Attention and postural control in patients with conversion paresis

J Psychosom Res. 2015 Mar;78(3):249-54. doi: 10.1016/j.jpsychores.2014.11.009. Epub 2014 Nov 15.


Objective: Current theories of conversion disorder (CD) propose that motor symptoms are related to heightened self-monitoring and excessive cognitive control of movements. We tested this hypothesis using quantification of performance on a continuous perceptuo-motor task involving quiet standing.

Methods: Twelve CD patients and matched controls maintained static balance on a force platform under various attention conditions: (1) with eyes open; (2) with eyes closed (requiring enhanced attention to proprioceptive information to regulate posture); and (3) while performing an attention demanding cognitive task.

Results: Compared to controls, CD patients displayed a greater decrease in postural stability in the 'eyes-closed' versus 'eyes-open' condition. In contrast, cognitive distraction led to a normalization of balance in CD. Moreover, sensitivity to the balance interventions correlated significantly with trauma reports and dissociative symptoms.

Conclusion: These results indicate that attention plays a crucial role in postural control in CD. More specifically, patients seem to inadvertently use deliberate control of posture (i.e., cognitive investment) of an otherwise nearly automatized perceptuo-motor task. Attentional distraction resulted in a temporary normalization of balance, which may be used to train individuals with CD to guide their attention in a more effective way.

Keywords: Balance; Cognition; Conversion disorder; Postural control.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attention*
  • Case-Control Studies
  • Cognition*
  • Conversion Disorder / physiopathology*
  • Conversion Disorder / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Paresis / physiopathology*
  • Paresis / psychology*
  • Postural Balance*
  • Posture
  • Proprioception
  • Psychomotor Performance*