Current conceptualizations of conversion disorder in childhood draw from a range of theoretical perspectives. A large subset of children afflicted with conversion disorder has recurrently been described as ‘good’, ‘helpful’, ‘compliant’, ‘high- achieving’ and ‘conscientious’. Family characteristics noted in this group include high family expectations, inarticulate family relationships and hostility towards psychological explanations with an over-emphasis on medical aetiology. Physicians experience parental displeasure and anxiety in the form of demands for investigations and treatment, and feel pressure to comply with parental requests. Like physicians, good children with conversion disorder also feel compelled to satisfy their parents. As children, they are even less able to openly disagree with parental views or expectations, and manage their fear of parental rejection, hostility, anger or displeasure through compulsive compliance. This article discusses the contributions of attachment theory to our understanding of relationship patterns in families of extremely good compliant children and expands Taylor’s concept of ‘intolerable predicaments’. The development of the ‘compulsive compliant’ attachment strategy is discussed, and its application to the theory and treatment of children with conversion disorder is examined. Case vignettes are presented.
Ainsworth, M.
, Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment: A study of the strange situation. Hillsdale, NJ: Erlbaum.
2.
Bass, C.
, & Benjamin, S. (1993). The management of chronic somatisation. British Journal of Psychiatry, 162, 472-480.
3.
Belsky, J.
, & Cassidy, J. (1994). Attachment theory and evidence. In M. Rutter & D.F. Hay (Eds.), Development through life. A handbook for clinicians (pp. 373-401). Oxford, UK: Blackwell.
4.
Belsky, J.
, Garduque, L., & Herncir, E. (1984). Assessing performance, competence, and executive capacity in infant play: Relations to home environment and security of attachment. Developmental Psychology, 20, 406-417.
5.
Bowlby, J.
(1982). Attachment and loss, Vol. I: Attachment. New York: Basic Books.
6.
Bowlby, J.
(1974). Attachment and loss, Vol. II: Separation. New York: Basic Books.
7.
Bowlby, J.
(1980). Attachment and loss, Vol. III: Loss. New York: Basic Books.
8.
Bretherton, I.
, Ridgeway, D., & Cassidy, J. (1990). Assessing internal working models of the attachment relationship: An attachment story completion task for 3-year-olds. Chicago: University of Chicago Press.
9.
Campo, J.V.
, & Fritsch, S.L. (1994). Somatisation in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 1223-1235.
10.
Caplan, H. (1970). ‘Hysterical’ conversion symptoms in childhood. M. Phil. Thesis, University of London, UK.
11.
[English edition: Clinical lectures on certain diseases of the nervous system. Detroit, MI: Davies, 1888.]
12.
Chodoff, P.
(1974). The diagnosis of hysteria: An overview. American Journal of Psychiatry, 131(10), 1073-1078.
13.
Cohn, L.J.
(1990). Child-mother attachment of 6-year-olds and social competence at school. Child Development, 61, 152-162.
14.
Crittenden, P.M.
(1990-1995). Preschool Assessment of Attachment: Coding manual. Unpublished manuscript, Family Relations Institute, Miami, FL. Available from the author.
15.
Crittenden, P.M.
(1992). Quality of attachment in the preschool years. Development and Psychopathology, 4, 209-241.
16.
Crittenden, P.M.
(1997). Toward an integrative theory of trauma: A dynamic-maturational approach. In D. Cicchetti and S. Toth (Eds.), The Rochester Symposium on Developmental Psychopathology, Vol. 10. Risk, trauma and mental processes (pp. 34-84). Rochester, NY: University of Rochester Press.
17.
Crittenden, P.M.
(1998). Dangerous behaviour and dangerous contexts: A 35-year perspective on research on the developmental effects of child physical abuse. In P.K. Trickett & C.J. Schellenbach (Eds.),Violence against children in the family and the community (pp. 11-38). Washington, DC: American Psychological Press.
18.
Crittenden, P.M.
(1999). Danger and development: The organisation of self-protective strategies. In J.I. Vonda & D. Barnett (Eds.), Atypical attachment in infancy and early childhood among children at developmental risk. Monographs of the Society for Research in Child Development, 64(3, Serial No. 258), 145-171.
19.
Crittenden, P.M.
(2000). Attachment in adulthood: Coding manual for the dynamic- maturational approach to the Adult Attachment Interview. Unpublished manuscript. (Available from the author).
20.
Crittenden, P.M.
, & DiLalla, D. (1988). Compulsive compliance: The development of an inhibitory coping strategy in infancy. Journal of Abnormal Child Psychology, 16, 585-599.
21.
Dubowitz, V.
