Abstracts

Rationale: In 1978 Charles Ford coined the term Humpty Dumpty Syndrome (HDS) to explain a type of conversion disorder that he observed in eight previously hard-working males. Each of the men decompensated and remained functionally disabled after an initial precipitating injury or illness. Patients with HDS characteristically have emotionally deprived childhoods and early excessive responsibility and may not have typical psychogenic risk factors. In our patient population the initial disabling symptom is typically interpreted as a seizure. The conversion disorder that follows consists of disabling psychogenic non-epileptic attacks (PNEA). Methods: We retrospectively reviewed the medical records of all patients diagnosed with exclusively PNEA on LTM over a 3 year period to determine the relative frequency of HDS. We considered patients to have HDS if they were in a productive vocation and then, after a perceived health crisis, lost their vocation due to persistent PNEA. Results: 167 patients had exclusively PNEA out of 943 patients who underwent LTM. Of the 167 patients, 33 had a perceived health crisis that was associated with the onset of the PNEA. Twelve were excluded because they had confounding major psychiatric disorders. Of the remaining 21, twelve had a known productive vocation that they subsequently did not return to and were diagnosed with HDS. The age of attack onset ranged from 17 to 56 years old (median 32). Eleven of the twelve were female.Conclusions: Seven percent (12/167) of our patients with exclusively PNEA had HDS based on strict criteria. The majority were female and middle aged. HDS may help explain the psychodynamic in some patients with PNEA.