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Cited by 111Psychosomatic Disorders and Their TreatmentsPain Management and Placebo EffectPsychoanalysis and Psychopathology Research

Life events and escape in conversion disorder

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Nicholson, T. R., Aybek, S., Craig, T., Harris, T., Wojcik, W., David, A. S., Kanaan, R. A·2016·Psychological Medicine
DOI 10.1017/s0033291716000714PMC PMC4988265
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Abstract

BACKGROUND: Psychological models of conversion disorder (CD) traditionally assume that psychosocial stressors are identifiable around symptom onset. In the face of limited supportive evidence such models are being challenged. METHOD: Forty-three motor CD patients, 28 depression patients and 28 healthy controls were assessed using the Life Events and Difficulties Schedule in the year before symptom onset. A novel 'escape' rating for events was developed to test the Freudian theory that physical symptoms of CD could provide escape from stressors, a form of 'secondary gain'. RESULTS: CD patients had significantly more severe life events and 'escape' events than controls. In the month before symptom onset at least one severe event was identified in 56% of CD patients - significantly more than 21% of depression patients [odds ratio (OR) 4.63, 95% confidence interval (CI) 1.56-13.70] and healthy controls (OR 5.81, 95% CI 1.86-18.2). In the same time period 53% of CD patients had at least one 'high escape' event - again significantly higher than 14% in depression patients (OR 6.90, 95% CI 2.05-23.6) and 0% in healthy controls. Previous sexual abuse was more commonly reported in CD than controls, and in one third of female patients was contextually relevant to life events at symptom onset. The majority (88%) of life events of potential aetiological relevance were not identified by routine clinical assessments. Nine per cent of CD patients had no identifiable severe life events. CONCLUSIONS: Evidence was found supporting the psychological model of CD, the Freudian notion of escape and the potential aetiological relevance of childhood traumas in some patients. Uncovering stressors of potential aetiological relevance requires thorough psychosocial evaluation.

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  • PNES are supposed to be not only a neuropsychiatric symptom, but an unconscious psychological defense mechanism to protect affected individuals from unwanted and overwhelming emotions in order to maintain their intrapsychic balance.

    “Therefore, PNES are supposed to be not only a neuropsychiatric symptom, but an unconscious psychological defense mechanism to protect the affected individuals from unwanted and overwhelming emotions in order to maintain their intrapsychic balance (14, 16).”

    From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [16]

    The Introduction describes a psychological model in which the ‘unbearable affect’ of stressors is converted into physical symptoms, reducing that affect. But the study examined motor conversion disorder, not PNES specifically, and the Discussion (Implications) reports no evidence of repression in its sample. The source supports the claim as a historical theory, not as an established unconscious defense mechanism in PNES. (LLM, conf=0.86)

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1 of the 37 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Neilson E, Brown GW, Marmot M (1989). Myocardial infarction In Life Events and Illness (ed. G. W. Brown and T. O. Harris). Guilford Press: New York.
  2. Wing JK, Cooper JE, Sartorious N (1974). The Measurement and Classification of Psychiatric Symptoms: An Instruction Manual for the Present State Examination and CATEGO Programme. Cambridge University Press: London, England.

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Authors
Nicholson, T. R., Aybek, S., Craig, T., Harris, T., Wojcik, W., David, A. S., & Kanaan, R. A.
Affiliations
  • King's College London (GB)
  • University of Geneva (CH)
  • The University of Melbourne (AU)
Corresponding author
Nicholson, T. R.
ORCID
Venue
Psychological Medicine
Publisher
Cambridge University Press (CUP)
Published
2016-07-05
Volume
46
Issue
12
Pages
2617-2626
ISSN
  • 0033-2917 (ISSN-L)
  • 1469-8978
DOI
10.1017/s0033291716000714
PMC
PMC4988265
OpenAlex
W2474723969
Cited by
110
References
37
Citations by year
2026: 6 · 2025: 13 · 2024: 6 · 2023: 7 · 2022: 14 · 2021: 8 · 2020: 17 · 2019: 14 · 2018: 14 · 2017: 9 · 2016: 2
FWCI
11.40
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychological Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • Research Portal (King's College London) (submittedVersion, cc-by)
Funders
  • National Institute for Health and Care Research
  • King's College London
  • Medical Research Council
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
conversion disorder, life events, escape, secondary gain, Freudian theory, psychosocial stressors, depression, child sexual abuse, symptom onset, psychosocial assessment
MeSH terms
Adult Survivors of Child Adverse Events, Adult, Conversion Disorder, Female, Humans, Life Change Events, Male, Middle Aged, Sex Offenses

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