Although the concept of emotionally derived neural energies has long since been abandoned, the work of Freud and Breuer still remains influential. The notion that a reduction in anxiety is the primary gain associated with unexplained symptoms is largely responsible for the continuing popularity of la belle indifference as a diagnostic indicator of somatoform illness. As noted previously, however, patients with somatoform illness show no more indifference to their condition than do patients with comparable physical illnesses. Moreover, it is clear that many individuals with somatoform illness show high levels of anxiety, demonstrating that any conversion process that is occurring is far from effective in controlling this emotion. However, there is evidence that somatoform illness is associated with an inability to identify and report on one's emotional states (so-called alexithymia). Such evidence could be interpreted as indicating that the process of conversion occurs as a means of discharging unexpressed emotion. These findings must be interpreted with caution, however, because there is evidence that existing measures of alexithymia are confounded by psychopathology in general.

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