-5 Hypothesis of the research:
1. Conversion disorders are more common among females .
2
2. Conversion
disorders
are
more
common
in
low
socioeconomic classes .
3. Age group (12-24)years (Adolescents ) are more affected
with conversion disorders .
4. Conversion disorders is common among unmarried subjects .
5. Conversion disorders is common among low – educational
level .
1-6 Study population: 100 subjects from the records of
outpatients.
1-7 Study location:
Altigani Almahi psychiatric hospital located in Omdurman city.
1-8 Study time : between 2003 – 2008
1-9 Terminology definition :
(a) Conversion disorders: earlier called hysteria, involves a
neurotic pattern in which symptoms of some physical
malfunction or less of control appear with out any
underlying organic pathology. The symptoms of conversion
disorders was -
seizer – Aphonic etc. (Principles
of
ambulatory medicines, third edition by L.Randal Borked, R
Burton. 1991) .
(b) Out patient: The patient who received the treatment out the
hospital.
(c) Altigani Almahi psychiatric hospital :
Located in Omdurman city, Khartoum state capital of Sudan.
The hospital consist of causality department with causality ward for
3
short stay, out patient and referral department, E.C.T department,
nutrition department and administration department.
Altigani Almahi hospital located in Omdurman city Khartoum
state capital of Sudan, it accommodate 119 beds in causality
department and 107 beds in general wards, there are 14 house officer,
17 medical officer, 10 medical registrar in psychiatry and 7
consultants, patients attending the hospital are about 2500- 3000
patients per year.
The hospital consists of causality department with causality
ward for short stay, out patient and referral department, E.C.T,
department, nutrition department and administration department.
Hysterical bar ground:
The hospital was founded in 1971 and named after the late Dr.
Altigani AlMahi who was the first psychiatrist in Sudan and Africa in
general. Before converting it to mental health hospital it was a
medical centre seems by the British Mission. Lack of mental health
hospital urged the mission to the Sudanese government to establish
the mental health hospital in this medical center .
The hospital had only three wards at the date of establishment,
one for addiction treatment, another for men and the third for women,
with the total capacity of 47 beds.
In 2001 a ward for neurology was insulated under the
supervision of proof. Faroug Yasseen with the capacity of 8 beds for
men and 4 beds for women.
4
Chapter Two
Literature Review
Definition and terminology of conversion disorders:
Conversion disorders, is a disorders in which an unexplained
loss or alteration of bodily function develops in the presence. The
disorders probably occurs more often in women than men and
generally begins in adolescence or early adulthood.
Patients may have histrionic or dependent personalities and
may exhibit remarkable indifference in face of their impairment.
Acute conversion symptoms have a good prognosis for
recovery, especially if the patient has not other psychiatric
disorders(49).
Conversion disorders is linked historically to the concept of
hysteria, comes from the Latin word (Hysteron) meaning the uterus.
It was previously thought the condition occurs only in females due to
certain uterus movements, it is a misnomer as it occurs in males and
has nothing to do with the uterus.
Hysterical reaction represents the attempt never fully conscious
and frequently totally unconscious in the part of the patient, to obtain
relief from an otherwise intolerable stress, by the exhibition and
experience of symptoms of illness (1).
Conversion disorders is characterized by deficit affecting the
voluntary motor or sensory function. Conversion disorders the term
used in the DSM-IV classification system originating from the
description by Breuer and Freud (6) of pseudo neurological symptoms
5
resulting from the conversion of unconscious psychological conflict
to somatic presentation. Other objectives historically used to describe
the same phenomena include "hysterical" or "psychogenic". The
seizure subtype of conversion disorders is often referred to as
"pseudo seizures" but it is better to choose the term "non-epileptic
seizures" because the term "pseudo seizures" may incorrectly imply
to the patient, that the symptom is not real. Non-epileptic seizures
correctly describe the symptoms without invoking a cause, and
patients tend to prefer this term. Beginning treatment with a power
struggle over terminology weakness the doctor-patient relationship
(19)
.
Etiology of conversion disorders:
1\ Heredity:
Genetic factors may play a role especially in the personality
deposition called hysterical personality, characterized by:
a) Emotional immaturity with mood swings, fluctuations of
temper, out bursts of anger and acting out alternating with
warmth and loving feelings.
b) Easily suggestible and accordingly takes decisions on an
emotional level.
c) Inability
to
sustain
long
lasting
loyalty
to
maintain
interpersonal relationship of any depth.
d) Selfishness, inclination to show off, seeking attention and
liking to be the centre of attention.
6
e) Dramatic, exaggerating facts, wearing heavy make-up and
colorful clothes.
f) Histrionic behavior, to him the world is (heaven or hell) at one
moment, the patient may be weeping screaming and
threatening suicide, disturbing the whole atmosphere and a few
hours later, she or he is enjoying herself (himself), laughing
and dancing.
g) Sexually provocative, although many of them are frigid.
2\ Emotional stress or conflict:
Arising from the life situation which differs between patients ,
may lead to intolerable anxiety which can be converted to physical
symptoms (conversion hysteria). E.g. vomiting as symbolic of
disgust, coughing as symbolic of protest, headache as symbolic of
fear from examination or sexual intercourse, etc… (1)
Path physiology:
At present treatment is not based on an understanding of the
underlying path physiology of conversion disorders. Recent
functional neuroimaging studies point to a neurophysiology basis for
conversion
disorders,
triggered
by
psychological
processes.
