That whatever-you-call-it-sign, to do with testing muscle response depending upon the action being taken, does move some of these diagnoses beyond being simply being: No idea, call it 'functional'.
It seems like this gets mixed in with some narrative building, unreasonable lumping etc, etc. The claims surrounding functional disorders can be quacky, but can have reasonable sections too, so it's best to be cautious and specific in criticisms.
A bit OT, but I didn't think this was worth starting a new thread about. I was just reading this paper on Conversion Disorder:
http://apt.rcpsych.org/content/12/2/152.full.pdf
It had this section on hypnosis:
Hypnosis
The similarities between hysteria, hypnosis and
conversion disorder were noted during the 19th
century. There is evidence that people with
conversion disorder have above average levels
of hypnotisability, making hypnosis a potential
intervention in the management of the disorder (Van
Dyck & Hoogduin, 1989). The goals of such hypnosis
include symptom reduction and exploration. Acting
through the evocation of a trance-like state, which
promotes suggestibility, hypnosis may be effective
against symptoms that are influenced by suggestion.
Hypnosis can also be used to evoke memories of
a traumatic event that has a positive link with the
symptoms.
Although there are many anecdotal accounts of
the efficacy of hypnosis in conversion disorder, a
recent randomised controlled trial of the addition of
hypnosis to a comprehensive treatment programme
for in-patients with the disorder found that it had
no additional effect on treatment outcome (Moene
et al, 2002).
Then these were the two cases mentioned:
Case vignette 1: Resolution by hypnosis
A 24-year-old cleaner had an argument with his boss.
Shortly afterwards he developed weakness of his
right arm and an inability to talk. He was brought
to an accident and emergency department. A full
neurological examination, including a number of
blood tests and a lumbar puncture, showed no specific
abnormalities. His computed tomography (CT) and
magnetic resonance imaging (MRI) scans were normal.
His symptoms did not improve after a week in hospital.
Finally, he was offered two sessions of hypnosis. His
symptoms resolved completely at the end of the second
session.
Case vignette 2: Resolution by abreaction
A 30-year-old African woman was the victim of an
assault. She received a severe blow to her head and lost
consciousness for about a minute. She subsequently
developed weakness on the left side of her body, in
both her arm and leg, and loss of vision in her left
eye. She underwent thorough investigation at her
local hospital, including a CT and MRI scan. Nothing
abnormal was found. In several interviews with a
psychiatrist she disclosed that she had been brought up
unable to express anger. During a session of abreaction,
she became very over-aroused and started screaming.
Following this she slowly regained the use of her left
arm and leg. It seemed apparent that her symptoms
were the result of her inability to express anger.
It's so like lots of CFS papers - building narratives out of anecdotes and 'clinical judgement'.
I thought this was a nice and concise write up of the explanation for some of the bullying many patients get:
Learning theory
In a model that emphasises the shaping of behaviour
by the environment, conversion symptoms are seen
as maladaptive operant behaviours that act on the
environment to produce reinforcing consequences
(secondary gains). Conversion disorder is then
sustained by the effects of these behaviours (McHugh
& Slavney, 1998: pp. 223–237). The therapeutic
implications of this theory are that it is important
to alter the patient’s belief by means of countersuggestion
and to take psychosocial measures to
reduce the external benefits associated with the sick
role. The aim of behavioural approaches is to ensure
that the patient gains more from relinquishing
symptoms than from maintaining them.
edit: There was a later bit on whiplash too, and I just stumbled upon this 1997 paper which showed no association between prior personality traits and the onset of whiplash, so thought I'd post a link to it here:
http://www.ncbi.nlm.nih.gov/pubmed/9160275