Self-Protective Organization in Children with Conversion Symptoms: A Cross-Sectional Study Looking at Psychological and Biological Correlates

Kozlowska K, Williams LM; Self-Protective Organization in Children with Conversion Symptoms: A Cross-Sectional Study Looking at Psychological and Biological Correlates. Mind & Brain, the Journal of Psychiatry, August  2010; 1(2):  43-58

REVIEW ARTICLE


Kasia Kozlowska^1,2 and Leanne M Williams²

Affiliations : ¹Department of PsychologicalMedicine, The Children’s Hospital atWestmead,Westmead, NSW, Australia and ²Brain Dynamics Centre, Sydney Medical School and Westmead Millennium Institute at Westmead Hospital, Westmead, NSW, Australia

ABSTRACT

Conversion disorder remains a long-standing puzzle concerning the interconnections of brain, mind, and body. Contemporary psychological assessments and neurophysiological techniques create a new window for investigating those interconnections, but the widely varying presentations of conversion disorder have made it difficult to isolate clinically well-defined groups for controlled studies. To overcome such difficulties, we propose an integrative framework to link the conceptualization of symptoms with levels of organization, as assessed by brain–body measures. We conceptualize conversion symptoms as the motor-sensory components of broader self-protective patterns of response—integrated sets of reactions involving physiological, motor-sensory, and psychological subcomponents—or their unwanted consequences. We describe a research program aimed at testing these relationships in children presenting with acute “conversion symptoms,” including somatoform pain. These relationships are examined using a standardized test battery that includes psychological measures (symptoms, attachment strategy, distress, daily function, life-event profile), measures of cognitive performance (on both general and emotional domains), and neurophysiological measures of brain and body function (including electroencephalogram, event-related potentials, heart rate, and skin conductance). Enrollment is under way for a minimum target of 40 children with acute conversion symptoms, 40 children with medically unexplained pain, and 40 healthy, matched controls. Our expectation is that these data will advance our understanding of conversion disorder and also improve the clinical care of this patient population.

Keywords: Conversion disorder, Somatoform pain disorder, Medically unexplained symptoms, Self-protective organization, Biologicalmarkers,
Emotion processing, Dynamic-Maturational Model of attachment, Integrative neuroscience
Correspondence: Kasia Kozlowska, Department of Psychological Medicine, The Children’s Hospital atWestmead, Locked Bag 4001,Westmead,
NSW 2145, Australia. Tel: 61-2-9845-2005; Fax: 61-2-9845-2009; e-mail: kasiak@chw.edu.au