Functional imaging data suggest that neural circuit linking volition,
movement and perception are disturbed in conversion disorders
(7)
although conclusions have been limited by the small numbers of
subjects, varying study designs and heterogeneous population.
Frontal sub cortical circuits mediate many aspects of behavior
(22)
. The orbito-frontal cortex serves as a control center, coordinating
various regions of the thalamus, amygdala and cortex.
7
Both the orbit-frontal cortex and the anterior cingulated cortex
have the emotional and central executive functions and are activated
when subjects suppress the competing response suggesting an
inhibitory role (3). The anterior cingulated cortex has been implicated
in the mediation of consciousness (23).
Blood flow to the anterior cingulated cortex is positively
correlated with emotional awareness
(39)
. Preliminary evidence
suggests that during conversion reactions, primary perception is
intact, but sensory and motor planning is impaired by disruption of
the anterior cingulated cortex, orbit-frontal cortex, and limbic brain
regions (7).
Furthermore, reduced activation of the frontal and sub cortical
areas is observed during conversion paralysis (57). A reduced soma tosensory cortex is seen as reduced activation during conversion
anesthesia, (42) and reduced activation of visual cortex is noted during
‫ظ‬conversion of blindness (68).
Other functional imaging studies of patient with acute
conversion paralysis
(67) (29)
and astasia – abasia
(70)
also implicated
disruption of striato-thalomo-cortex, premotor pathways, with
possible pathological inhibition from activation of the anterior
cingulate cortex and the orbito-frontal cortex 19).
The character of hysteria has many traits in common with that of
children, the cortex of the child is insufficiency developed and the
sub cortex plays an important part of the child's behavior. In hysteria
the cortex is weak, unable to inhibit the sub cortex with the result that
8
there is increased emotionality and so ideas are guided not by reasons
but by feelings (1).
Conversion disorders symptoms are risk factors:
1\ Motor disturbances:
a. Paralysis: in forms of monoplegia, hemiplegia, paraplegia
either flaccid or spastic with no true clonus and no Basniski
reactions, contractures not uncommon, contrary to organic
hemiplegia, proximal weakness is extended instead of the semiflexion, and the gait is extended and not in cirucumduction.
b. Aphonia: The patient cannot phonate words but continues to
cough as the vocal cords are not affected, he can't utter a single
word although he communicates freely and correctly in writing,
a point of differentiation from organic aphasia.
c. Fits: Those should be differentiated from epileptic fits by the
usual sequence of tonic than colonic movements, fits occur in
presence of an audience and never occur during sleep, they
rarely hurt themselves, absence of incontinence or cyanosis or
tongue biting and resistance to interference, attempts to pull
their hair, to tear clothes and to scratch and strangle
themselves.
d. Tics and tremors: Usually coarse in nature and semi-chore
form, clonic movements may occur.
e. Coma or stupor: The patients appears to be a sleep without
breathing difficult and no abnormal signs apart from organic
coma, it should be differentiated from catatonic schizophrenia,
depression stupors and delirious states.
9
f. Torticollis: Should be differentiated from inflammatory,
rheumatic, glandular, spondilosis, etc… All these motor
disturbances have a symbolic meaning e.g. Aphonia as she
cannot explain her feelings paraplegia as she is disinclined to
proceed with her marriage or examination.
Torticollis as she does not want to look at her husband, who
sleeps beside her.
Fits: whenever she faces a difficult examination or to escape
from an argument with her husband.
2\ Sensory disturbances:
a. Hysterical anesthesia: Not follow anatomical distribution but
is frequently total as the patient cannot feel the pin prick as
compared with organic anesthesia.
b. Hysterical blindness: It has a sudden onset, pupils react to
light and the patient avoids objects that would injure him.
c. Hysterical pains: The commonest form of expression of the
illness, it is bizarre in description and its fluctuation, is related
to emotional conflicts. It is frequently miss-diagnosed as
rheumatic pains and is usually symbolic of some conflicts in
the patient's life.
d. Visceral disturbances: All somatic symptoms can be
stimulated by hysteria, e.g. vomiting, cough, hiccough,
belching, globus hysterics, pseudocyesis, etc…
Anorexia Nervosa in its hysterical form is characterized by:
a. Refusal of food either by induced vomiting or forced purgation.
10
b. Loss of weight.
c. Amenorrhea.
The patient is active and energetic in spite of her fragile state, a
point of differentiation with Simmons’s and Addison's disease (1).
So symptom list of conversion disorders can include amnesia,
difficulty swallowing, loss of voice, deafness, double vision, blurred
vision, blindness, fainting or loss of consciousness, seizures or
convulsions, trouble making, paralysis or muscle weakness, urinary
retention or difficulty urinating (49).
Diagnosis of conversion disorders and risk factors:
Conversion disorders is linked historically to the concept of
hysteria, toward the end of the 19th century Pierre Janet
conceptualized hysteria as a dissociative disorders and described
somatoform aspects of this condition in his traumatized patients
(66)
.
