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Conversion Reactions in Adolescents

Few situations in practice present as more frustrating for a busy pediatrician than an adolescent who appears for a ten-minute walk-in visit with a prolonged history of unexplained abdominal pain or headache. Obtaining a brief history of the symptom may contribute little to a timely diagnosis, and physical examination is often unrewarding in understanding the symptom. If the adolescent's demeanor suggests little discomfort, the pediatrician is often left with the impression that the pain is "psychosomatic" and/or that the adolescent is exploiting a physical symptom for some secondary gain. A diagnosis of conversion reaction is seldom considered. The focus of this article will be to aid the pediatrician in identifying conversion reactions, differentiating conversion reactions from other disorders (eg, hypochondriasis, malingering), and outlining an approach to the treatment and referral of patients with conversion reactions.

DESCRIPTION AND PREVALENCE

Conversion reactions represent a form of communication of the uncomfortable, or as Engel¹ writes: "a psychic mechanism whereby an idea, fantasy, or wish is expressed in bodily rather than in verbal terms and is experienced by the patient as a physical symptom rather than as a mental symptom." The idea or wish is psychologically threatening to the individual or unacceptable for him or her to express directly.

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