Behavioural interventions in the rehabilitation of acute v. chronic non-organic (conversion/factitious) motor disorders

Abstract

Background: Repeated case series have documented the effectiveness of multidisciplinary in-patient behavioural treatment for conversion disorders. However, in the absence of controlled research, treatment success could be attributed to providing patients with a face-saving opportunity to get better. Aims: The present study contrasts two behavioural treatments to elucidate the factors underlying successful in-patient rehabilitation ofthis population. Method: Thirty-nine patients underwent a standard behavioural programme. Using a crossover design, patients who did not improve underwent a strategic- behavioural treatment in which they and their families were told that full recovery constituted proof of an organic aetiology whereas failure to recover was definitive proof of a psychiatric aetiology. Results: Chart review indicated that the standard behavioural treatment was effective for 8/9 'acute' patients but only for 1/28 chronic' patients. Of the 21 patients with chronic motor disorder who then underwent the strategic-behavioural intervention, 13 were symptom-free at discharge. Conclusions: The strategic intervention was superior to standard behavioural treatment for patients with chronic motor disorder. Treatment components previously deemed critical for the effectiveness of behavioural treatment may be unnecessary.