In the beginning of his career, Janet's contemporary Sigmund Freud
also considered hysteria as a trauma – based disorders
(29)
. However,
Freud later conceptualized the somatoform symptoms of hysteria as a
result of neurotic defense mechanism, and referred to them as
conversion symptoms.
In DSM II, the conversion and dissociative types of hysterical
neurosis were classified as variants of single disorders, in DSM III
and its sequence versions, dissociative disorders have been
considered as a separate group. On the other hand the latest
international classification of disease, the ICD-10, put all
manifestations of hysterical neurosis as dissociative disorders; this is
in accordance with the findings of modern studies that have evidence
11
for the relationship between somatoform symptoms and dissociation
(58, 59, and47)
Conversion disorders is unique among DSM – III – R
somatoform disorders in that the definition not only describes the
diagnostic criteria, but also proposes psychological mechanism as
explanation of mechanism termed "secondary gain" which is invoked
when unexplained symptoms allow the patient to avoid onerous tasks
or undesirable duties. A secondary mechanism "primary gain" is
invoked when conversion symptoms appear to resolve an internal
conflict created by a feeling, impulse or wish that individual may find
frightening or morally unacceptable. So conversion disorders has a
good prognosis for recovery, especially if the patient has no other
psychiatric disorders (49).
Conversion disorders characterized by the presence of deficits
affecting the voluntary motor or sensory function, these symptoms
suggest neurological or organic causes but are believed to be
associated with psychological stressors (DSM IV).
Pierre Janet had emphasized the relation between conversion
disorders and childhood trauma by the end of 19th century. He viewed
dissociation of cognitive, sensory and motor processes as adaptive in
the context of an over whelming traumatic experience
(34,50)
.
Unbearable emotional reactions to traumatic experiences would result
in an altered state of consciousness. Because Janet considered this
alteration in consciousness to be a form of hypnosis, he referred to as
"autohypnosis" theory of conversion disorders with assumptions that
there is a relation between conversion symptoms and hypnotic
susceptibility confirmed by two systematically controlled studies
12
(35,55)
, the other assumption is that conversion disorders is associated
(50)
with childhood traumatization
. Despite the fact that this
assumption is widely adopted, pseudo seizures from the only type of
conversion disorders to which clear evidence with traumatic
experiences has been shown (4 ,36).
Now there is evidence that there is a relation between the
presence of childhood traumatization with conversion disorders.
Currently, the emotional neglect
(27,48)
and physical abuse (43) is
strongly emphasized and sometimes found to be more important that
sexual abuse, not like until recently all etiology of dissociation in
adults has focus primarily on sexual abuse.
The main prediction of autohypnosis theory is that there is a
relation between childhood traumatization cognitive or somatoform
dissociation symptoms that is mediated by a process in which trauma
patient uses his or her innate hypnosis capacities to induce "self
hypnosis" as a defense mechanism of response to over whelming
traumatic events
(10, 30)
, this prediction implies that persons who are
more capable of evoking dissociative experiences under hypnosis
might be more likely to develop conversion symptoms in reaction to
traumatization (21).
Risk factors of childhood traumatization:
1. Parental dysfunction: The expression (parental) refers to
biological parents, stepparents and adaptive parent. Parental
dysfunction is a conceptualization of emotional neglect,
(27,48)
referring to the unavailability of parent to recurrent illness,
13
nervousness, depression or use of sedatives and lack of parental
affection (27).
2. Physical abuse: Defined as severe parental aggression
including recurrent and chronic forms of violence frequently
resulting in injuries, such as repeatedly being kicked or hit with
a fist or an object (stick or belt), being tied up, or being thrown
down the stairs.
3. Sexual abuse: Defined as any pressure to engage in or any
forced sexual contact before 16 years ranging from fondling to
penetration
(27)
, notice fondling is not taken in account because
it lacks evident clear definition and its relation to adult.
Psychopathology lacks evidence. More important is to know
about perpetrators (more than one, in different times, sexual
activities, force or pressure, frequency, age at onset and
duration of sexual abuse.
There are studies that show that patients with conversion
disorders who reported multiple traumatization show more sever
symptom than patients with one type of traumatization
(21)
, and that
patients with conversion disorders reported higher incidence and
more sever forms of physical, sexual abuse than patients with
affective disorders. Contemporary authors argued that conversion
symptoms involve a dissociation of sensory and motor processes
"dissociative phenomena" evoked in hypnosis conversion disorders.
The dissociative phenomena are characterized by "inhibited explicit"
(conscious, voluntary) information processing while implicit or
automatic information processing is still intact
(11).
Patients with
conversion blindness, for example typically report no explicit
14
awareness, whereas visual stimuli have frequently been shown to
implicitly influence their behavior, dissociation between implicit and
explicit information processing is called cognitive dissociation when
memory functioning and somatoform dissociation when it affects
sensory or motor functioning, as it is in conversion disorders (21).
Diagnosis criteria for conversion disorders (6):
1. A loss of, or alteration in, physical functioning suggesting a
physical disorders.
2. Psychological factors are judged to be etiologically related to
the symptom because a temporal relationship between a
psychological stressor that is a parentally related to a
psychological conflict or need and initiation or exacerbation of
the symptom.