, & Hersov, L. (1976). Management of children with non-organic (hysterical) disorders of motor function. Developmental Medicine and Child Neurology, 18, 358-368.
22.
Frankel, K.A.
, & Bates, J.E. (1990). Mother-toddler problem-solving: Antecedents in attachment, home behaviour, and temperament. Child Development, 61, 810-819.
23.
Heredity and the aetiology of the neuroses. In The complete works of Sigmund Freud (1953-1974) (standard ed., Vol. 3, pp. 143-156). London: Hogarth Press.
24.
Freud, S.
(1896b). The aetiology of hysteria. In The complete works of Sigmund Freud (1953-1974) (standard ed., Vol. 3, pp. 191-221). London: Hogarth Press.
25.
Freud, S.
(1905). Drei Abhandhlungen sur Sexualtheorie. Leipsip and Vienna: Franz Dentiche. Three essays on the theory of sexuality. In The complete works of Sigmund Freud (1953-1974) (standard ed., Vol. 3, pp. 125-245). London: Hogarth Press.
26.
Fritz, G.K.
, Fritsch, S., & Haginl, O. (1997). Somatoform disorders in children and adolescents: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1329-1338.
27.
Fury, G.S.
, Carlson, E.A., & Sroufe, L.A. (1997). Children’s representations of attachment in family drawings. Child Development, 68, 1154-1164.
28.
Garralda, M.E.
(1992). A selective review of child psychiatric syndromes with a somatic presentation. British Journal of Psychiatry, 161, 759-773.
29.
George, C.
, & Solomon, J. (1999). The development of caregiving: A comparison of attachment theory and psychoanalytic approaches to mothering. Psychoanalytic Inquiry, 19, 618-646.
30.
Gooch, J.L.
, Wolcott, R., & Speed, J. (1997). Behavioural management of conversion disorder in children. Archives of Physical Medicine and Rehabilitation, 78, 264-268.
31.
Goodyer, I.
(1980). Hysterical conversion reactions in childhood. Journal of Child Psychology, 22, 179-188.
32.
Goodyer, I.
, & Taylor, D.C. (1985). Hysteria. Archives of Disease in Childhood, 60, 680-681.
33.
Grattan-Smith, P.
, Fairly, M., & Procopis, P. (1988). Clinical features of conversion disorder. Archives of Disease in Childhood, 63, 408-414.
34.
Hansburg, H.G.
(1972). Adolescent separation anxiety: Vol.1. A method for the study of adolescent separation problems. Springfield, IL: Charles C. Thomas.
35.
Head, H.
(1922). An address on the diagnosis of hysteria. British Medical Journal, 27, 827-829.
36.
Hesse, E.
(1996). Discourse, memory, and the Adult Attachment Interview: A note with emphasis on the emerging Cannot Classify category. Infant Mental Health Journal, 17, 4-11.
37.
Jacobson, T.
, Edelstein, W., & Hofmann, V. (1994). A longitudinal study of the relation between representations of attachment in childhood and cognitive functioning in childhood and adolescence. Development Psychology, 30, 112-124.
38.
Jacobson, T.
, & Hoffman, V. (in press). Children’s attachment representations: Longitudinal relations to school behaviour and academic competency in middle childhood and adolescence. Developmental Psychology.
39.
Jacobson, J.L.
, & Wille, D.E. (1986). The influence of attachment pattern on development changes in peer interaction from the toddler to the preschool period. Child Development, 57, 338-347.
40.
Janet, P.
(1889). L’Automatisme psychologique. Paris: Alcan.
41.
Janet, P.
(1892-1894). Etat mental des hystériques [The mental state of hystericals]. Paris: Rueff et Cie.
42.
Kaplan, N. (1987). Individual differences in six-year olds’ thoughts about separation: Predicted from attachment to mother at one year of age. Unpublished doctoral dissertation, University of California at Berkeley.
43.
Kendell, R.E.
(1982). A new look at hysteria. In A. Roy (Ed.), Hysteria. Chichester: Wiley.
44.
Klagsbrun, M.
, & Bowlby. J. (1976). Responses to separation from parents: A clinical test for young children. British Journal of Projective Psychology, 21, 7-21.
45.
Leslie, S.A.
(1988). Diagnosis and treatment of hysterical conversion reactions. Archives of Disease in Childhood, 63, 506-511.
46.
Main, M.
, & Solomon, J. (1986). Discovery of a disorganised disorientated attachment pattern. In T.B. Brazelton & M.W. Yogman (Eds.), Affective development in infancy. Norwood, NJ: Ablex.
47.
Main, M.
