VISUAL CONVERSION REACTION IN CHILDREN AND ADULTS


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Abstract

Recent reports indicate that visual conversion reactions are not as rare as previously believed. The ophthalmological diagnosis is made by unique positive findings (tubular fields and fluctuating visual acuity) in the presence of a normal electrooculogram, electroretinogram, and visual evoked responses. The psychiatric findings in children and adults differ; in general, adults have more psychopathology, tend also to have other psychosomatic symptoms or conversion symptoms, and have greater personal and social disability from the symptoms.In young children, inadequately understood feelings of being threatened, usually because of strife within the family, tend to predominate. In adults, long-standing stress or insoluble conflicts of various kinds tend to be prominent. In addition there is sometimes a history of trauma to the eye, a fear of eye disease, a history of eye disease in the family, or other preoccupations with vision such as can occur in the families of professionals treating eye disorders.Visual conversion reactions must be differentiated from organic eye disease and from malingering. Visual conversion reactions can complicate organic disease of the eye or optic pathways and can precede or mask early symptoms of organic eye disease. Several features are described in this paper which may be useful in differentiating visual conversion reactions from organic disease and from malingering.The treatment of visual conversion reactions of recent onset in children can usually be carried out successfully by a concerned and understanding ophthalmologist with occasional psychiatric consultation, whereas in adults referral to a psychiatrist is usually indicated. In adults, recovery is usually less rapid and the ultimate prognosis tends to be worse.

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