Case Study #8
Adjustment disorder arising from conversion disorder
Dianne Perrett-Abrahams, Forensic & Health Psychologist, Victorian Occupational Support Service
This case study explores the impact of conversion disorder resulting from a workplace injury and the resulting delicate psychological condition of the patient.
Ms. P reported that she suffered a workplace injury in 2003 by way of a heavy fall, on a slippery walkway, in which she injured her spine and knee, five weeks after commencing new employment. A workers compensation claim was implemented and accepted. She reported that following her fall she spent 5½ months in hospital and stated that during her rehabilitation she lost significant motor skills, specifically in her lower limbs initially. Her rehabilitation was conducted at various facilities including a regional hospital, and city hospitals and rehabilitation facilities. Multiple and repeated tests were undertaken, which did not reveal a physical diagnosis. Ms P was ultimately diagnosed with a conversion disorder. A further diagnosis of Dupuytrens contraction was identified, affecting both hands, and in this patient’s case, likely caused from weight bearing on her hands when transferring in and out of a wheelchair and propelling herself in a wheelchair. Her condition has deteriorated to a stage where she can no longer sit up, or hold her head up and she suffers phases where she cannot speak.
She is treated by a health psychologist who has diagnosed a chronic adjustment disorder, arising from her severe and increasing conversion disorder, which has emanated from her workplace injury.
Ms P has been compelled to reside in a nursing home since 2010, as a consequence of her substantial loss of upper body strength and increasing incapacity. Such deterioration has involved loss of neck muscle strength; causing profound head instability. Her presentation is indicative of severe quadriplegia. Her upper body regression has caused added symptoms of increased and ongoing pain in her shoulders, elbows, wrists and hands with sciatic pain in her mid to lower back and buttocks. She is unable to manage without intense nursing and is now bed-ridden mostly. She requires full-time carers to assist her at all times and when she occasionally goes out of the nursing home she must be accompanied by two carers with her mobilisation in a specialised electric wheelchair. Ms P utilises a wheelchair which requires extension to almost a fully reclining position, necessitated by the patient’s inability to sit up or control her head. This wheelchair, however, is unstable and dangerous and has caused Ms P numerous falls from the chair as it is prone to tipping over.
Of psychological necessity, Ms P needs to reside in her own purpose-built home with full disability aids tailored to her needs. In her psychologist’s view, an aged care facility designed for residents until their death is inappropriate for Ms P at age 43. Further, Ms P reports that the aged facility are short staffed and she reports neglect regarding hygiene needs.
To sustain such independent care, she requires two carers during the day with a carer at night to turn her every two hours due to her inability to turn herself. This is essential to reduce pulmonary compromise and bed sores.
Ms P requires a minimum of 30 carer hours per week while she resides in the nursing home. Without carer assistance Ms P is isolated and bed 24-hour day. The impact psychologically to this patient cannot be overstated and will, in her psychologist opinion, provoke and engender significant depression and anxiety and increased psychological crisis.
Ms P reported that she is required to take an extensive array of medication to relieve her condition. She is prescribed venlafaxine for depression, with analgesics and anti-inflammatory drug therapy.
Psychological treatment intervention is comprised of CBT, cognitive reconstruction, psychotherapy and strategies to engender distraction with modalities incorporated in therapy to assist the patient in coping with a devastating disability. Ms P, in her psychologist’s opinion, suffers from a chronic and severe adjustment disorder with depression arising from a maladaptive response to the ongoing stress of having a chronic disability with such disability incorporating a chronic complex regional pain syndrome arising from a workplace injury on 14 May 2003 with ongoing sequelae diagnosed as conversion disorder in 2006.
Symptoms of conversion disorders may appear suddenly after a stressful event, or with emotional or physical trauma. Conversion disorder is still a poorly understood diagnosis in adult patients and even more so in children. The term ‘conversion disorder’ refers to the conversion of emotional stress to physical symptoms. However, these same kinds of physical and sensory problems can occur with or without known psychosocial or traumatic stressors. An adjustment disorder can arise from maladaptive ways of coping after a stressful event or events.
- How significant is the stress or emotional or physical trauma in understanding conversion disorder?
- What is the relevance of an adjustment disorder in this case study and how does such a disorder impact on treatment efficacy?
- Some symptoms of conversion disorder, specifically, if not treated, can result in substantial disability and impoverished life quality, similar to chronic medical pathologies. How do health psychology interventions on adjustment disorder provide better health outcomes for such individuals?
- Are women more likely than men to develop conversion disorders?