Conversion Disorder Survey

  1. How old are you? <41□ 41-45□ 46-50□ 51-55□ 56-60□ >61□
  2. What is your gender? Male□ Female□
  3. In which country did you train? ______
  4. How many years have you spent working in neurology? ______
  5. How many months have you worked
  6. in psychiatry? _____
  7. in neuropsychiatry? ____
  8. Approximately how many new patients (with any diagnosis) do you see in a month? ___
  9. In what percentage of these do the presenting symptoms have no sufficient neurological basis in your opinion? <10%□ 10-25%□ 25-50%□ >50%□
  10. What proportion of these unexplained patients do you think have conversion disorder?
  11. All or virtually all
  12. The majority
  13. A minority
  14. None
  15. Which of the following best depicts the relationship between conversion patients and other unexplained patients in your opinion?

ABCD

  1. Briefly describe a memorable case, if you have time
  2. How likely is a diagnosis of conversion disorder in the following people?
  3. A woman whose paralysis is inconsistent on and off the couch but who appears psychologically healthy

Impossible / possible / probable

  1. A distressed man with an unexplained tingle in his arm Impossible / possible / probable
  2. A man whose paralysis is better when he thinks he’s not observed

Impossible / possible / probable

  1. Do you think psychiatrists have a sufficient psychological model for conversion? Yes / probably / possibly / no
  2. Which model best explains your view of conversion disorder?
  3. Effects of stress on the nervous system
  4. Subconscious behaviour
  5. Disorder of brain function
  6. Abnormal illness behaviour
  7. Feigning
  8. Other: ______
  9. What proportion of your unexplained patients do you think are feigning?
  10. None
  11. A few
  12. Many
  13. Most or all of them
  14. Which of the following best depicts the relationship between conversion and feigning in your opinion?

ABCD

  1. Please rate the five features you find most important in diagnosing conversion disorder from 1 (most important) to 5 (least important)

Inconsistency
Amount of work for you
Symptom type
Abnormal illness behaviour
Disability
Psychological abnormality
Symptom severity
Dislikeable
Observer-dependence
Other (please specify)
  1. Please mark with an ‘x’ any of the above which you think do not contribute to your diagnosing conversion disorder.
  2. With full testing, how confidently can you diagnose conversion disorder?

Very confidently□ Fairly confidently□ Not very confidently□ Not at all□

  1. What role do psychiatrists have in the diagnosis of conversion disorder?

Essential□ Helpful, but not necessary□ Not helpful□

  1. If a psychiatrist sends a patient you referred with conversion back to you saying they can find no psychiatric disorder, what would you presume?

I must have been wrong about conversion, and should look again□ They have only excluded other psychiatric disorders, not conversion□They have looked for conversion, but failed to find it□ Other:______

  1. Which model do you prefer to use to explain conversion disorder, if patients ask? i. Effects of stress on the nervous system

ii. Subconscious behaviour iii. Disorder of brain function iv. Mind over matter v. I Can’t explain it. vi. Other: ______

  1. Do you refer to psychological factors when explaining your diagnosis in conversion patients
  2. If they seem open to it? Always□ Usually□ Rarely□ Never□
  3. If they seem resistant? Always□ Usually□ Rarely□ Never□
  1. Do you talk about feigning with patients
  2. If you suspect it? Always□ Usually□ Rarely□ Never□
  3. If you’re sure of it? Always□ Usually□ Rarely□ Never□
  1. Who should address feigning in your patient?

Me□ The GP□ A psychiatrist□ The police, or some other agency□ no-one□

  1. Does giving the diagnosis of conversion disorder seem to be easier now than for those who trained you? Yes□ No□
  1. Do you copy letters about your conversion patients to them?

I prefer to□ I prefer not to□

  1. Do you use ‘codes’ or euphemisms in those letters?

Always□ Usually□ Rarely□ Never □

  1. What do you hope the GP will understand by your codes? (tick all that apply)
  2. That the patient has a conversion disorder
  3. That their problem is psychological
  4. That there is nothing really wrong with them
  5. Other: ______
  1. Did you have exposure to conversion disorder (or a condition which you consider similar) prior to studying medicine? (tick all that apply)

In myself□ A family member□ (specify_____) A friend□

  1. If you say a conversion patient has a functional disorder, what does that mean? (tick all that apply)
  2. Abnormality of brain function?
  3. Abnormality of bodily function?
  4. A psychiatric problem
  5. Not ‘organic’
  1. Do you understand conversion disorder to be neurological, in the same way that multiple sclerosis is neurological?

Yes□ Not now, but I expect to one day□ No, and I expect I never will□

  1. Did you know that Chronic Fatigue Syndrome (CFS) is classed as a neurological condition in ICD-10? Yes□ No□
  1. Do you believe that CFS is a neurological condition, in the usual sense of ‘neurological’? Yes□ No□