Somatic Therapies - Conversion Disorder and Somatoform Disorder Not Otherwise Specified

Treatments that include some manipulation of the body or its functions have been suggested for conversion disorder. These adjunctive therapies have proven to be invaluable contributions to a comprehensive treatment plan.

Pharmacotherapy Pharmacotherapy is primarily indicated for the depressed patient with conversion symptoms. A full discussion of pharmacotherapy for depression is provided in Chapter 47 of this volume.

Electroconvulsive therapy Electroconvulsive therapy (ECT) has been reported to be effective in some patients with conversion symptoms (Cybulska 1997). This is probably because ECT is an effective treatment for underlying depression, but ECT also may have a direct effect on cortical inhibition, memory, or both (Merskey 1989). The response also may be attributable to the placebo effect of a dramatic treatment.

Physical therapy Physical therapy plays an important, perhaps essential, role in the treatment of a variety of paralyses or gait disturbances. The physical therapist provides encouragement, reassurance, and reinforcement for improvements (Delargy et al. 1986; Keane 1989; MacKinnon 1984). Furthermore, physical therapy prevents, and sometimes treats, disuse atrophy. Physical therapy tends to legitimize the sick role and provide a face-saving mechanism for recovery (Lazarus 1990). On the other side of the coin, legitimizing the sick role can be a reinforcer for maintenance of the symptom, particularly if the patient perceives the therapist as providing attention (nurturance) not easily obtained elsewhere.

Biofeedback Biofeedback allows a patient to have concrete evidence of the intact physiological functioning of the disabled body part. Intact sensory organs and innervation can be demonstrated through evoked potentials, and muscle activity can be demonstrated via electromyography (Fishbain et al. 1988; Klonoff and Moore 1986; MacLeod and Hemsley 1985). Furthermore, the use of biofeedback allows for measurable physiological activity that can be used within a behavioral modification treatment plan (Klonoff and Moore 1986). A unique treatment strategy used by Jellinek et al. (1992) was a transcranial magnetic stimulator that created motor-evoked potentials and involuntary leg muscle contractions in a patient with a conversion paraplegia. The patient was able to witness his leg contractions, and his conviction of physiological preservation was reinforced by viewing his motor-evoked potentials on the display of the recording equipment. He had a complete recovery a week after this treatment.

{embed="ref/stat-menu-psy1"}

Faradic stimulation Faradic stimulation is the stimulation of skin and underlying structure with a low-amperage electrical current. It has been used since the beginning of the 20th century. The sensations created, when mild, may provide a placebo effect. When the current is increased, the shocks may be used for aversive conditioning (but this is not recommended). Hafeiz (1980) found faradic stimulation to be as effective as other treatment modalities when used to treat acute conversion symptoms in unsophisticated patients. Pu et al. (1986) also used electrical stimulation in selected patients but preferred supportive therapy for most patients because they believed the latter promoted a better therapist-patient relationship.