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|Title:||Emotion Processing In Children with Conversion Disorders: A Developmental and Relational Perspective|
dissociative motor disorder
|Publisher:||University of Sydney.|
Discipline of Psychiatry
|Abstract:||Objectives: Historically, conversion symptoms have been understood to emerge within situations that generate strong emotions. From the modern perspective of integrative neuroscience, conversion symptoms can be conceptualised more specifically as involving motor-sensory/autonomic responses to situations that present a serious threat to self and that, in turn, elicit strong negative emotions. Like other responses to threat, they may be primed and fine tuned in the context of repeating, stressful interactions with attachment figures—the child’s environmental context—and automatically triggered when the individual is highly aroused and when other mechanisms for managing threat and danger (for example, verbal negotiation or running away) have failed or been blocked. This theoretical framework predicts that children and adolescents presenting with conversion disorders ought to process emotional information differently to healthy controls and that differences in emotion processing ought to be evident on standardized measures of emotion processing. To study this hypothesis, a research program was developed, involving multiple levels of analysis—psychological (cognitive and behavioural), physiological, and neural. The material presented in this thesis includes (a) articulation of the ideas (theory) that underpin the individual studies and the broader research program; (b) a detailed description of the methodology for the research program as a whole, and of the Dynamic-Maturational-Model of attachment (DMM) methodology used to assess emotion processing on the cognitive-psychological level (as investigated in the studies comprising this thesis); (c) presentation of the pilot attachment data; and (d) presentation of the final attachment data. The remaining components of the broader research program—analyses on the behavioural-psychological, physiological, and neural levels—are still in progress and will be carried through after completion of the thesis. Methods: Consecutive conversion subjects and age- and sex-matched controls were recruited over four years from the candidate’s consultation-liaison service at The Children’s Hospital at Westmead, Australia. Seventy-six subjects participated in structured interviews about attachment relationships and autobiographical events. Fifty-seven of these subjects completed a computerized battery of psychological and physiological tests in the laboratory (the broader research program). Recruitment for a modified version of this test battery in the functional magnetic resonance imaging machine (fMRI) is still ongoing. Publications Being Presented for Examination (Articles 1-4): Kozlowska, K. (2007). The developmental origins of conversion disorders. Clinical Child Psychology and Psychiatry, 12(4), 487–510. Kozlowska, K., & Williams, L. M. (2010). Self-protective Organization in Children with Conversion Symptoms: A Cross-Sectional Study Looking at Psychological and Biological Correlates. Mind & Brain, The Journal of Psychiatry, 1(2), 43–57. Kozlowska, K., & Williams, L. M. (2009). Self-protective organization in children with conversion and somatoform disorders. Journal of Psychosomatic Research, 67, 223–233. Kozlowska, K., Scher, S. et al. (2011). Patterns of emotional-cognitive functioning in pediatric conversion patients: implications for the conceptualization of conversion disorders, Psychosomatic Medicine 73(9): 775–788. Summary of Results: On a cognitive level of analysis—using the DMM—children and adolescents with conversion disorders show differences in emotion processing versus controls. Children and adolescents with conversion disorders were classified as falling into non-normative patterns of attachment, implying a chronic disruption of what are normally safe and nurturing attachments. Their attachment narratives were characterised by distortions in information processing: discrepancies in information about emotional events held in different memory systems; imbalance of information about affect and temporal order; imbalance of self and other perspectives; imbalance of self-responsibility and blame on others; a lack linguistic coherence and a high frequency of linguistic markers for unresolved loss and trauma. Unlike controls who fell largely into normative patterns of attachment (Type A1-2, Type B1-5, Type C1-2), children with conversion disorders showed two distinct patterns of emotion processing. Psychological inhibition (Type 3-6 or Type A+) was associated with conversion symptoms defined by discrete motor-sensory loss and positive motor symptoms (tremors and tics). Psychological coercion-preoccupation (Type 3-6 or Type C+) was associated with all other motor symptoms—bizarre gaits and postures, whole-body floppiness, and refusal to move. Non-epileptic seizures occurred across both groups. Additional publications articulating the application of this research to clinical practice. The following articles describe the integration of theoretical ideas and research findings from this thesis into clinical practice. The articles were written by the candidate in collaboration with her clinical team during the period of the thesis and are included in appendix 3 (articles B-E). Kozlowska, K. and R. Khan (2011). A developmental, body-oriented intervention for children and adolescents with medically unexplained chronic pain. Clinical Child Psychology and Psychiatry, 16(4): 575–598. Kozlowska, K., English, M., & Savage, B. (in press). Connecting body and mind: The first interview with somatizing patients and their families. Clinical Child Psychology and Psychiatry. Kozlowska, K., English, M., Savage, B., & Chudleigh, C. (in press). Multimodal rehabilitation: A mind-body, family-based intervention for children and adolescents impaired by medically unexplained symptoms. Part 1: The program. American Journal of Family Therapy. Kozlowska, K., English, M., Savage, B., Chudleigh, C., Davies, F., Paull, M., et al. (in press). Multimodal rehabilitation: A mind-body, family-based intervention for children and adolescents impaired by medically unexplained symptoms. Part 2: Case studies and outcomes. American Journal of Family Therapy. Conclusions: Contrary to the classic understanding of conversion disorder as a unified diagnostic entity with diverse symptoms, the studies comprising this thesis identified two distinct subgroups of conversion patients—those using psychological inhibition and those using psychological coercion-preoccupation—whose symptoms fell into discrete clusters. Psychological inhibition was associated with conversion symptoms reflecting motor-sensory inhibition or failure of inhibition, and psychological coercion-preoccupation was associated with all other motor-sensory conversion symptoms. Non-epileptic seizures occurred across both groups. These results suggest functional linkages between cognitive and motor-sensory processes in patients with conversion disorders. Motor-sensory conversion symptoms appear to be subcomponents or the unwanted consequences of broader self-protective patterns of response to threats—integrated sets of reactions involving psychological (cognitive and behavioural), physiological, and neural components. By contrast, non-epileptic seizures appear to be underpinned by an independent mechanism. Further research is needed to determine the neural mechanisms underlying these various processes.|
|Rights and Permissions:||The author retains copyright of this thesis.|
|Type of Work:||PhD Doctorate|
|Appears in Collections:||Sydney Digital Theses (Open Access)|
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