Conversion Disorder
Something I've long suspected was somewhat confirmed last night. I was talking with a number of new attendings (faculty physicians) in our department who have come recently from a variety of areas around the country, and they all voiced the same sentiment regarding what has surprised them the most about coming to Birmingham. Namely, the remarkably high incidence of conversion disorder found here.
For those of you not in medicine, conversion disorder is any constellation of physical symptoms that do not have a physical cause. To be clear, this is not under the conscious control of the patient, ie the patient is not just "faking it." This is a well-known phenomenon, as we have all experienced mild versions of it, like a nervous diarrhea before a big test or something like that.
To see patients with conversion symptoms every once in a while is inevitable in the medical field. But since moving here, I've encountered an alarming number of patients with conversion disorder in the hospital and in the clinic, and apparently I have not been alone in this observation. Reviewing our numbers here, a full 40% of the patients admitted to our seizure monitoring unit in the past year were found to have psychogenic pseudoseizures. Roughly 30% of patients who have presented to our emergency room with stroke-like symptoms were found to have conversion disorder. The issue for me is mainly the cost burden that this presents, both in terms of physician time and hospital resources. But why is there so much conversion disorder in the south? And how do we combat the problem?
My wife, the psychiatrist in the family, says that it is because of "Southern repression." By this she means to say that in order to preserve social appearances, psychologic stressors are repressed. Combine this with the social stigma of "needing to see a psychiatrist," especially compared to less socially conservative parts of the country, and there is your cadre of patients with symptoms manifested when their psyche can repress the stresses no longer.
Understand that these are my personal ramblings as I struggle to provide as excellent care to these patients as those who are having a physiologic stroke that threatens their life. I know that it is equally debilitating to not be able to move half of one's body from a stroke as from conversion disorder. But am I wrong for feeling frustrated by this at 3 in the morning when I have other patients who may suffer for the time I am spending telling a patient that they have nothing physiologically wrong with them?
For those of you not in medicine, conversion disorder is any constellation of physical symptoms that do not have a physical cause. To be clear, this is not under the conscious control of the patient, ie the patient is not just "faking it." This is a well-known phenomenon, as we have all experienced mild versions of it, like a nervous diarrhea before a big test or something like that.
To see patients with conversion symptoms every once in a while is inevitable in the medical field. But since moving here, I've encountered an alarming number of patients with conversion disorder in the hospital and in the clinic, and apparently I have not been alone in this observation. Reviewing our numbers here, a full 40% of the patients admitted to our seizure monitoring unit in the past year were found to have psychogenic pseudoseizures. Roughly 30% of patients who have presented to our emergency room with stroke-like symptoms were found to have conversion disorder. The issue for me is mainly the cost burden that this presents, both in terms of physician time and hospital resources. But why is there so much conversion disorder in the south? And how do we combat the problem?
My wife, the psychiatrist in the family, says that it is because of "Southern repression." By this she means to say that in order to preserve social appearances, psychologic stressors are repressed. Combine this with the social stigma of "needing to see a psychiatrist," especially compared to less socially conservative parts of the country, and there is your cadre of patients with symptoms manifested when their psyche can repress the stresses no longer.
Understand that these are my personal ramblings as I struggle to provide as excellent care to these patients as those who are having a physiologic stroke that threatens their life. I know that it is equally debilitating to not be able to move half of one's body from a stroke as from conversion disorder. But am I wrong for feeling frustrated by this at 3 in the morning when I have other patients who may suffer for the time I am spending telling a patient that they have nothing physiologically wrong with them?
posted by Victor | 7:19 PM
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