Diagnosis and treatment of hysterical conversion reactions

SUMMARY Twenty children with hysterical conversion reactions were reviewed. The ways in which they became ill, the attitudes of their families to their illnesses and their underlying personal problems were noted. Treatment comprised avoiding unnecessary investigations and removing symptoms by using graded exercises given by physiotherapists. Exploration of the underlying psychological problems took place at a pace with which the family could cope because many families were reluctant at first to accept that the illness was psychological. Seventeen of the 20 children recovered completely within three months of starting treatment. The results show that early diagnosis and close liaison between paediatricians, physiotherapists, and child psychiatrists are necessary if prolonged handicap is to be avoided. Hysterical conversion reactions are not common in the United Kingdom ' being diagnosed in between 0-5-1 % of referrals'to a child psychiatric inpatient centre2 3and 1 % of referrals to adult neurological units.4 The prevalence in paediatric practice is not known. When they do arise, however, they presen