Conversion Disorder. J.P. Leleszi, D.O . FAACAP, FAPA, FACN, FAAHPM Director of Pediatric Consultation/Liaison and Palliative/Hospice Psychiatry Children’s Hospital of Michigan Associate Professor - Psychiatry Wayne State University Medical School. Antigone by Sophocles.
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J.P. Leleszi, D.O.
FAACAP, FAPA, FACN, FAAHPM
Director of Pediatric Consultation/Liaison and Palliative/Hospice Psychiatry
Children’s Hospital of Michigan
Associate Professor - Psychiatry
Wayne State University Medical School
“No one loves the
messenger who brings
Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision American Psychiatric Association
The hypothesis that the individual’s somatic symptom represents a symbolic resolution of an unconscious psychological conflict, reducing anxiety and serving to keep the conflict out of the person’s awareness.
The emotional conflict is kept from the person’s awareness by the use of a somatic symptom.
External benefits are obtained or
dangerous or undesired responsibilities
Frequently Do Not Recognize
The Various Forms of
“the beautiful indifference”
DO NOT WANT TO BE IN A
ON the surgeon.
“When I first saw you at Children’s,
you told me to “get out of bed”.
I knew right then and there
If I didn’t I would be dead!
At first I didn’t like you I thought
you were being mean.
I knew at this point in time
I had to grow up and be a teen.
Once I was in the process, the family
And soon I could slowly see
my problems begin to dissolve.”
17 year old male, three younger siblings; single mother, father in and out of his life last 12 years.
GPA: 9th 3.5; 10th 3.25; 11th 2.20; 12th not in school
Post high school hopes – Central Michigan for chemical engineering
Worked 9 months successfully earning $100 a week in fast food industry, promoted to head cashier
“I work hard and am honest. I pay for all my school stuff helping out my Mom”
“Change in management in 11th grade, new manager brought in his family members; “I was the last one left. He said I stole, so we argued and I was let go”
“Two weeks later I fell out in school”
“My doctor said it was nerves, but the guidance center said I didn’t have a problem so they let me go”
”The emergency doctor said I have seizures and now on Trileptial”
Four hospitalizations in past 6 months, multiple ambulance brought emergency department visits
“I still fall out and all the tests are normal” said with la belle indifference
Taught his body is talking for him not his words
Not faking anything – relieved, “So I’m not going crazy?”
Primary gain: Do not physically attack your accuser so you don’t go to jail.
Secondary gain: Not attending school, not needing school expense money, no money stress for his mother.
Not successful as defense mechanism:
a. Can not get into Central Michigan
b. Not helping his family
c. Issues of emancipation, individuation, and
d. Prior medical interventions not successful
a. Close to sister who left her for college
b. Soon after sister left, mother diagnosed with cancer, fear of her mother dying
c. Everyone at school telling her how mature and bright she is and how happy she’ll be away at
college, when she never told anyone she is terrified to leave home at this time
la belle indifferent affect, “I’m used to these. It doesn’t stop me from going to all of the school dances and watching my friends.” Mother weeping silently, father glaring angrily.
“This doctor doesn’t have a leg to stand on”
“Thanks, but my daughter is no psycho”
“I have no sons and the other two are girls”
infection of Neisseria gonorrheae along with Candida albicans