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Conversion and Somatization in Pediatrics

Although conversion disorder rarely is diagnosed formally in ordinary pediatric practice, busy pediatricians often do encounter the phenomenon of conversion. Conversion is the experiencing of unacceptable emotional conflicts as symptoms, usually but not always physical, rather than as mental events. Conversion is commonplace, affecting almost all body systems. It must be recognized and managed appropriately early in its course, lest inappropriate evaluations and treatments occur; in addition to their other costs, such unnecessary procedures may introduce the child inadvertently to such symptomatization as a life-long pattern of behavior. More than a century ago, Briquet recognized that at least 50% of adult "professional patients" begin their symptomatic careers before puberty; thus, inappropriate care of the young patient who has conversion symptoms may have serious, long-lasting consequences.

Problems in Diagnosing Conversion

The traditional diagnostic elements of conversion often are difficult to demonstrate in pediatric practice. Almost all are either not specific to conversion or hard to confirm in young patients for reasons of developmental immaturity. These "standard" elements include the following:

• Stress or conflict preceding symptoms (true of many illnesses)

• Unconscious symptom production outside the patient's awareness (thus often inaccessible to the pediatrician)

• A model for the symptom (either unverifiable or prone to observer bias)

• Primary gain or relief of underlying conflict (again, difficult to confirm)

This article has been cited by other articles:

				T. J. Silber and M. Pao Somatization Disorders in Children and Adolescents Pediatr. Rev., August 1, 2003; 24(8): 255 - 264. [Full Text] [PDF]