3. The person is not conscious of intentionally producing the
symptom.
4. The symptom is not a culturally sanctioned response pattern
and can not, after appropriate investigations be explained by a
known physical factor.
5. The symptom is not limited to pain or to a disturbance in sexual
functioning (49).
Diagnostic of psychogenic non epileptic seizures has become
easier by video EEG monitoring
(12)
measurement of serum
prolactin(13) selective use of neuropsychological tests
other diagnostic methods like seizure like events (25).
15
(14)
and various
Psychiatric co-morbidity in patients with conversion disorders:
Majority of the patients with conversion disorders (89.5%) still
has a psychiatric disorders at follow up. The most prevalent were
anxiety disorders. Somatoform, affective and dissociative disorders
were common as well.
At least one psychiatric diagnosis was found in (89.5%) of the
patients of conversion disorders, dissociative disorders was seen in
47.4% of conversion disorders patients. They can have dysthymic
disorders, major depression, somatization disorders and borderline
personality disorders, also childhood emotional and sexual abuse,
physical neglect; self mutilate behavior. So co morbid dissociative
disorders should alert clinicians for the chronic and complex
psychiatric conditions. The predominate of acute conversion
symptom in admission should not lead the clinician to over look the
underlying psychopathology process among these patient (20).
For example therapy for non epileptic seizure must take into
account the likelihood that patients with conversion disorders will
also meet the criteria for another axis I disorders. Typical co morbid
diagnosis include mood disorders post traumatic stress disorders
panic disorders, generalized anxiety disorders, dissociative disorders,
social or specific phobias and obsessive compulsive disorders (37,60).
Axis II pathology with close relatives to psychotic illness are
also common.
Example of study in patients with non epileptic seizures,
depression is the most co morbid diagnosis occurring 100%, also
common are anxiety disorders (11 – 80%), dissociative disorders
16
(90%), other somatoform disorders (42 – 93%) and personality
disorders (33% - 66%) (42). The strong overlap of non epileptic
seizures with dissociative disorders has prompted some authors to
propose reclassifying conversion disorders in the dissociative
disorders spectrum (43).
For proper diagnosis of conversion disorders there is a need of
using DSM IV axis I and axis II with psychiatrist specialized in
treatment of conversion disorders, trained psychologist neurologist
responsible for the somatic screening.
A study about childhood trauma in Turkey showed that both
somatoform and psycho form dissociation are correlated with
reported childhood trauma
(51,61)
, 46.0% reported childhood physical
abuse and 33.0% reported childhood sexual abuse (48), high sexual
abuse rates have been found among patients with pseudo seizures and
somatization disorders (49) and in conversion disorders patients in
general (50).
Sexual abuse and dissociation are independently associated
with several indicators of mental health disturbance, including taking
behavior such as suicidal, self mutilation and sexual aggression (38).
In Turkey prevalence of conversion disorders in one month as
observed both in psychiatric clinics and general medical settings is
quite frequently 27.2% prevalence of conversion symptoms
(5)
.
Patients with conversion disorders have overall psychiatric symptom
scores close to those of other psychiatric patients
(59)
suggesting high
psychiatric co morbidity. In a primary health care centre, conversion
symptoms were more frequently observed among subjects who had
17
an ICD – 10 diagnoses, depression, generalized anxiety disorders,
and neurasthenia were the most prevalent psychiatric disorders (5).
In other study in Turkey over a 12 month period (1997) in
psychiatric unit of university medical hospital in Sivas, the patients
who are diagnosed of conversion disorders 68 patients 48 (70.6%)
had pseudo seizures. 9 (13.2%) had paralysis (7 (10.3%) had
paresthesia and 2 (2.9%) had been unable to speak(16).
Pseudo seizure: is the most frequently seen conversion
symptom in Turkey (5) and female patients are usually over presented
in studies of conversion disorders from Turkey
(64)
, Western Europe
(22.50) and Northern America (55). In an epidemiological study in
Turkey (56) although, there was no difference in average dissociation
score between genders, two times as many women than men
including among high scores.
18
Management:
Guidelines for the management of patients with conversion
disorders include:
1. Be certain that the patient had an adequate medical evaluation
since many patients have an undiagnosed medical disorders.
2. Review the various explanatory perspectives for factors that
might be promoting the development of conversion symptoms.
a. Psychiatric illness (especially major depression).
b. Personality disorders (especially dependent and histrionic
types).
c. Behavioral models e.g. sick family members, increase
attention from family members supporting the sick role.
d. Aspects of the patient's life story, e.g. violent feelings
toward an abusive alcoholic father.
e. Emphasize the evidence that no serious disease is present,
express optimism about the prospect of full recovery.
f. Stress that emotional factors may exacerbate such problems.
Review the patient's current life and difficulties and consider
undertaking course of short time counseling (49).
Treatment options of conversion disorders e.g. non epileptic
seizures.
1. Address relevant risk factors, e.g. psychiatric co morbid
conditions and communication difficulties.
19
2. Psychological intervention (to minimize the perpetuator) factor
and recognizing triggering events (17, 24, 32,65).
