Dear Dr. Welty,
I am writing to you about my 14-year-old daughter. Six months ago she started a new private school. My husband and I have worked very hard in order to afford this school, and we want her to be able to succeed. Unfortunately, for the past month she has developed a shaking in her right hand. It has become so bad that she is unable to attend school. She shakes all day long, and she has really fallen behind in her studies.
We took her to her pediatrician who examined our daughter and then referred her to a neurologist for more tests. She had the "million dollar" work-up, with all of the blood work, and lots of student doctors, X-rays and even an MRI. At the end they told us that our daughter’s problems were not caused by any "medical" condition. They said that she had a "conversion" reaction, and that she needed counseling, and a visit to a psychiatrist!
What on earth is going on? Is our daughter crazy?
Conversion reactions are those where there are neurological symptoms, such as fainting, or loss of sensation in a part of the body. It may present as seizure-like activity, or blindness where there is no physical cause discovered. It is felt that these problems are caused by stress or anxiety about an event in one’s life. A conversion reaction is the mind’s way of telling the body that it is "stressed out". Often times there are changes in one’s life that need to be made in order to deal with these stressors more appropriately.
It sounds as thought your doctors took great pains to assure that there was no medical reason for her symptoms. Roughly 25% of symptoms presenting as conversion symptoms eventually have a medical basis. There are other causes to consider. Is she consciously creating her symptoms? Is she depressed?
You may want to look at your daughter’s current life situation with her. Help her identify her stressors. Is her school too challenging for her? How is her social life? How has the school affected your home life, and your economic situation?
Many times it is a good idea to have an objective third party, such as a therapist or psychiatrist. This person can help identify the various issues going on in your daughter’s and your family’s lives. They can also help your daughter deal with her various anxieties more directly and more efficiently. Thus, her hand shaking will not be as necessary. A psychiatrist may also be able to offer a medication, if necessary. Your pediatrician will be able to offer referrals to qualified therapists and child psychiatrists in your area who are expert in this field.