The DOI matches its Crossref record; 36 of the 37 references it cites were found in a registry or an index.
Life events and escape in conversion disorder
Open accessAbstract
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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“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]
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Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders
Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., LaFaver, K., LaFrance, W. C., Lang, A. E., Nicholson, T., et al. (2018) · JAMA Neurology · doi:10.1001/jamaneurol.2018.1264 · Cited by 786
Ludwig, L., Pasman, J. A., Nicholson, T., Aybek, S., David, A. S., Tuck, S., Kanaan, R. A., Roelofs, K., Carson, A., & Stone, J. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30051-8 · Cited by 495
Pathogenesis and pathophysiology of functional (psychogenic) movement disorders
Baizabal-Carvallo, J. F., Hallett, M., & Jankovic, J. (2019) · Neurobiology of Disease · doi:10.1016/j.nbd.2019.02.013 · Cited by 163
Stress and functional neurological disorders: mechanistic insights
Keynejad, R. C., Frodl, T., Kanaan, R., Pariante, C., Reuber, M., & Nicholson, T. R. (2019) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2018-318297 · Cited by 151
Perez, D. L., Aybek, S., Popkirov, S., Kozlowska, K., Stephen, C. D., Anderson, J., Shura, R. D., Ducharme, S., Carson, A. J., Hallett, M., et al. (2020) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.19120357 · Cited by 134
Metadata
- 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.
- 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
- 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
- hybrid
- doi.org
- 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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