Is this conversion disorder but also a medical aspect?

[Susan Wh.]

My daughter just turned nine.  Four weeks ago she had a stomach bug.  After the usual vomiting and recouperating, she said her eyes hurt.  She was diagnosed with eye allegies.  The next day she could hardly move her neck. She said the back of her head and neck hurt bad (these are the major complaints to this day).  She was diagnosed with sinusitus. Then she was diagnosed with torti collis (wry neck).  Pain medicine didn't touch it.  Two days later she was admitted to the hospital.  They tested her for incefilitous, menengitis, west nile virus, lyme disease and I'm not sure what else.  They did a chest x-ray, a MRI of the neck and back, and a ct scan.  Everything came back ok.  In the five days she was in the hospital she also developed severe back and jaw pain, dizziness, double vision, blurry vision, body tremors, body jerks, and what they now call "hysterical gait." The EEG was normal. She was ambulanced up to Strong Memorial hospital where they determined she just had a virus and would be fine.  Instead of being all worried, we felt relieved and starting really trying to encourage her and plan her birthday party and things like that.  Absolutely no change.  Still in terrible pain.  I called the neurologist a coulple days later and her said it's conversion disorder and we need to start zoloft and therapy.  I couldn't get into a therapist right away but I made an appointment and started the zoloft.  I still wasn't convinced and the peditrican said we should do an MRI of the brain.  We did and they did find Chiari I Malformation (5mm).  We went to another neurologist who said the chiari malformation is small and isn't causing these symptoms.  We went back to Rochester to a neurosurgeon who agreed. She was (and still is even more today) sensitive to
the touch in certain areas like her back, neck, and face. She was admitted for a few more days to rule out more things like rhumetoid (sp?) arthritis but they are convinced it is conversion disorder. She also developed symptoms like ringing in her eyes and a sensation on her face when urinating but I think this is because the neurosurgeon mentioned them. She has difficuly swallowing now. Now she is home in 2x week therapy (we just started- no real clue as to a "stressor" yet) and still in awful pain. I have to carry her but she says it is excruciating for me to touch her.  I was trying to wean her off the darvaset but is that the right thing? Now her hair is falling out in clumps(they want to test thyroid). Sometimes, I give her alleve but nothing helps much. She has been on 50mg of zoloft twice a day.  It seems odd that the back of the head, neck, and back pain are the worst and those symptoms came before the MRI.  They said it wasn't necessary to do a "flow study MRI."  Should they?  She is a normal healthy child.  Please advise on this situation.

[Kevin Kennedy, Ph.D.]

If your daughter's baseline (re: emotional functioning) was normal, it makes this diagnosis suspect. It's probably not coincidental that she experienced a viral condition prior to the onset of the other symptoms; these various myalgias may well represent something other than conversion disorder. Conversion Disorder is not unheard of in children, but it is not common. And, to be frank, the particular symptom picture your daughter displays is not really typical of conversion disorder. It's important to be cautious about assuming conversion disorder; too often we leap on that diagnosis in the absence of an identifiable organic illness/condition. Now, the medication and the therapy are likely sensible; they will not do harm. But I think it makes sense to do all that you are doing and not rest with the conversion disorder diagnosis. Part of the reason I'd be cautious is that the diagnosis was issued by a neurologist; mental disorders are not the expertise of neurologists. It may be a correct diagnosis, but I'd be more comfortable with it if it issued from a thorough evaluation in Child Psychiatry (in consultation with the other specialists).