International Handbook of Clinical Hypnosis - E-Lib FK UWKS

160 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
`converted itself' into another. It is not dif®cult to recognize in this echoes of
hysteria.
In DSM-IV APA, 1994), conversion disorder is de®ned as follows: the diagnosis
`conversion disorder' is applicable when the complaints consist of unexplainable
disorders of the voluntary muscular tissue or of the sensory functions. The
symptoms suggest a neurological or other physical disorder. However, no physical
explanation for the complaints is discovered, so they are referred to as pseudoneurological.
Moreover, psychological factors e.g. stress) should be associated with the
onset or an exacerbation of the complaints.
The theories which attempt to explain the onset of a conversion disorder are
speculative in nature. Good empirical research is lacking, but theories that have
stood the test of time have one important aspect in commonÐthe underlying notion
that conversion symptoms are brought on by particular events that are experienced
as threatening or catastrophic. These can be either one-off calamities or threatening
circumstances that persist over many years.
Support for this supposition has come from, for example, studies of incest
victims and the incidence of conversion symptoms in men during wartime. Albach
1993) studied the incidence of conversion symptoms in victims of incest n ˆ 97)
and in a control group n ˆ 65). The ®nding was that the women in the incest
group exhibited these phenomena signi®cantly more often. Paralysis, blindness,
deafness and similar af¯ictions were shown by 26%, as against 0% in the control
group. For fainting, the percentages were respectively 28 and 0%. For `hysterical
attacks'Ðthe term used to cover episodes of kicking and screaming followed by
imperfect memory of the eventÐthe percentages were respectively 28 and 3%.
These are impressive differences, though it must be noted that much could be said
about the methodology employed in this study.
Farley, Woodruff & Guze 1968) also found a high incidence of conversion
symptoms in 100 otherwise healthy mothers of new-born children. The percentages
here were: paralyses, 22%; fainting, 5%; hysterical attacks, 4%. It should be noted,
however, that the authors did not check for a history of incest.
The disorder is rare in men, except in wartime. `We've never seen so much male
hysteria,' commented Binswanger in his book on war hysteria, recounting his
experiences of treating First World War soldiers Binswanger, 1922). Carden &
Schramel 1966) studied 12 Vietnam soldiers with conversion disorders. In each
case, the conversion symptoms had come on quite soon within hours or days)
following a traumatic event e.g. a bomb attack).
Recent research has pointed to a relationship between trauma and dissociation
Boon & Draijer, 1993; Chu & Dill, 1990; Vanderlinden, van Dyck, Vandereycken &
Vertommen, 1993; for an overview, see Spiegel, 1993). Cognitive theorists such as
Kihlstrom see conversion disorder as a dissociative disorder Kihlstrom, 1992a) and
indeed it is classi®ed as such in ICD-10 World Health Organization, 1992). There are
indications that the way in which the memory of traumatic events is stored differs
from the norm Alpert, 1995; Christianson, 1992; Le Doux,1993; van der Kolk, 1994;