Helping Your Child With a Conversion Disorder
A Convergence Disorder is when the body -- for psychological reasons -- displays what looks like a medical disorder, when there is no medical origin or explanation for the symptoms.
While chronic pain is not a Conversion Disorder (CD), these two syndromes sometimes co-occur or appear at different times in a person’s life. Those with a history of medical ailments are more susceptible to developing a Conversion Disorder. In addition, many people with CD also have comorbid anxiety and/or depression.
For example, it can look like the person with CD is having a seizure, but there is no epileptic seizure activity occurring in the brain. Other examples of CD symptoms are drop attacks (suddenly falling/passing out), and sudden/transitory paralysis, blindness, or deafness. The symptoms feel so real -- and they are -- they just don’t have a medical basis.
The child with CD will experience the symptoms in the same way as if there was a medical cause. The symptoms are not made up, so they are just as scary as they would be if there was a medical cause. The good news is that, because there is no medical issue, the symptoms are ultimately not as serious because they can be helped through treatment by a psychotherapist who works with Conversion Disorders.
Note: This blog is in no way intended as a substitute for treatment.
Conversion Disorder is something that requires therapy for the child and the family. This blog is intended to give some initial help to parents navigating their way to finding the right practitioners to help. You can use this information to start working on helping your child now, but you need to find a therapist who has experience working with Conversion Disorders or somatic (bodily) symptoms to get the full benefit.
First off, you need to rule out medical causes for your child’s symptoms. Once that is done and practitioners feel that the symptoms are psychogenic, you will need a therapist to help you. In the meantime, here are some strategies to get started:
Look for emotional and physical triggers: Begin to take note of when the CD symptoms happen. They can be external (e.g., hearing parents arguing), internal (e.g., feeling anxious) or physical (e.g., feeling fatigued or in pain). Keep a log of when they happen and look for trends. Knowing the triggers can assist in avoiding situations that can cause the symptoms or confronting those situations head-on before the symptoms appear.
Jasmine was a 13-year-old girl whose parent tended to overwhelm her with requests and would repeat a request many times. Jasmine did not feel, based on past experiences, that her parent would stop doing this if she said she was getting overwhelmed and requested a break. So, she would have a non-epileptic seizure, which would allow her to escape the situation. She did not do this consciously -- it came out as part of therapy that this was one of the functions of her symptoms.
Don’t feed the symptoms: Put some thought into the function of the symptoms. Do they help your child avoid conflict or intense feelings? Avoid expectations? Bring attention to your child?
If your child is receiving extra attention during these episodes of CD, especially if the rest of the family is often working or busy, they could be providing your child with secondary gain. While you want your child to be safe, avoid giving too much attention during these episodes.
If you are stressed when these episodes are happening (which is totally understandable, as it can be very frightening), practice taking deep breaths and relaxing your muscles while they occur. The more upset and panicky you are while they are happening, the more attention the episodes (and your child during them) will receive.
During a non-epileptic seizure, do not crowd around, hold, or talk continuously to your child. Move your child to a safe place, if not in one already. Tell your child, “You’re having an episode. You’re safe. I will be nearby and will come back when the episode is finished.”
I have witnessed families giving a great deal of attention and loving care to their children during CD episodes – attention and care that the children are seeking. Focus on giving that attention and comfort when your child is NOT displaying these symptoms.
Many parents feel that they cannot leave their child alone because of the symptoms. This is another way that the child receives attention. Look for safe ways to let your child at least be in a room alone, and focus as much attention as you can while your child is not in an episode.
This becomes even trickier with drop attacks, as parents are understandably concerned that their child will get hurt (particularly head trauma from falling) during one of these. This situation has to be delicately worked out with the therapist and doctor, but in most cases, I have noticed that children typically do not get hurt – perhaps they have a subconscious awareness of their surroundings.
Daisy was a teenager with multiple CD symptoms, one of which was drop attacks that tended to occur when she went into the bathroom to shower. This is obviously a dangerous place to pass out, but somehow she never got hurt. Of course, you have to balance the child’s safety with not giving the symptoms too much attention -- so again, the goal is to attend to the child as much as possible outside of these symptoms. It is very easy to do the opposite, especially when you are trying to get work done during the periods that your child is okay.
