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In an analysis of one hundred thirty-four patients with the diagnosis of conversion
hysteria, the defensive use of conversion symptoms to circumvent neurotic anxiety was clearly corroborated. Less than half the patients had a histrionic (hysterical) personality, indicating that this is not a prerequisite for the conversion process. Forty patients had latent depression which was avoided through conversion reactions, as was the threat of ego disorganization in nineteen incipient schizophrenics. The conversion symptoms reflect the unconscious imitation of physical disease and vary with the patient's knowledge of the disease and the attitudes of his cultural milieu. Symptoms are formed through identification, simulation, and the physical symbolism of specific unconscious conflicts and affects. Pain was often the somatic representation of an affect and was found more often in patients with underlying depression. A significantly large proportion of patients was either the youngest child or the youngest child of his or her sex in the family, suggesting that a special relationship in the family may later lead to difficulties in role stabilization.