Conversion disorder is a psychiatric condition in which a person develops physical symptoms that are not under voluntary control and are not explained by a neurological disease or another medical condition. Conversion disorder is also called functional neurological symptom disorder.
A key feature of conversion disorder is the incompatibility between an individual’s symptoms and recognized neurological or medical conditions. Although a neurological cause can't be identified, the problem isn't just "in the person's head"—there is a real, physical problem. Conversion disorder is a psychosomatic illness, in which physical symptoms often mask emotional distress.
To be diagnosed with conversion disorder, the physical symptoms must cause significant distress or impairment in day-to-day functioning. If the conversion symptoms are commonly seen within a culture and do not cause significant distress or disability, then a diagnosis of conversion disorder would not be given.
Symptoms of conversion disorder can be temporary or can persist for a long period of time. Temporary symptoms of conversion disorder are common, but the prevalence of the condition is not known. The rate of new diagnoses of persistent conversion symptoms is approximately two to five cases per 100,000 each year.
Conversion disorder can have many different presentations and symptoms. Motor symptoms include weakness or paralysis, abnormal movements such as tremors, and difficulty walking. Sometimes people experience sensory symptoms, such as altered, reduced, or absent skin sensation, vision, or hearing. Conversion disorder can also take the form of “psychogenic” or “non-epileptic” seizures, which include limb shaking and impaired or loss of consciousness but without the electrical activity that occurs in the brain during a seizure. Other common symptoms include episodes of unresponsiveness that resemble fainting or coma, reduced or absent speech volume, changes in articulation when speaking (slurred speech), a sensation of having a lump in the throat, and double vision.
People with conversion disorder are not faking their symptoms, and despite not having a clear physiological origin, the symptoms cause real distress and cannot be controlled at will. The severity of the disability caused by conversion disorder can be similar to that experienced by people with comparable medical diseases.
A case study of conversion disorder, according to one therapist, involved a young woman who was a Marine, following in the footsteps of her family members. The Marine Corps job assignment she received didn’t align with her expectations or her family’s hopes. She suddenly became paralyzed from the waist down and was confined to a wheelchair. She was able to walk backward but could not stand or walk moving forwards.
No neurological cause could be detected. She was diagnosed with conversion disorder and referred for psychoanalytic treatment. This patient was unable to verbally express her discontent, and her paralysis may have represented the physical manifestation of that tension.
Freud was strongly influenced by conversion disorder, believing that it represented an unconscious attempt to resolve psychological conflict. If a patient was unable to express himself through conventional modes of communication, that expression might emerge somatically. Helping the patient to communicate freely and directly would hopefully address their condition.
Since Freud’s time, the condition has shifted from a psychoanalytic framework to a more descriptive framework, for example from “conversion hysteria,” to “conversion reaction,” to “conversion disorder” and “functional neurological symptom disorder.”
The onset of symptoms is usually sudden and can be associated with stress or a traumatic event. Stressful life events are often present in people who develop conversion symptoms, but this is not always the case.
Conversion disorder can develop at any time throughout the lifespan. The onset of non-epileptic seizures is most common in the third decade of life, and motor symptoms have their peak onset in the fourth decade of life.
Conversion disorder can emerge any time, although some symptoms may be more common at certain times, such as motor symptoms in the 30s and non-epileptic attacks in the 20s. Identifying the condition as early as possible will likely lead to better treatment outcomes.
Conversion disorder often occurs alongside anxiety disorders, specifically panic disorder, and depression, according to the DSM-5. Personality disorders are also more common in those with conversion disorder than the general population. For example, there is often overlap between histrionic personality disorder and conversion disorder.
Treatment for conversion disorder typically consists of psychotherapy, physical therapy, and/or medication. The focus of psychotherapy is to help the individual understand the emotional conflict behind their physical symptoms, and to resolve this underlying psychological distress. Psychotherapy treatment can include individual or group therapy, relaxation training, and, more controversially, hypnosis and biofeedback.
Physical therapy attempts to maximize physical functioning and prevent any secondary complications that may result from physical symptoms, such as muscle weakness or stiffness that follows periods of physical inactivity. Conversion disorder may also be treated through the use of psychotropic medications that address underlying psychiatric problems, such as depression and anxiety.
A positive prognosis can be expected when conversion symptoms have a sudden onset, are present for a short period of time, the individual is accepting of their diagnosis, and there are no additional psychiatric disorders present.
Confronting and overcoming functional neurological disorders can be difficult for patients, because physicians may make dismissive, condescending, or inaccurate statements such as that their symptoms “aren’t real.” Patients may also struggle to identify one particular stressor or conflict when asked. These challenges can lead patients to feelings of guilt and shame. But acknowledging the patient’s symptoms and identifying triggers for those symptoms can set clinicians and patients on the right path toward healing.