The Incidence and Characteristics of Patients with Conversion Reactions: I. A General Hospital Consultation Service Sample

The brief survey data presented above should demonstrate that conversion, or hysteria, still exists in a significant proportion of patients seen in a general hospital psychiatric practice. The critical incidence study would, of course, involve a prospective, case-finding approach rather than relying upon identification through consultation request, since the conversion mechanism, like tuberculosis and syphilis, is a "great imitator." In addition, the frequent coexistence of conversion reaction with demonstrable organic disease mitigates against early recognition by physicians of the psychological disturbance. There does seem to be some reciprocal relationship between depression and conversion reaction which is not completely accounted for by diagnostic distortion. Conversion reactions are found in men at a frequency about half that in women. Finally, patients recognized as having conversion symptoms are referred for outpatient psychotherapy much more often than are patients with other psychiatric diagnoses. However, a follow-up study is necessary to determine what percentage of these patients with physical symptomatology, frequently reinforced by medical or surgical diagnostic and therapeutic procedures, actually carry out recommendations for psychiatric treatment. This brief survey of a large sample of patients seen in psychiatric consultation should provide a basis of comparison and suggestions for further investigations and should emphasize the need for close evaluation of psychological factors in all medical and surgical patients.