It is my opinion that it would be unprofessional (and possibly illegal) to withhold therapy simply because a patient presents with a conversion/psychosomatic disorder. The latest insight into the phenomenon of conversion disorders shows that the unconscious mind plays a role in the pathophysiology of the disorder. It is therefore less likely that the patient will respond to treatment when the manifestations of the conversion disorder are confronted directly as the only method of therapy.
Hospital admission may be considered in some cases. For example, for a patient that appears unlikely to return for follow-up treatment after being given a psychiatric diagnosis. In addition, Physical therapy may be warranted and is often helpful in providing the patient with a way out as they are being provided a benign treatment to which they can respond and improve.
As a healthcare professional providing therapy for a patient who presents with a conversion disorder, one should always be aware that the clinical situation may be worsened by providing the patient with the secondary gain he or she is seeking.
Here are some points to consider:
Avoid invasive diagnostic and therapeutic interventions.
Tactful presentation of the diagnosis to the patient includes the following:
Avoid giving the patient the impression that you feel there is nothing wrong with them.
Do not inform the patient of the diagnosis on the first encounter.
Reassure the patient that the symptoms are very real despite the lack of a definitive organic diagnosis.
Provide socially acceptable examples of diseases that often are deemed stress-related (e.g. peptic ulcer disease, hypertension).
Provide common examples of emotions producing symptoms (e.g. queasy stomach when talking in front of an audience, heart racing when asking someone for a date).
Provide examples of how the subconscious influences behavior (e.g. nail biting, pacing, foot tapping).
Provide reassurance that no evidence of an underlying neurological disorder is present based on the tests that were performed and that the prognosis for recovery is very good.
Provide positive reinforcement that the symptoms can improve spontaneously.
Inform patients that the symptoms are not volitional, and no one believes that they are faking.
Provide a graceful way for the patient to improve from the symptoms. (Allow for the symptom to get better over time, just as an organic entity might improve.) This is perhaps the most important point. A patient admitted to the neurology ward with a psychogenic gait disorder should not be discharged suddenly once any mild improvement is seen. It may be the better part of valor to hold a patient a day or so to ensure that the treatment is taking hold.
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