A Case study (2006)

Conversion DisorderPeripheral Biofeedback

Elizabeth L. Stroebel, PhD

Neurodevelopment CenterProvidence, RI

My “biofeedback prescription” for this case

Professional adaptability and collegiality Histoires de Nez (Kruss) 1989

Reference and Definition Boundaries

Conversion DisorderREFERENCE Etiology, pathogenesis, phenomenology and management continue to arouse debate. Isaac, M. (2006)

Current Opinions in Psychiatry, 19, 61-66.• Hysteria• Malingering (less common)- Feigned-Factitious disorders• Somatoform disorder• Conversion disorder• Psychogenic nonepileptic, pseudo seizures, conversion seizures• Dissociative disorder

STATISTICSIn strictly defined CD-estimated one in 5,000 per years. 2/3 women, appears any age

usually between adol and 40. Note 1%-3% mild CD patients referred to mental health clinics.

DEBATEDSM-IV ICD-10 classification unsuitable across cultures-call for reviews

GENERAL DEFINITION Psychological factors and autonomic activity-symptoms create appearance of medical illness that has not clear medical explanation (Harvard Mental Health Letter. Vol 22. Number 2, 2005)

Unexplained dramatic physical symptoms

• Nausea, vomiting, abdominal pain, dizziness • Pallor and peripheral temperature• Violent tremors, frequent eye rolls• Non-seizures• Blindness (black contact patch) Eye rolls• Reading difficulty, inability to write• Paralysis (waist to fee)• Involuntary sustained contractions of opposing muscles

causing twisted movements or abnormal fixed postures • Dysponesis (clenched and weakened fingers/hands).

Reported total “bodily pain” • Heightened anxiety• Shallow rapid breathing, racing heart sensation, loud voice

Brief patient history• Hospital Admission

• Background

• Profile (patient)

• Onset

• Previous medical and psychological care

Treatment PlanIn-patient

*Complete medical evaluation unremarkable

• In-patient hospital

• Psychiatrist• Peripheral Biofeedback• Hypnotherapy

• Behavioral modification• Group• Recreation

Peripheral Biofeedback: An integrative approach

Modalities HRV---HeartMath/Freeze-Frame

GSR---Galvanic skin conductance

Home trainers/audio tapes

Quieting Reflex (Stroebel)

Autogenic Training

Progressive Relaxation

Guided imagery and visualization

“….it is not the muscles which refuse to obey the will, but the will itself which has ceased to work.” Brodie(1837)

Static electricity generated by

fear, anxiety, anger consumed her….

Osmosis of BeingShe whispered……….

“Look at me”“What am I?”“Who am I?”“I am a non-being”“I feel non-existent”

Heidegger

The plight of the dehumanized. Of connection of that which is real and that

which is possible.

OsmosisA process of absorption or diffusion from

higher concentration to lower vulnerability.

Usually effortless often unconscious assimilation with intermingling of kinetic energy of molecules.

“It is the dead bird in the heart that kills.” Laurence Ferlinghetti Coney Island of the Mind

Placebo Hidden Present Powerful

The power of the individual’s complexity is a covert force linked to the placebo. Seems inaccessible to direct observation yet surfaces as empirical phenomena. (C.F. Stroebel, MD)

Lessons from Biofeedback….

“Still waters run deep” propelled down the pathways of the nervous system to fuel symbolic construction, imagery, emotion, thought, and reactivity, wellness or illness” E. stroebel

“I’m not sure I can get better?” EMPATHY

Histoires de Nez (Kruss) 1989

Biofeedback loopSelf Regulation-Inner core of strength

• Emotional strength

• Empowerment

• Participation

• Not just hope but actualization and restoration

“Talking heads, hearts, and bodies”

Electrodermal (EDR) biofeedback in treating psychogenic nonepileptic seizure Pop-Jordanova et al. University of Skopje, Macedonia. Prilozi:

2005;26(2):43-51.

Discriminative and validation for levels of distress

Good therapeutic results for enhancing patients awareness of choice/power to self-regulate

Interrupting dysponetic patterns/reactivity

Stabilization of hypersensitivity, lower neurotic tendencies. “emotional maturation”

Initial behavioral plan

Softening stress related physical and emotional pain

HeartMath Freeze-Frame Heart rate variability

DISCHARGE“Yeah me!!!! Yeah Me!!!!!!

I’M IN THE GREEN”