Read: When clinicians assume that somatic complaints are the result of somatic symptom disorders, they must be quite certain of their diagnosis. A false negative (failing to see an existing physiological condition) is a much more serious mistake than a false positive (claiming that a physiological condition exists when there is none). The wise psychologist makes sure that every conceivable medical test and specialist has been used prior to concluding that conversion disorder is the correct diagnosis. Consider this case presented by Fishbain and Goldberg. A young man was in a fight when he was hit over the head with a bottle. He was arrested for assault and taken to the hospital. He never lost consciousness and x-rays of his skull showed no fracture. Neurological examinations were normal. However, the patient complained that he was unable to move his left arm and leg. He was reassured by hospital personnel and when given the direct suggestion that he was able to move the arm and leg, he moved them. Over a period of time, the patient continued to complain of an inability to move his left limbs, was reassured that he could, and showed movement. He was diagnosed with conversion disorder. Only later, using CAT scans, which can detect damage better than x-rays, did doctors discover that he had a hematoma (bloody swelling) in the right frontoparietal area of the cortex, which accounted for his incomplete loss of movement on the left side. In a study of 30 patients diagnosed with conversion disorder, 80 percent were eventually found to have a medical disorder that was the cause or contributing factor of symptoms that were originally believed to have a psychological origin. In many cases, current technology cannot detect physiological causes of neurological disorders in their earliest stages. To immediately assume that disorders are conversion disorders, with the social stigma attached, is to be reckless in diagnosis. Two key factors in separating conversion from physiological disorders are selective symptoms and la belle indifference. Selective symptoms are evident when, for instance, a paralyzed leg moves when the person is asleep or when blind individuals can see well enough to catch an object thrown unexpectedly. La belle indifference is a traditional sign of conversion: the individual’s way of discussing symptoms and their impact in a dispassionate, even unconcerned, manner. Patients with organic disorders, especially those whose impairment has been sudden and traumatic, are likely to be quite upset about their symptoms. However, this “beautiful indifference” is reported in only about one-third of individuals with conversion disorder so this is not a very strong means of differentiating psychological and physiological disorders either. Sources: Fishbain, D. A., & Goldberg, M. (1991). The misdiagnosis of conversion disorder in a psychiatric emergency service. General Hospital Psychiatry, 13, 177–181. Discussion: In 2012, several teenage girls in the same high school in LeRoy, New York developed unexplained tics. The situation captured national attention and some of the girls were interviewed, along with therapists who identified a possible cause as conversion disorder. Links to some of the many interviews (CBS, 2012; NBC, 2012), written reports (Dominus, 2012; Nickell, 2012), and follow-up commentary (Gulley, 2012; Skeptical Raptor, 2013) are provided below. What were the symptoms, what was the public response, what theories evolved or came about, and what was the eventual diagnosis? Sources: CBS. (2012). Medical mystery: “Conversion disorder” [Video: 3:16]. Charlie Rose and Erica Hill speak with Dr. Jennifer McVige, a pediatric neurologist, about the mysterious illness that had more than a dozen N.Y. teens from the same upstate school suffering from tics. http://www.cbsnews.com/videos/medical-mystery-conversion-disorder/ (Links to an external site.) Dominus, S. (March 7, 2012) What happened to the girls in LeRoy, The New York Times. http://www.nytimes.com/2012/03/11/magazine/teenage-girls-twitching-le-roy.html?pagewanted=all&_r=0 (Links to an external site.) Gulley, N. (June 23, 2012). School’s end clears up New York students’ mystery twitching. Reuters, U.S. ed. [Online]. http://www.reuters.com/article/2012/06/23/us-students-twitcnew-york-h-idUSBRE85M0DF20120623 (Links to an external site.) NBC. (2012). School baffled by 12 girls’ mystery symptoms. [Video: 6:51] NBC Today exclusive interview with 2 of the girls suffering symptoms. The therapist identifies conversion disorder as a possible diagnosis. https://www.youtube.com/watch?v=T9RPs_ysYgE (Links to an external site.) Nickell, J. (July/August 2012). Neurologic illness or hysteria? A mysterious twitching outbreak. The Committee for Skeptical Inquiry, 36(4) [Online]. http://www.csicop.org/si/show/neurologic_illness_or_hysteria_a_mysterious_twitching_outbreak/ (Links to an external site.) Skeptical raptor. (Oct. 31, 2013). Whatever happened to the LeRoy mystery neurological illnesses? Skeptical Raptor’s Blog [Online]. http://www.skepticalraptor.com/skepticalraptorblog.php/whatever-happened-leroy-mystery-neurological-illnesses/ (Links to an external site.) For this discussion, you will submit a post that is between 400-500 words minimum. Using APA for both in-text citations and works cited.You do not need a running header, page number, or abstract. You will answer the following post and back up your responses with reliable sources.
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