A patient with conversion disorder:
(1) does not have voluntary control over the abnormal neurologic findings.
(2) may feel distress, shame or embarrassment.
(3) may have a worse prognosis if the condition is long-term (Feinstein)
Things to avoid:
(1) confrontation
(2) rejection
(3) an exhaustive workup (which may heighten anxiety)
(4) therapy with opiates, benzodiazepines or other drugs with abuse potential
(5) expect a rapid recovery
Interventions:
(1) Try to identify the underlying stressor(s) and the psychological response to it.
(2) Give positive feedback and encourage involvement.
(3) Encourage the patient to express the affected function, then gradually amplify upon this (systematic enhancement of function, Andrade et al).
(4) Some patients may benefit from hypnosis or nonstandard interventions depending on culture and personality.
(5) Recovery may take time so prepare for a long-term treatment relationship.
(6) Address disability and rehabilitation needs.
