Hypnosis in the treatment of conversion and somatization disorders

Hypnosis in the treatment of conversion and somatization disorders

Moene, F.; Roelofs, K.; Nash M.R., Barnier A.J.

Citation

Moene, F., & Roelofs, K. (2008). Hypnosis in the treatment of conversion and somatization disorders. In B. A. J. Nash M.R. (Ed.), The Oxford Handbook of Hypnosis. (pp. 625-645).

Oxford: Oxford University Press. Retrieved from https://hdl.handle.net/1887/14252

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The Odord Hand book of 1

Hypnosis

Theory, Research and Practice

Edited by

Michael R. Nash

Psychology Department, University of Tennessee, Knoxville, TN, USA

Amanda J. Barnier

Macquarie Centre for Cognitive Science, Macquarie University, Sydney, NSW, Australia

OXFORD

U N I V E R S I T Y P R E S S

A., Tope, I). kl. and Burish, T. G.

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and Faragher, E. B. (1984) ipnotherdpy in the treatment of table-bowel syndroriie. Lancet,

and Colgan, S. M. 11987) .ere irritable-bowel syndrome. Girt

:.C., Siegler, I. C., Eigenbrodt, hl. L., er, H. A. (1000) Anger proneness ,art disease risk: prospective analysis osis risk in comrniinities (ARIC) 11: 2034-2039.

G. E,, \Vells and V. E. (1999) of the niortality of depression.

iine, 61: 18-20.Wulsin, L. K..

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~dititiiitrics, 101: 1032-1035.

\?.J., LeRaron, S. and LeBaron, C.

ed, controlled stiidy of behavioral :motherapy distress in childreii with 8: 34-42.

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1 ^{CHAPTER 26}

1 Hypnosis in the treatment 1

I of conversion and

1 somatization disorders

1 Franny C. Moene and Karin Roelofs

26.1. Domain of the problem

Conversion disorder (CD) refers to the presence of deficits affecting the voluntary motor or sensory functions. These symptoins suggest neurological or other organic causes, but are believed to be associated with psychological stressors (American Psychiatrie Association, 1994). Conversion and somatization symptoms were initially described in the context of hysteria, and have always been subject to debate arid con- ceptual confusion. That this debate is still alive is reflected in the manner in which the disorder is currently classified within the two niajor current nosologies: in the DSM-IV (American Psychiatric Association, 1994) CD is a type of somatoform disorder; In the ICD-l0 (World Health Oraganization, 1992) it is a dissociative disorder.

For convenience, we follo~v the DSM-IV criteria, although in our theoretica1 review we present arguments for a dissociative classification.

Neurological symptoms for which no adequate physiological explanation can be found can be subsumed not only under the diagnosis of CD, but also under the diagnosis of somatization disorder (SD). Aside from differences in symptom numbers and illness chronicity, the available data indicate that there is little that distiriguishes

CD from SD (Rori, 2001; Wade, 2001; Brown, 2004). We focus on CD, with the notion that most of the described features and treatment models apply to both CD and SD.

The presentation of conversion symptoms mimics a broad spectrum of neurological dis- eases. The most common conversion symptoms are motor symptoms, such as paraiysis, inco- ordination, ataxia and tremor. The second most common symptom cluster consists of somatosen- sory symptoms that may involve anesthesia, blindriess and sometimes deafness. Another cluster of symptoms niay involve seizure-like activity. There can also be a mixed presentation in which there are motor symptoms, sensory and seizure-like symptoms.

