Barr R, Abernethy V
J Nerv Ment Dis. 1977 Apr;164(4):287-92.
The criteria for differentiating between psychophysiological disorder and hysterical neurosis, conversion type, have been reviewed in the light of recent biofeedback research. The data strongly support the view that a single process, instrumental learning, can explain functional disorders mediated by either the voluntary or autonomic nervous systems, so that a differential diagnosis should probably not be based on the autonomic/voluntary dichotomy. On the contrary, both biofeedback findings and a case history support the definition of conversion reaction broadened to include fantasied bodily sensations that develop into either behavioral or physiological dysfunctions. It is a central consideration that instrumental learning depends on a system of rewards, and that, in clinical observations of conversion reactions, it also is apparent that the conversion sympton is rewarding: the sympton provides the patient with a relatively gratifying adaptation to a frustrating stressful life experience. Classification of many, if not most, functional disorders mediated by the autonomic nervous system as conversion reactions has the advantage of emphasizing the primary and secondary gain characteristics of these symptoms. Thus, the use that the patient makes of his illness becomes salient in the therapeutic process at the same time that the diagnosis is established.
根据最近的生物反馈研究，对区分心理生理障碍和癔症性神经症（转换型）的标准进行了回顾。数据有力地支持了这样一种观点，即单一过程，即工具性学习，可以解释由自主神经系统或躯体神经系统介导的功能障碍，因此鉴别诊断可能不应基于自主/躯体二分法。相反，生物反馈研究结果和一个病例史都支持将转换反应的定义扩大到包括发展为行为或生理功能障碍的虚幻身体感觉。一个核心考量是，工具性学习依赖于一个奖励系统，而且在对转换反应的临床观察中，转换症状具有奖励作用这一点也很明显：症状为患者提供了一种相对令人满意的方式，以应对令人沮丧的压力性生活经历。将许多（如果不是大多数）由自主神经系统介导的功能障碍归类为转换反应，具有强调这些症状的原发性和继发性获益特征的优势。因此，在确立诊断的同时，患者对其疾病的利用情况在治疗过程中变得显著。