3. If a patient has substantial cognitive impairment or
communication difficulties, treatment is best focus on simple
behavioral intervention, physical therapy, reason and helping
the patient verbality, distress (56,71).
4. Working with family unit may be necessary when family and
socio cultural factors predominate. Family therapy intervention
help the patient and family recognize and find issues that may
be cause of symptoms, to suppress emotion stress, and to use
the therapy with a problem centered system approach (45).
5. Recognition and treatment of comorbid conditions are almost
always necessary for symptoms resolution.
6. If patient continues to be symptomatic offer risk factor have
been addressed, turn to psychological treatment focusing direct
on perpetuating factors using cognitive behavior therapy to
address illness believes and denial of stress and modifying the
control (46, 45).
7. You can also use psychodynamic psychotherapy to help
patients to reform their world viewing empathic interpretations
and the development of insight enabling the process of working
through past rather than relying on dissociation as a defense (46).
8. Group therapy preferably in conjunction with concurrent
individual therapy for psychoeducational concept and provide
opportunities for patients to learn from and help each other
(41,13)
.
20
9. Multidisciplinary inpatient treatment, for patients with severe
and prolonged symptoms but such resources are not available
for many patients (18).
10. Hypnosis as adjunctive treatment but not essential for treatment
(54)
.
11. Pharmacotherapy: medications for comorbid and somatic
symptoms (28).
12. The most effective is comprehensive approach or treatment
program, recognition of risk factor, treatment of comorbid
disorders and conditions with a focus on cognitive styles that
perpetuate symptoms focus on patient – doctor relationship,
which can influence outcomes, limiting the unnecessary testes
and medication and procedures. Judicious medication to treat
comorbid conditions a lone or in combination with psychotherapist is often needed for sustained recovery.
Prognosis and course:
Between 50% and 90% of patients with conversion disorders
exhibit short term resolution of symptom after reassurance, but as
many as 25% of these responders relapse or develop new conversion
symptom over time (28).
Along duration of symptoms and tremor on non epileptic
seizure subtype are associated with a worse prognosis.
Among patients with non epileptic seizures even those with
symptomatic improvement may remain disabled (28).
Diagnoses of personality disorders, previous treatment and along
history of illness were associated with a poor diagnosis.
21
Previous Studies:
The researcher did not find any previous studies in the research
domain , there are some previous studies related to conversion
disorder with other variables .
study (1) Effectiveness of
hypnoses
in treatment
conversion disorders . Done by Amona Taj El ser (2005).
of
The
objective is to know the effectiveness of hypnoses in treatment of
conversion disorders, and explain the relationship between hypnoses
response and demographic change of conversion disorders patients,
the research design is experimental design . Using tools such as
application,
primary
information
(data), personnel interviews
(meeting) and conversion disorders measure .
sample of study 40 patient divided into 2 groups control group
,experimental group.
The data are analized
using (ALPH,) K2 test.
research results is that there are variations
The study
in the degrees of
conversion disorders measurement , before and after hypnoses that
proove the effectiveness of hypnoses in treatment of conversion
disorders . Also the study prove that there are no
in the hypnoses
response according to the sex (male- female) in the age classification
(22-28) (29-35) years. And this response can be decreased when the
duration of conversion disorders prolonged . And the response is
decrease in people who has a high educated level.
Study (2)
The
prevalence of childhood
abuse among the
patients of conversion disorders . Done by Samia Higazi (2002) .
Objectives:
22
1. to investigate the prevalence of child abuse i.e. emotional,
physical, and sexual abuse that took place in medium and late
childhood (6-12) years among the patient of conversion disorders .
2.To investigate the difference in child abuse among patient of
conversion disorders according to sex and caretaker in childhood .
The researcher used the descriptive method . The sample of the
study include all patients of conversion disorders who visited the
psychiatric hospital in Khartoum state during the period of data
collection the size of the sample is (50) patient (36) Females (14)
males .
The tool of data collection is by biographical form designed
by researcher ,by the child abuse scale prepared by David Benstien
(1995), and the diagnostic criteria of conversion disorders prepared
by the American psychiatric diagnostic statistical manual for mental
disorders (1994) (DSM VI), as a reference in diagnostic conversion
disorders .
1. The data had been manipulated by the computer using
the statistical
package for social science (SPSS) .the
results of the research: 1.there is high prevalence of
child abuse and sexual abuse in children( 6 -12)years
among patients of conversion disorders.
2. There are differences among patients of conversion
disorders according to sex and care taker in childhood .
study(3) Dissociation, Childhood interpersonal Trauma, and
Family Functioning in Patients with somatization Disorders
23
Richard.J Brown, Ph.D, Clin. Psy. D. Anette Scharge, M.D. Ph.D.,
and Michael R. Trimble, M.D.
The Objectives:
1.to
determine the occurrence
of various dissociative
phenomena in patients with somatization disorders.
2.the occurrence of six different types of childhood
interpersonal trauma in these patients, and the
nature of
these patients, early family environment .
Method:
Twenty–two patient with somatization disorders and medical
comparison subject completed the structured clinical inter-view for
DSM- IV dissociative disorders the childhood trauma interview ,
and the family
functioning
scale .the type of the
study is
comparative study .
