Self-Generated Stigma and Illness Attributions in Motor Conversion Disorder Patients

Vindhya Ekanayake

Purpose:
According to Goffman, stigma can be defined as an “attribute that is deeply discrediting” and that reduces the bearer “from a whole and usual person to a tainted, discounted one” (Goffman 1963, p. 3). Stigma is a common feature of many disorders, particularly psychological disorders. Motor conversion disorder is presumed to be psychological in etiology and is known as psychogenic movement disorder (PMD) among neurologists. PMD refers to involuntary movement symptoms that are not due to a known medical disorder. To our knowledge and based on the existing scientific literature, the issue of stigma has never been examined in PMD patients. Stigma may be a real and unrecognized concern for these patients, as many are unwilling to accept their diagnosis or seek services from a mental health professional regarding their symptoms.

Procedure:
Four motor conversion disorder patients (3 of 4 female [75%]; mean age 30.8 years [SD, 6.2 years]) were recruited from the Human Motor Control Section Clinic. Eleven dystonia patients (7 of 11 female [63%]; mean age 59.8 [SD, 10 years]) were recruited from the Botulinim Toxin Clinic, in order to serve as a neurological control group. Patients were asked to fill out a series of questionnaires during their visit. Three different stigma measures were utilized: the Self-Stigma of Mental Illness Scale (SSMIS), The Stigma Scale for Chronic Illness (SSCI) and The Attribution Questionnaire (AQ-27). Patients also completed the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and the Balanced Inventory of Desirable Responding (BIDR) (Paulhus, 1988).

Results:
PMD patients are significantly more aware of (P = .001) and agree more (P = .024) with negative stereotypes regarding physical disorders than patients with an organic neurological condition. These results remained significant even after controlling for depression, anxiety, and socially desirable responding. PMD patients are also more likely than dystonia patients to agree with publicly held stereotypes regarding psychological disorders (P = .018). They are more likely than dystonia patients to avoid an individual with a physical illness (P = .029). PMD patients scored higher than dystonia patients on a scale measuring the stigma associated with a chronic neurological disorder (P = .005).

Conclusions and Implications:
Having a better grasp of stigma in these patients will allow us to design interventions that target the stigma they are dealing with on a day-to-day basis as well as over the long term. One of the key goals of treatment should be addressing the stereotypes regarding physical and psychological disorders that PMD patients agree with and hold to be true. By better understanding stigma in these patients, it may be possible to increase the chances that PMD patients will be more amenable to seeking services from mental health professionals. By reducing stigma in PMD patients, we may be able to help these patients manage their disorder and learn to cope with their symptoms in a more constructive way.