Management of conversion disorder.

Conversion disorder is a psychologically produced alteration or loss of physical functioning suggestive of a physical disorder. Conversion symptoms are often superimposed on organic disease and can be overlooked. Psychological techniques are central to the management of conversion symptoms. Principles of psychological management include the following: avoiding confrontation with the patient; avoiding reinforcement or trivializing the symptoms; reviewing results of tests and exams and creating an expectation of recovery; educating the patient by providing a benign explanatory model of symptoms; evaluating the patient's emotional adjustment and referring for psychotherapy when possible. Use of behavior therapy reinforcement and double-bind psychotherapy strategies may be helpful with more chronic or resistant symptoms, especially when there is a history of vague or excessive somatic complaints or significant secondary gain. Four case studies are presented to illustrate these principles.