Behavioral treatment of conversion disorder in adolescence. A case example of Globus Hystericus.
A simple contingency contract plus relaxation coaching helped a 12-year-old overcome fear-based swallowing and regain lost weight.
01Research in Context
What this study did
A 12-year-old girl felt a lump in her throat every time she tried to eat. She lost weight fast. Doctors ruled out medical causes and called it globus hystericus, a fear-based swallowing block.
The team wrote a simple contract. If she ate her target amount, she picked a fun activity after dinner. They also taught her to relax and challenge scary thoughts. Sessions ran at home and in clinic for several weeks.
What they found
The girl’s daily calories climbed. She gained weight and kept it off for ten months. The lump feeling faded and meals stopped being battles.
How this fits with other research
Silverman et al. (1994) used a bigger package to stop ruminative vomiting in a teen with autism. Both studies show teens can regain lost weight when behavior plans target eating directly.
Bailey et al. (2000) took the opposite road. They let a young adult escape the table right after each bite. Escape worked for food refusal, but Roche et al. (1997) added rewards instead. The two tactics differ, yet both produced weight gain.
Carter et al. (1988) taught infants to swallow safely. Together these papers stretch from babies to teens, proving behavior plans can fix feeding at any age.
Why it matters
If a teen says it feels like food is stuck and weight is dropping, try a short written contract. Pair it with calm coaching. You may see fast gains without medication or tubes.
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02At a glance
03Original abstract
The present single case study evaluated the efficacy of a cognitive-behavioral intervention for the treatment of a patient diagnosed with globus hystericus, a conversion disorder characterized by a perceived lump in the throat. The patient was a non-mentally retarded 12-year-old female who refused to swallow solids because she thought that her throat muscles would involuntarily constrict and result in choking. She lost approximately .5 lbs. per week during the 6 months prior to treatment. Improvements in weight gain were demonstrated consequent to the implementation of behavior therapy, with weight gain being particularly pronounced after contingency contracting was added to therapy. Weight gain was maintained at 1, 6, and 10 months posttreatment.
Behavior modification, 1997 · doi:10.1177/01454455970212006