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Good Children Presenting with Conversion Disorder

The Children’s Hospital at Westmead, Parramatta, Australia, KasiaK{at}chw.edu.au

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.

Key Words: attachment theory • compulsive compliance • conversion disorder • predicament

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