, & Solomon, J. (1990). Procedures for identifying infants as disorganised/disorientated during the Ainsworth Strange Situation. In M. Greenberg, D. Cicchetti, & E.M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention. Chicago: University of Chicago Press.
48.
Maisami, M.
, & Freeman, J.M. (1987). Conversion reactions in children as body language: a combined child psychiatry-neurology team approach to the management of functional neurological disorders in children. Pediatrics, 80, 46-52.
49.
Maloney, M.J.
(1980). Diagnosis of hysterical conversion reactions in children. Paediatrics, 97, 1016-1020.
50.
Matas, L.
, Arend, R.A., & Sroufe, L.AA. (1978). Continuity of adaptation in the second year: The relationship between quality of attachment and later competence. Child Development, 49, 547-556.
51.
Mayou, R.
(1975). The social setting of hysteria. British Journal of Psychiatry, 127, 466-469.
52.
Nijenhuis, E.R.S.
, Spinhoven, P., Vanderlinden, J., Van Dyck, R., & Van der Hart, O. (1998). Somatoform dissociative symptoms as related to animal defensive reactions to predatory threat and injury. Journal of Abnormal Psychology, 107, 63-73.
53.
Nijenhuis, E.R.S.
, & Van der Hart, O. (1999). Somatoform dissociative phenomena: a Janetian perspective. In J.M. Goodwin & R. Attias (Eds.), Splintered reflections: images of the body in trauma (pp. 89-127). New York: Basic Books.
54.
Park, K.A.
, & Waters, E. (1989). Security of attachment and preschool friendships. Child Development, 60, 1076-1081.
55.
Rabkin, R.
(1964). Conversion hysteria as a social maladaption. Psychiatry, 27, 349-363.
56.
Redwin, R. (1998). A study of conversion disorder in children. Dissertation. Available from Royal Melbourne Hospital, Health Sciences Library, Melbourne, Australia.
57.
Resnick, R.J.
(1993). Block play. In Play therapy techniques (pp. 109-113). Nortvale, NJ: Aronson.
58.
Rock, N.L.
(1971). Conversion reactions in childhood. A clinical study of childhood neurosis. Journal of the American Academy of Child Psychology, 10, 65-78.
59.
Seltzer, W.J.
(1985a). Conversion disorder in childhood and adolescence: A familial/cultural approach, Part I. Family Systems Medicine, 3, 261-280.
60.
Seltzer, W.J.
(1985b). Conversion disorder in children and adolescence, Part II. Therapeutic issues. Family Systems Medicine, 3, 397-416.
61.
Shouldice, A.
, & Stevenson-Hinde, J. (1992). Coping with security distress: The Separation Anxiety Test and attachment classification at 4-5 years. Journal of Child Psychology and Psychiatry, 33, 331-348.
62.
Slater, E.
(1982). What is hysteria? In A. Roy (Ed.), Hysteria. Chichester: Wiley.
63.
Slough, N.M.
, & Greenberg, M.T. (1990). Five-year olds’ representations of separation from parents: Responses from the perspective of self and other. In I. Bretherton & M.W. Watson (Eds.), New directions for child development: No. 48. Children’s perspective on the family (pp. 67-84). San Francisco: Jossey Bass.
64.
Speed, J.
(1996). Behavioural management of conversion disorder: Retrospective study. Archives of Physical Medicine and Rehabilitation, 77, 147-154.
65.
Sroufe, L.A.
, Fox, N.E., & Pancake, V.R. (1983). Attachment and dependency in developmental perspective. Child Development, 54, 1615-1627.
66.
Steinhausen, H.C.
, Aster, M.V., Pfeiffer, E., & Gobel, D. (1989). Comparative studies of conversion disorders in childhood and adolescence. Journal of Child Psychology and Psychiatry, 30(4), 615-621.
67.
Szasz, T.S.
(1970). The myth of mental illness: Foundations of a theory of personal conduct (rev. ed.). New York: Harper & Row.
68.
Taylor, D.C.
(1986). Hysteria, play-acting and courage. British Journal of Psychiatry, 149, 37-41.
69.
Trieschmann, R.B.
, Stolov, W.C., & Montgomery, E.D. (1970). An approach to the treatment of abnormal ambulation resulting from conversion reaction. Archives of Physical Medicine and Rehabilitation, 51, 198-206.
70.
Van Ijzendoorn, M.H.
, & Kroonenberg, P.M. (1988). Cross-cultural patterns of attachment: A meta-analysis of the Strange Situation. Child Development, 59, 147-156.
71.
Volkmar, F.R.
, Poll, J., & Lewis, M. (1984). Conversion reactions in childhood and adolescence. Journal of the American Academy of Child Psychiatry, 23(4), 424-430.