Results:
1.The somatization disorders patients reported
significantly
higher level of dissociative amnesia than the comparison
subjects .
2.The
two
group
reported
similar
levels
of
depersonalization,identity alteration.
3.Somatization disorders patients reported significantly greater
childhood emotional abuse and more severe form of physical
abuse, relative to the comparison subject,
4.chronic emotional abuse being the best predictor of
unexplained symptoms.
24
5.childhood sexual abuse, separation / loss , and witnessing
violence were equally common in the two group .
6.The somatization disorders
group reported significantly
more family conflict and less family cohesion. conclusions:
7.only some types of dissociation are more server in patients
with somatization disorders ,relative to medical comparison
subjects.
8. Many patients with somatic conversion disorders action
disorders
are raised in an emotionally cold, distant, and
unsupportive family environment characterized by chronic
emotional and physical abuse.
9. Sexual abuse is not a necessary prerequisite for the disorders.
Study(4) Childhood Abuse in Paints with conversion disorders,
Karin roleofs, Ph.D. Ger. P.J. Keijsers, Ph.D Kess. A.L Hoogduin,
M.D., Ph.D., Gerard W.B. Narining, Ph.D., and Franny C. Moene .
Ph.D . November 2002
Objectives:
1.to examine the relationship between conversion disorders and
childhood traumatization,
and to investigate whether phonetic
susceptibility mediates the relation between trauma and conversion
symptoms, as suggested by Jane's
auto-hypnosis theory
of
with conversion disorders and
50
conversion disorders.
Method and sample size :
A total of 54
matched
patient
comparison patients with an affective disorders were
25
administration the structured
measures of cognitive
Trauma
interview
as
well as
(Dissociative Experiences Scale
and
somatoform (20 item somatoform dissociation questionnaire)
dissociative experience.
Results:
1.Patients with
conversion disorders reported
a higher
incidence of physical /sexual abuse, a larger number of different
types of physical abuse, sexual abuse
of longer duration, and
incestuous experiences more often than comparison patients.,
2. within the group of patients with conversion disorders,
parental dysfunction by the mother – not the father- was associated
with higher scores on the dissoicative experiences scale and the
somatoform dissociation symptoms, (Structural clinical interview for
DSM-IV Axis I disorders)
3.Hypnotic
susceptibility proved to partially mediate the
relationship between physical abuse and conversion symptoms .
4.there is evidence of a relationship
between
childhood
traumatization and conversion disorders.
Study (5) A study
of
clinical
correlations and socio–
demographic profile in conversion disorders, Kamala Deka, Pranti K
Chaudhyry, Kavery Bora, Pranab Kalita Department of psychiatry,
Assam Medical college and Hospital, Dibrugarh , Assam India . Jun
2008 .
Objective :
26
to study the clinical presentations and relationship of sociodemographic variables with conversion disorders .
Method:
for patients admitted to the department of psychiatry, Assam
Medical collage and Hospital, Dibrugrh, during November 2004 to
August 2005 who fulfilled the inclusion criteria of the study were
evaluated for socio – demographic variables and clinical presentation
on a semi – structural pro forma .
Results :
1. conversion disorders is more common in young adults
(57.5%) females,(92.5%) and among student belonging to unclear
family of lower socioeconomic status.
2.A majority of the patients had obvious precipitating factor, for
which family related (40%) and school– related (30%) problems
accounted for the major types.
3.Motor symptoms were the predominant presentation (87.5%)
with pseudo seizure being the commonest.
Researcher comment :
From the previous studies the researcher extract that there is no
variations in the effectiveness of hypnosis treatment in patients of
conversion disorders according to age groups and sex, the
effectiveness of hypnosis treatment is decreased in patents of
conversion disorders with higher educational levels, there is increase
prevalence of child abuse (6 -12)years among patients of conversion
disorders as a predisposing factors with differences in sex and care
taken by parents, also there is a significant relationship between
child abuse (sexual, physical, emotional, the parental dysfunction by
the mother )and the conversion disorders .
27
The conversion disorders are common in young adults, females,
students from lower socio-economic status and precipitating factors
(school related, family related.
28
Chapter Three
Methodology and procedures
This chapter explains how this study and carried out on the
light of the following headings: Study approach, population materials
(data collection method) in addition to the statistical processing used
o verify the hypothesis.
Study Approach:
The approach utilized in this study is the retrospective study
design, due to the fact that it is the most appropriate approach for
such type of study. since it seeks to correlate various variables with
conversion disorders (correlational study).
This study is conduct on patients with conversion disorders
who are attending Altigani Almahi psychiatric hospital during period
(2003-2008)
data collection method:
The information was gathered using secondary sources (hospitals
records) from the archives.
Study area:
Altijani Almahi hospital located in Omdurman city Khartoum state
capital of Sudan, it accommodate 119 beds in causality department
and 107 beds in general wards, there are 14 house officer, 17 medical
officer, 10 medical registrar and 7 consultants. Patients attending the
hospital about 2500- 3000 patients per year.
29
The hospital consists of causality department with causality
ward for short stay, out patient and referral department, E.C.T,
department, nutrition department and administration department.
Study population:
Records of out patients attending at the referral clinic in the
hospital in the period form 2003- 2008.