The same principle applies for other CD symptoms, such as temporary blindness, deafness, or paralysis. Aside from obviously meeting basic needs, do not pamper or go overboard, doing everything for your child. You do not want to allow for any secondary gain of the symptom and do not want to attend to it too closely. Treat it as something that it is difficult but not alarming or permanent.
When the CD episode is over, that is a good time to comfort your child about how scary it felt and to talk about what the trigger could have been and how your child could get support next time before the symptoms occur.
Create fun experiences to just connect with your child: With a child with CD, so much of the discussion and so many interactions are about symptoms, medical appointments, and such. Carve out 15 minutes per day to just have fun with your child, with no discussion about anything medical. Play a game together, watch a TV show you both enjoy, make a snack, garden, etc. This should happen every day, regardless of symptoms or behavior. We want your child to have as much attention as possible while not having CD symptoms.
If your child has Psychogenic Non-Epileptic Seizures (PNES), do not call them seizures: I like to call them “episodes.” We do not want to call them “seizures” because that invokes an underlying medical cause instead of a psychogenic cause. Epileptic seizures are very scary and very serious -- so calling them seizures will likely cause others to treat your child very carefully and bestow more attention on the symptoms. This will keep your child in the sick role, which we want to reverse.
Jenna is a 12-year-old with non-epileptic seizures. She has older siblings and parents who are all very busy. She has a history of many medical ailments, as well as pain. When I first met her and her family, they referred to her episodes as seizures. Family members would come running to help her. She was held, caressed, talked to like a baby, and became the sole focus of the family. She was never left alone. She said she could not hear during an episode, and so her well-meaning sibling would trace out letters on her hands to communicate during them. It was clear to me that Jenna could hear during the episodes (not all people can) but that the exchange was providing her with much needed attention.
Help your child to express feelings: Many kids with CD have difficulty identifying and/or expressing feelings, especially negative feelings like sadness and anger. Those feelings then come out in other ways through the body.
Sometimes the link is even symbolic. For example, one of my clients with CD was mad at her mother. She did not fully recognize the feeling and did not express it verbally. Instead, while riding in the backseat of the family car, her leg would begin to spasm, kicking (without her control) the passenger seat in front of her that her mom was sitting in.
Encourage your child to express her feelings and just validate them, even if they are angry feelings. You can give your child a journal to write or draw thoughts and feelings in. You can model expressing feelings to your child and invite your child to share her feelings with open-ended questions. Praise your child for being open about those feelings, and be sure not to judge the feelings.
Sometimes children have a CD episode because they feel they cannot express feelings openly without repercussions, so it is important to notice how you react to your child’s expression of feelings. I typically use a metaphor to explain to kids how negative feelings being trapped inside the body lead to physical symptoms:
Imagine your body is a jar, and each negative feeling goes into it like goop. If enough goop builds up in the jar, eventually the lid will explode off. This explosion is like pain or CD symptoms. But if we poke even a small hole in the jar each day, it releases enough of the pressure so that the lid does not blow off.
Aside from just expressing feelings, you can help your child problem-solve how to handle situations that are causing negative feelings or stress in order to try to avoid the issue causing the CD symptoms.
Model calming activities: Listen to a guided meditation with your child or take deep breaths together when your child is stressed. Doing it together helps the child learn the skills and sends the message that it is worth taking the time to calm the body and the mind. Taking walks is also a good way to spend time talking, while getting fresh air and exercise.
Having a child with a Conversion Disorder is very frightening. The symptoms are scary, and your child’s body seems so out of control. I know it feels like there is nothing to do to help your child whose body is betraying her. Normal milestones like going to sleepovers or learning to drive get postponed.
But I promise that there is hope. There are effective treatments. It will take time, and it will require the participation of the entire family, at some level. But in the end, your child will gain insight into her feelings and learn much more effective ways to handle stress.
The calmer and more positive you can stay, the better off your whole family will be. Be sure to get support for yourself too, as this is a very emotional, difficult challenge. In the end, my hope is that your child and your entire family will become closer and more communicative.