Abstract
We reported a case of paraplegia with an obvious secondary gain that was successfully treated usin! a confrontation technique. A 38-year-old man was admitted to the department of neurology in our hospital because of paraplegia of sudden onset. He had been admitted twice, each time for a period of 6 months, for treatment of paraplegia and had been diagnosed as having anterior spinal artery syndrome 8 years earlier and transverse myelitis 7 years earlier. This time the neurologists diagnosed him as having multiple sclerosis, and steroid therapy was started. However, magnetic resonance imaging of the head and spine showed no abnormalities, and there was a marked discrepancy between his disability and objective findings. On the 18th hospital day, the neurologists suspected conversion symptorn and referred the patient to our department. Inteviews with his parents and wife revealed that the patient had repeatedly embezzled money and accumulate debts, which his father had paid without any criticism of the patient's action. Just before this addmission, it had been revealed that he had again embezzled money. A secondary gain to evade his responsibility obviously existed. Since childhood, he had been doted on by his parents and had never been scolded by his father. We explained the concept of secondary gain and psychological origin of symptoms to his parents and asked them whether they intended to continue paying his debts. Since the parents said they would not continue paying his debts, we decided to use a confrontation technique to treat the patient. We instructed the father to tell the patient that this was the last time he would pay his debts and that if he embezzle money again, he must take resposibility by himself and might be put in jail. The patient began to walk on that day and was discharged three days later. Immature development of superego due to doting by parents is thought to have been associated with the symptoms in this patient. Differentiation between conversion disorder and malingering was actually difficult in this case.
