Published February 13, 2012
David G. Lichter, MBChB, professor of neurology, has been interviewed by numerous local and national media outlets about the cases of conversion disorder that have emerged at a high school in LeRoy, New York.
An expert in movement disorders, including Tourette’s Syndrome, Lichter has been featured on “The Today Show,” NPR’s “Here and Now” and in the Buffalo News, among others. He is a fellow of the Royal Australasian College of Physicians.
In the following Q&A, he discusses conversion disorder and what might be causing it.
Conversion disorder is a loss of, or alteration in, physical functioning caused by psychological factors.
This causal link is suggested by a temporal relationship between a significant psychosocial stressor and initiation or exacerbation of the symptom.
Importantly, the person is not conscious of intentionally producing the symptom. This differentiates conversion disorder from factitious disorder or malingering.
Yes, and it particularly affects adolescent girls and young women.
One suggestion is that females are more prone to internalize stress than males. Females may also be more suggestible.
In the past, symptoms or behaviors of mass psychogenic illness have been spread from a small number of individuals to larger numbers of individuals by what we call “line of sight” and “line of hearing,” where the affected sufferers share a common, enclosed environment, such as a school.
Social networking now provides another avenue for symptoms to be transmitted rapidly to potentially vulnerable individuals who may be geographically distant from, or not yet directly exposed to, the original cohort.
It is difficult to know whether media attention may have contributed to the spread of symptoms. It is important to note that three of the girls have pre-existing tic disorders that were not due to psychogenic illness.
However, I believe that the intense media scrutiny, including the continued attention to alternative possible causes of the students’ symptoms, has heightened anxiety and fostered an environment of mistrust.
It also has diverted attention away from the diagnosis accepted by all professionals who have been directly involved in the evaluation and care of these students—i.e., conversion disorder. In some cases, this has resulted in a failure to initiate or continue appropriate care, which, in turn, has led to behavioral regression.
In comparison, those who have accepted the diagnosis and continued with appropriate therapy are experiencing symptomatic improvement.
Conversion disorder can be successfully treated within a few weeks if the family accepts the diagnosis and rapid, appropriate and supportive intervention is undertaken.
This is particularly likely in cases where the individual has healthy personality characteristics and good family support.
In the absence of such positive predictors of outcome, the disorder may become chronic and refractory to treatment efforts.
Yes. For example, experts in biologically and psychologically based movement disorders are conducting research at the Human Motor Control Section in the National Institute of Neurological Disorders and Stroke (NINDS).
They have offered free evaluations to the LeRoy students as well as inclusion in their ongoing conversion disorder study.