According to the DSM-IV criteria of CD, the onset or exacerbation of these symptoms has to he associated with psychological stress or trauma. Childhood sexual, physical and emo- tional abuse have indeed been linked to conver- sion and somatization symptoms (e.g. Morrison, 1989; Betts and Boden, 1992; Alper et al., 1993;

Binzer and Eisemann, 1998; Kuyk et al., 1999;

Litwin and Carderia, 2000; Roelofs et al., 2002a;

Salmon et al., 2003; Brown et al., 2005) Further, it is not uncommon for conversion symptoms to develop following exposure to acute stressors

626 . C H A P T E R 26 Hypnosis in the treatment of conversion and somatization disorders

(Binzer et al., 1997; Roelofs et al., 2005). patients with coriversion blindness could niodify Nevertheless, several authors have questioned their behavior in response to visual inforrriation the necessity of identifying psychosocial precip- they deny seeing. Yet they remain oblivious itants in order to make a firm diagnosis of CD to this strategy. Sackheim et al. (1979) proposed or SD (e.g. Merskey, 1979; Ron, 1994). Altliough that hysterically blind patients performed clear environmental precursors are often found, differently o11 a visual task depending o n they can be absent in some cases (Ron, 1994; whether or not the visual task was presented as a Roelofs et al., 2002a). test for blindness. In a clinica1 setting, we Psychiatric co-rriorbidity is common in CD. observed a patieiit who claimed to have no k i s - l (DSM-IV) co-morbidity, mainly of visual awareness of his immediate environment, depression and anxiety disorders, is observed but who was reasonably able to maneuver in 22-75 per cent of the patients (Mace and through an exan-iiriation room without bump- Trimble, 1996; Binzer ct al., 1997; Crirrilisk et al., ing iiito the furniture. In the case of conversion 1998). Personality disorders are observed in paralysis, a conversion patient is unable to move 37-59 percent of the patients (Binzer et al., one or more parts of the body intentionally.

1997; Crimlisk et al., 1998; Moeiie et al., 2001; Under less controlled or intentional circum- Roelofs e r al., 2002b). In some of these studies, stances such as diiring sleep (Lauerina, 1993) or histrionic personality disorders have been hypnosis (Moene et nl., 1998) the patient may, observed, but other types of disorders such as however, show soine movement with the deperident personality disorder are far more affected area. Ziv et al. (1998) clearly deinon- comrnon. The co-morbidity rates of neurologi- strated this pherionienon by testing the involun- cal disorders largely depend on the treatment tary exterision of an affected leg when setting. Mrhereas approximately 50 percent of voluntarily flexing the contralateral ínorrnal the patients in neurological settings show neu- functioning) leg against resistance. Compared rological co-morbidity (Marsden, 1986; Factor with healtliy coiitrols and patients with neuro- et nl., 1995), only 3 percent of the patients logica1 weakness, patients with conversion in psychiatrie settings were identified to have paralysis showed significantly more involuntary additional neurological disorders (Roy, 1979). than voluntarily limb contractions with the Despite the difficulties of excluding neurologi- affected limb. These discrepancies between cal disease and malingering, CD can be diag- explicit (voluntary) and implicit (involuntary) nosed with a fair amoiint of reliability provided motor as wel1 as sensory functions have raised a standard diagnostic protocols are carefully fol- lot of confusion in clinica1 practice. The ques- lowed (e.g. Crinilisk et al., 1998; Halligan et al., tion of what accounts for these contradistory 2001). This view was recently supported by two phenomena has intrigiied and preoccupied neurophysiological studies showing differential philosophers, psychiatrists and neurologists neurophysiological correlates for CD and malili- throughout history.

gering in cases of sensory (Lorenz et al., 1998) and motor loss (Speiice et al., 2000), respectively.

26.3. Explanatory constructs 26.2. Theoretica1 models

observed with CD patients, we focus here on Despite the variety of manifestations of conver- dissociative explanations. The basic assumption Sion symptonis, the symptoins share one impor- of dissociation theory is that under the influence tant feature, i.e. the CD patient's symptom of psychological stress, dissociation can occur presentation is observably altered by environ- between higher level explicit inforrnation pro- mental and social influences, yet the patient cessing and lower level implicit information reinains unaware of it. There rippears to be a dis- processiiig, in which the explicit information connection between conscioiis esperience or processes fail (Janet, 1907). According to this knowledge and irriplicit automatic or proce- theory, the apparent contradictions in symptom dural knowledge (Kihlstrorn, 1992). For esarn- presentatiori in the previously mentioned exam- ple, Bryarit and McConkey (1989) showed that ple of conversion blindness where the patient