Sampling:
all patients records in the period mentioned were checked. The
table(1) indicate the frequency of basic information. The age of
patients , gender , education level social economic status, martial
status.
30
Table (1): Socio-demographic profile subjects Show the frequency and percentage
of the basic information of ( n=100) for the study (sample ) variables.
Variables
Variants
frequency Percentage
variable levels
1
2
3
4
5
Age
Sex
Educational level
Marital status
Socio-economic classes
Less than 12
5
5%
12 – 24
67
67%
25- 36
18
18%
37-48
9
9%
Above48
1
1%
Male
30
30%
Female
70
70%
Illiterate
12
12%
Primary
31
31%
Secondary
36
36%
University
21
21%
Married
25
25%
Un married
75
75%
Poor
12
12%
(middle) average
88
88%
Study Design:
Retrospective study design , The retrospective studies
investigate aphnomon , situation , problem or issue that has happened
in the past they are usually conduct either on the basis of the data
available for that period or basis of respondents recall of the
situation. (Research methodology Second edition by Rannjit Kumar
p.g. 99 (2005).
31
Material and methods:
All available records form hospital statistical office and archives.
Procedures:
1.The researcher collected the data and information after the
approval of the hospital authority from the hospital records and files
2.The researcher arrange the information collected in tables with
the variables required for the study and give specific number for
every variable.
3. The data is manipulated by the computer applying the
statistical package for social sciences (SPSS) using Chi-square test to
analyze the data .
4. . The researcher explain the result, make comparison with the
hypotheses to obtain the final results .
32
Chapter four
Results and Discussion
The results from the research are compared with the hypotheses
formulated by the researcher
hypothesis (1)
Conversion disorders is more common among females.
Research result of hypotheses (1)
As
observed from table (2) that there is no significant
correlation between gender and symptoms.
Table (2) X2:
to investigate the relationship between gender and symptoms among
the study population.
Precipitate
Paralysis
Seizer
A Phonia
Body pain
Total
Gender
Male
6
10
8
6
30
Female
14
36
14
6
70
DF
Chi-square
Asymp. Sig.
(2 sided)
1
4.205
0.240
Hypothesis number (2):
Conversion disorders is more common in low socio-economic
classes:
Research result of hypotheses (2)
Is that Conversion disorders is more common in low socio economic
classes. From table (3)
33
Table (3) X2: to investigate the relationship between socio-economic
status and symptoms among the study population.
socio-economic
status
Precipitate
poor
Paralysis
Seizer
A Phonia
Body pain
Total
avarage
18
42
21
7
88
2
4
1
5
12
Chi-square
DF
Asymp. Sig.
(2 sided)
11.710
1
0.008
Hypothesis (3):
Conversion disorders affect more age group (12 -24)adolescents group
Research result:
As observed from table (4) is that there is no significant relationship
between conversion disorders and age group
(12 -
24)adolescents group
Table (4) X2: to investigate the relationship between conversion
disorders ,age group (12 -24)adolescents group and age as general.
Age
> 12
12-24
25-36
37-48
> 48
0
4
1
0
13
29
16
9
3
9
3
3
3
4
2
0
1
0
0
0
ChiSquare
DF
Asymp.Sig
2 sided
9.814
12
0.632
Symptoms
Paralysis
Seizer
A Phonia
Body pain
Hypothesis (4)
Conversion disorders is common among unmarried subjects
The Research result:
34
As observed from table (5) is that there is no significant
relationship between conversion disorders and marital status.
Table (5) X2:investigate the relationship between conversion
disorders and marital status among the study population.
Precipitate
Martial
Married
Unmarried
Chi-square
Paralysis
Seizer
A Phonia
Body pain
Total
14
37
16
8
75
6
9
6
4
25
1.496
DF
Asymp.
Sig.
(2 sided)
3
0.683
By referring to result in table (5) above it seen that there is no
significant difference between the married and unmarried in
conversion disorders.
Hypothesis (5):
Conversion disorders are common among low-education level
classes.
The Research result :
As observed from table (6) is that there is no significant
relationship between educational level and conversion disorders
according to the result of chi-square test.
Table (6) X2:
to investigate the relationship between conversion disorders and
educational level among the study population.
Precipitate
Educate
Illiterate
Primary
Secondary
University
Paralysis
Seizer
A Phonia
Body pain
Total
3
5
2
2
12
7
15
6
3
31
6
17
9
4
36
4
9
5
3
21
35
Chisquare
DF
Asymp
. Sig (2
sided)
1.511
9
0.997
Chapter Five
Discussion
This chapter deals with the discussion of the results after being
analyzed statistically by chi–square test. Since the hypothesis discussed in light of previous studies.
In the first hypothesis, which postulated that conversion
disorders is more common among females due to the following:1. conversion disorders appears to be more frequent in women
than in men , with reported ratios varying from 2:1 to 10:1 ,
ratio – among children .
2. in men , there is an association between conversion disorders
and anti social personality disorders.
3. conversion disorders in men is after seen in the context of
industrial accidents or military .
