Strategic-behavioral intervention in the treatment of chronic nonorganic motor disorders.

Chronic nonorganic motor disorders pose particular difficulties because of a combination of diagnostic confusion and intractability to psychotherapeutic or behavioral interventions. Three cases are presented, all of whom failed a rehabilitation approach that emphasized basic behavioral principles of shaping and reinforcement. Despite this initial failure, all three patients showed dramatic and rapid improvement after implementation of an intervention combing elements of strategic and behavior therapy. The strategic element consisted of placing patients in a double bind by telling them full recovery constituted proof of an organic etiology and failure to recovery constituted conclusive evidence of a nonorganic or psychiatric etiology. These cases also illustrate the difficulty in distinguishing between conversion and factitious disorders.