Childhood conversion reactions in the emergency department: Part I--Diagnostic and management approaches within a biopsychosocial framework.

The pediatric emergency physician faces several difficulties when he is unable to diagnose an organic etiology that sufficiently explains a child's somatic symptoms. Biomedical or psychological approaches alone often result in unsatisfactory outcomes, such as continued symptomatology, increased family anxiety, and either excessive or suboptimal use of medical resources to search for less obvious diseases. This paper suggests that the best approach toward a child's unexplained somatic symptoms is a biopsychosocial orientation that includes conversion reaction within the differential diagnosis. Comprehensive strategies are described for both diagnosis and management of conversion reactions so that both organic and psychosocial factors can be understood and addressed in the emergency department setting. Prognosis, epidemiology, and questions involving the definition of conversion reaction are also discussed. A follow-up paper will address specific diagnostic issues regarding both the general features and the most common presentations of conversion reactions.