Research paperConversion disorder: A systematic review of current terminology
Introduction
Conversion disorder is a condition where neurological symptoms are present without an identifiable “organic” neurological cause, and which are instead understood to be psychiatric in origin [1]. The disorder is widely considered to be unpopular with patients and clinicians [2], with uncomfortable diagnostic encounters and patients feeling dismissed [3], [4]. It has been argued that the diagnostic labels used contribute to this - stigmatising patients and implying unhelpful aetiologies - and there has been intense recent debate over the need for a change [5], [6], [7], [8], [9].
Clearly this discussion is not new. The historical term, hysteria, was replaced by conversion disorder as recently as ICD-10 and DSM-III, presumably at least as much for its public connotations of emotional explosiveness as for its aetiological connotations of a wandering womb [10]. New terminology has flowered, but divided along aetiological lines (dissociation, stress) and those that shun aetiology (unexplained, non-epileptic); and between those of neurologists (functional, non-organic) and psychiatrists (conversion, psychosomatic). There is no consensus, even among the official diagnostic manuals, with both ICD and DSM hedging their bets, in “dissociative (conversion) disorder” and “conversion (functional neurological) disorder”, respectively. This proliferation of terms may of course be as unhelpful as the terms themselves.
There have been several attempts to clarify clinicians' and patients' preferences with empirical surveys. This article aims to systematically review those surveys to see whether a consensus can be found.
Section snippets
Methods
Internet databases were searched for articles examining the use of terminology in conversion disorder from inception to May 2015. This included PubMed and OVID combined searches of EMBASE, MEDLINE and PSYCINFO. The MeSH terms “conversion disorder” and “Terminology as topic” were used, with search terms (“conversion disorder” or “psychogenic motor” or “medically unexplained”) and “terminology”, returning 31 and 54 abstracts from PubMed and OVID respectively. Excluding duplicates left 55
Clinician perspectives
There were 4 studies identified that assessed clinician preferences, all by questionnaire (see Table 1).
The earliest study surveying clinician's preferences was by Mace & Trimble in 1991. This survey of 168 British neurologists found that the most popular terms used either informally/formally were “hysteria”, “functional” and “psychogenic” [11]. Notably, when questioned on what was classified as functional, the majority of neurologists considered Munchausen's syndrome should be and a minority
Discussion
This review found seven studies that investigated the use of terminology in conversion disorder with varying results. Though the seven studies had only partial overlap in the terms considered (see Table 3), many compared the terms “functional” and “psychogenic” and “non-neurological/organic/epileptic”, with few studies looking at any of the other terms. Classifying ‘endorsement’ and ‘rejection’ on the basis of terms' preference relative to other terms surveyed, ‘endorsed’ being those in the top
Conflicts of interest and source of funding
None declared.
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