Conversion Disorder

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, referring to abnormal central nervous system functioning. A key feature of conversion disorder is the incompatibility between an individual’s symptoms and recognized neurological or medical conditions.

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. Conversion disorder is two to three times more common in females than males. The rate of new diagnoses of persistent conversion symptoms is approximately two to five cases per 100,000 each year. 

Symptoms

Conversion disorder can have many different presentations and symptoms. Motor symptoms include weakness or paralysis, abnormal movements such as tremor, 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 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. 

Causes

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. 

Treatment

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, hypnosis, biofeedback, and relaxation training.

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. 

References

  • Ali, S., Jabeen, S., Pate, R. J., Shahid, M., Chinala, S., Nathani, M., & Shah, R. (2015). Conversion Disorder—Mind versus Body: A Review. Innovations in clinical neuroscience, 12(5-6), 27.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  • Yakobov, E., Jurcik, T., & Sullivan, M. J. (2017). Conversion Disorder. In Practical Psychology in Medical Rehabilitation (pp. 277-285). Springer International Publishing.

Last reviewed 11/08/2017