Pediatric Case Study and Review: Is it a Conversion Disorder?

• Published in: International journal of psychiatry in medicine Vol. 38; no. 2; pp. 185 - 193
• Main Authors: Spratt, Eve G., Thomas, Stephanie G.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-01-2008; Baywood; Sage Publications Ltd
• Subjects: Adolescent; Adult and adolescent clinical studies; Alcoholism - diagnosis; Alcoholism - psychology; Arm; Arteriovenous Malformations - diagnosis; Arteriovenous Malformations - psychology; Attention Deficit and Disruptive Behavior Disorders - diagnosis; Attention Deficit and Disruptive Behavior Disorders - psychology; Biological and medical sciences; Birth defects; Blood and lymphatic vessels; Cardiology. Vascular system; Comorbidity; Congenital diseases; Conversion disorder; Conversion Disorder - diagnosis; Conversion Disorder - psychology; Diagnosis, Differential; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Edema - diagnosis; Edema - psychology; Female; Hemorrhage - diagnosis; Hemorrhage - psychology; Humans; Hypnosis; Magnetic Resonance Imaging; Marijuana Abuse - diagnosis; Marijuana Abuse - psychology; Medical diagnosis; Medical sciences; Mental disorders; Paresis - diagnosis; Paresis - psychology; Patient Care Team; Patients; Pediatrics; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Somatoform disorders. Psychosomatics; Spinal Cord - blood supply; Tobacco Use Disorder - diagnosis; Tobacco Use Disorder - psychology; arteriovenous malformation; conversion disorder; diagnostic errors; Human; Pediatrics; Medical error; Cardiovascular disease; Review; Congenital disease; Vascular disease; Case study; Somatoform disorder; Adolescent; Somatic conversion; Diagnosis; Woman; Arteriovenous malformation
• ISSN: 0091-2174; 1541-3527
• DOI: 10.2190/PM.38.2.e

Objective:
It is common in health care settings for adolescent patients to report physical symptoms that are unexplained by physical disease or pathophysiologic processes. The diagnosis of conversion disorder is difficult to make as many of these patients present to primary care with complex, difficult-to-understand medical symptoms. Patients can present with a medical dilemma and a symptom model consistent with a conversion disorder, but there is a danger of misdiagnosis without a thorough medical work up.
Method:
This case report describes a patient where the misdiagnosis of conversion disorder could have had devastating long-lasting neurologic sequelae. It appeared as if an unconscious conflict was being expressed through physical symptoms as she had ongoing family stressors prior to the onset of mysterious symptoms.
Conclusions:
The patient was found to have a spinal cord arteriovenous malformation. This condition is relatively uncommon in the pediatric age group, and early diagnosis is rarely made.