Kozlowska Kasia, Williams Leanne M
Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia.
J Psychosom Res. 2009 Sep;67(3):223-33. doi: 10.1016/j.jpsychores.2009.03.016. Epub 2009 May 19.
Two centuries of clinical observations have suggested that conversion symptoms are associated with strong emotions or situations that threaten the individual's physical or psychological integrity. This study tested the hypothesis that childhood conversion reactions reflect the motor-sensory components of two distinct emotional responses (one inhibitory, one excitatory) that develop as adaptations to recurring threats within intimate relationships.
Emotional responses to interpersonal threats were assessed in 28 children with conversion disorders using Dynamic-Maturational-Model (DMM) assessments of attachment. Attachment strategies (the inhibitory, Type A; the balanced, Type B; and the excitatory, Type C) provide information about (1) the child's behavioural (motor-sensory) organization in the face of interpersonal threats, and (2) the information processing that underpins this behavioural organization.
Twelve children (43%) used an inhibitory attachment strategy. Twelve (43%) used an excitatory attachment strategy. A smaller group (14%) alternated between inhibitory and excitatory strategies, their conversion symptoms reflecting the latter.
These data suggest that conversion reactions are not a single clinical entity and reflect the motor-sensory components of two distinct human emotional responses to threat. This distinction may help to account for the broad range of conversion symptoms seen in clinical practice, both those that involve loss of function and can be explained by a central inhibition hypothesis and those that involve positive symptoms and secondary gain.
两个世纪的临床观察表明，转换症状与强烈的情绪或威胁个体身体或心理完整性的情境有关。本研究检验了这样一个假设，即儿童期转换反应反映了两种不同情绪反应（一种抑制性，一种兴奋性）的运动感觉成分，这两种反应是作为对亲密关系中反复出现的威胁的适应而发展起来的。
使用动态成熟模型（DMM）依恋评估法，对28名患有转换障碍的儿童对人际威胁的情绪反应进行评估。依恋策略（抑制性的A型；平衡型的B型；兴奋性的C型）提供了有关（1）儿童面对人际威胁时的行为（运动感觉）组织，以及（2）支撑这种行为组织的信息处理的信息。
12名儿童（43%）使用了抑制性依恋策略。12名（43%）使用了兴奋性依恋策略。一小部分儿童（14%）在抑制性和兴奋性策略之间交替，他们的转换症状反映的是后者。
这些数据表明，转换反应不是一个单一的临床实体，而是反映了人类对威胁的两种不同情绪反应的运动感觉成分。这种区别可能有助于解释临床实践中看到的广泛的转换症状，包括那些涉及功能丧失且可以用中枢抑制假说来解释的症状，以及那些涉及阳性症状和继发获益的症状。
