Metaphor and meaning in conversion disorder: a brief active therapy

Psychogenic Equinovarus Caused by Dislocation of the Chopart Joint Complex

Patients with conversion disorder (CD) present with weakness or unexplained movement disorder that may evolve from inciting psychological events, but presentation with rigid deformity is rare. Only one case of CD presenting as foot deformity with atraumatic rigid psychogenic equinovarus has been reported previously. Here we describe a rare case of psychogenic equinovarus in a physically healthy 10-year-old boy. He had noticed left equinovarus deformity upon waking abruptly but had no history of preceding trauma and no relevant medical history. Computed tomography (CT) images revealed dislocation of the left Chopart joint complex, but clinical examination did not suggest an organic neurologic disorder. On further history taking, he reported that he was under psychological stress because of being required to play baseball against his will. When he was given permission to withdraw from this stressful situation, the equinovarus improved without the need for surgical invention. This report highlights the importance of early and accurate diagnosis of psychogenic equinovarus, so that unnecessary surgery can be avoided. This is the first report of psychogenic equinovarus caused by dislocation of the Chopart joint complex that was confirmed with CT.

Flight into Health: A New Interpretation

Although its origin remains a mystery, the term flight into health has been part of the psychotherapeutic lexicon for more than half a century. Historically, the term has been used as an interpretative label, suggesting that patients who responded “too quickly” to therapeutic intervention were actually engaging in escape tactics. According to this view, rapid responses to therapy were attempts to avoid the pain and anxiety of further exploration and self-disclosure. This article reviews the literature, explores the issues, and presents a radically different view: That most flight into health phenomena actually represent positive and genuine expressions of emerging health and are not self-deceptive pseudosuccesses, as tra-ditionally interpreted. To provide theoretical support for this posi-tion and to explain the phenomenal results often achieved in short-term therapy, the author draws upon the theoretical work of Andras Angyal and his concept of the ambiguous Gestalt. Two relevant case studies are presented.

Psychodynamic psychiatry in the general medical setting

For more than half a century analytically trained psychiatrists have been making observations about psychodynamic factors impacting on medical illness and treatment. Some of these reports have been subsequently supported by evidence-based research while others have been found to be clinically useful to varying degrees even if not substantiated by research. In this article we have presented some of the highlights of the application of psychodynamics to the treatment of physical illness in the general medical setting. It is not meant to be a comprehensive review but we hope it will demonstrate how psychodynamic thinking has permeated many aspects of care in the general medical setting. Topics considered include onset of disease (giving up complex, specificity, role of stress, anniversary reactions), reactions to illness (psychological defenses, fantasies, role of psychotherapy), specific conditions (pregnancy, cancer, human immunodeficiency virus, conversion and alexithymia, heart disease, death and dying), and the doctor-patient relationship.

Valproate in conversion disorder: a case report

Few data are in literature about the pharmacological treatment of conversion disorder and there are not any studies about the use of Valproate extended release (ER) in treating conversion disorder. In this article, we are reporting a case of an Italian woman with a diagnosis of conversion disorder treated effectively and quickly by Valproate ER.

Psychogenic voice disorders--heroes or hysterics? A brief overview with questions and discussion

A brief overview of the field in relation to psychogenic voice disorders is given with reference to past and present terminology used, the common presentations seen, followed by the more subtle or ambiguous examples which may challenge our notions of psychogenic or clear-cut functional versus organic dichotomies. Issues related to aetiology, personality and psychological correlates are discussed, and a number of questions regarding the phenomenology of psychogenic dysphonia and its therapeutic resolution are raised. Since prevalence continues to be significantly in favour of women, it is suggested psychogenic voice disorder as a feminist issue might be worthy of our further consideration.

Psychogenic equinovarus: the importance of recognition and non-operative treatment

Although the potential for musculoskeletal symptoms in hysteric conversion disorder was recognized by Sigmund Freud, reports of it in the orthopaedic literature have been limited to upper extremity manifestations. This study reports 3 cases which illustrate hysteric conversion presenting as primary foot and ankle complaints. Given its relative rarity, it is a diagnosis that is easy to miss. Clinical clues to its diagnosis and accepted methods of treatment are discussed. It is important to realize that this condition arises from an unconscious conflict and does not represent a voluntary falsification of symptoms. As such, confrontational treatment is not generally successful.