The attribution of affect in pain clinic patients: a psychophysiological study of the conversion process

In a study to examine the relationship between the conversion process and physiological correlates of emotional arousal, three key elements of conversion were assessed separately in patients experiencing chronic pain for which no adequate somatic cause could be demonstrated. Thirty-seven patients referred to a pain clinic were categorized as members of either high, intermediate, or low conversion groups on the basis of their scores on the Disease Conviction, Affective Disturbance and Denial scales of the Illness Behaviour Questionnaire (IBQ). All patients scored in the high range on Disease Conviction. High conversion patients acknowledge little dysphoric affect and denied life problems apart from physical illness. Intermediate conversion patients also denied life problems other than somatic, but acknowledged high levels of dysphoria. Low conversion patients reported dysphoria and acknowledged life problems which they did not attribute to physical illness. The prediction that the high conversion group would show lower levels of resting skin conductance than the low conversion group was confirmed. Patients in the intermediate conversion group resembled those in the high conversion group in that their resting skin conductance was significantly lower than that observed in members of the low conversion group. These findings are consistent with those of previous studies of conversion disorders. They point to the importance in these conditions of the interaction between dysphoria and the cause to which it is attributed by the patient.