سازمان خود حفاظتی در کودکان مبتلا به اختلالات شبه جسمی و تبدیلی

Two centuries of clinical observations have suggested that conversion symptoms are associated with strong emotions or situations that threaten the individual's physical or psychological integrity. This study tested the hypothesis that childhood conversion reactions reflect the motor-sensory components of two distinct emotional responses (one inhibitory, one excitatory) that develop as adaptations to recurring threats within intimate relationships.

Two centuries of clinical observations have suggested that conversion symptoms are associated with strong emotions or situations that threaten the individual's physical or psychological integrity [1]. Concurring with these observations, many contemporary theories of conversion disorder conceptualize conversion symptoms as part of the individuals' emotional response to threat, reflecting either (a) the implicit processing of information resulting in an automatic motor-sensory response or (b) errors related to how information about body state is processed or represented within the brain [1]. A variety of methodologies—each focusing on a different level of the mind–body system—have been used to analyze human emotional responses to threat [2], [3], [4], [5], [6], [7], [8] and [9]. One recently developed method for assessing self-protective emotional responses derives from the dynamic-maturational theory of attachment (DMM), a theory about human emotional development across the lifespan [10] and [11]. Within the DMM conceptual framework, definable patterns of emotional response are known as “attachment” or “self-protective” strategies. These have two key components. On a behavioral level of analysis, they refer to the child's emotional/behavioral organization in the face of specific threats by caregivers or significant others. Accordingly, the attachment behaviors seen in children who feel threatened subsume (a) innate, genetically determined patterns of motor-sensory defense responses; (b) the priming and fine-tuning of these patterns through repeated interactions with caregivers; and (c) learned patterns of behavior [12]. On an information-processing level of analysis, attachment strategies refer to the implicit and explicit learning (alternatively, implicit and explicit memory or mental representations) that occurs in the context of past experience and provides the basis of future behavioral organization [13], [14] and [15]. Although this article focuses on the motor-sensory components, Text Box 1 provides a simple summary of attachment strategies. More detailed descriptions of the behavioral and cognitive aspects of these strategies are available in the literature [10], [11], [12], [16] and [17]. Text Box 2 familiarizes readers with the nomenclature used in this article [10] and [15].