Some psychiatrist think that the high female to male ratio. in this
disorders reflects the cultural pressures on women in north American
society and the social ( permission) given to women to be physically
weak or sickly. However the gender ratio is closer to 1:1 may reflect
the greater vulnerability of females to abuse .
Cultural influences appear to affect the gender ratios as will as
there frequency in a specific population.
Some cultures (( for example) Greek and Puerto Rican ) report
higher rates of somatiza tion disorders among men than is the case
36
for the united states , and that show the finding in this study although
there are differences in culture ( religious, traditions and costumes )
there are certain believes like express of feelings which is accepted in
our culture to female rather than male .
In the second hypothesis which stated that conversion disorders
is more common in low socio-economic status .
It be observed that there is significant correlation coefficient
between the economic status and conversion disorders in study
population from the result of (3) .
This argument supported by studies that conversion disorders is
a major reason for visits to primary care practitioner .one study of
health care utilization estimate that 25-72% of office visits to primary
care doctors.
A study estimates that at least 10% of all medical treatment and
diagnostic services are ordered for patients with no evidence of
organic disease .
Conversion disorders carries a high economic price tag .
Patients who convert there emotional problems into physical
symptoms spend nine times as much for health care as people who do
not somatize and 82% of adults with conversion disorders stop
working because of their symptoms . the annual bill or conversion
Disorders in the in the united states comes to $20 billion , not
counting absentceism from work and disability payment.
Hypothesis three claimed that adolescent are more affected with
conversion disorders .
37
The incidence and prevalence of conversion disorders are unclear it may be seen at any stage of life. it is fairly common in
children but not most common in adolescent and young adults , rarely
before age of 10 years or after age of 35 years , but onset as late as
the 9th decade of life has been reported when an apparent conversion
disorders.
First develops in middle or old age, the probability of an occult
neurological or other general medical Conditions is high according
to DSM4 conversion disorders was classified as a somatoform
disease. The somatoform disorders are difficult to recognize and treat
because patients often has long histories of medical or surgical
treatment with several different doctors .
Somatization disorders is consider to be a chronic disturbance
that tends to persist through out the patients life may be that why we
did not found any significant correlation coefficient between adolescent and conversion disorders among study population .
Hypotheses four which
states that conversion
disorders
common among unmarried subjects .
The researcher hypothesis that because
she think that the
married subjects are more happy and stable in their life because
they have their own
family, children ,
security and
has their
emotional live , but the result came negatively may be that is related
to some causes, un married in our culture have a support from the
family members, solve their problems and this is our culture which
give psychological and social support .
38
Un married women are busy with their work friends home,
shopping that minimize ,the stresses also the personal relationship.
Also the man have also his friends spend time with them.
In the adolescent, and this period of human life, which is
characterized by gradual development to words physical, sexual,
intellectual and psychological maturity, the psychological and social
development of the adolescent is influenced by the social and family
environment with all its contents (culture, traditions and customs,
Norms) which direct
the adolescent attitudes and influence his
adaptation with himself and with the surrenders.
One of the most important feature of psychological development in this period is the tendency of the adolescence to attain an
emotional independence from the family, characterized by irritation
and anger .
This psychological changes are attributed to the feeling of him
that he is not longer a child .
In addition he may be under many psychological conflicts are
as a result of these changes.
In the secondary education the student may face many stresses,
because of the conflict between his need and his family needs.
Hypothesis five postulated that
conversion disorders
is
common among low – educational level classes .
The researcher suggested that education level has a role in conversion disorders because the low educated people has ability to
suggestion and this is a precipitating factors and the hysterical
39
personality characterized by easily suggestibility and accordingly
takes d decisions on an emotional level .
There is no significant correlation coefficient between educational
level and conversion disorders.
As we see in table (6) Illiterate showed (12%) primary (31%)
secondary (63%) university (21%) .
That the symptoms should cause impairment in social,
occupational, educational, or other important area of functioning.
Table (7) Patients attending the hospital during 2007
The total number of patients is (1894)
Kind of illness
SZP
Patients (No)
( %)
712
38%
Depression
296
5.8%
Mania
159
8.5%
Bipolar
97
5.2%
Psy. Shock.
80
4.3%
Toxic Psychosis
108
5.8%
Psychological disturbances
283
5.1%
Alcohol addiction
51
2.7%
Epilepsy
23
1.2%
Purple psychosis
15
0.8%
Psychosis
7
0.4%
Conversion
12
0.6%
Dementia
19
1.1%
Mental retardation
6
0.3%
Anxiety
4
0.2%
40
From the statistical office in Al Tajani Al Mahi Psychiatric hospital .
41
Chapter six
Conclusion , Recommendation , References and
Appendix
Conclusion :
1) There is no significant relationship between gender (male,
female) and symptoms of conversion disorders
2)
There is significant relationship between socio- economic
status and symptoms of conversion disorders
3)
There is no significant relationship between conversion
disorders and adolescent as age group .
4)
There is no significant relationship between conversion
disorders and martial status .
5)
Their is no significant relationship between coefficient
between educational level and conversion disorders .
42
Recommendation :
1) To improve the socio-economic
status of population to
minimize the predisposing factors leading to conversion
disorders symptoms.
2) To make more researches in the same topic to cover other
psychiatric hospitals and other psychiatric health center .
43
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