Conversion disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 21, 2016
StartDiseasesConversion disorder

Conversion disorder (sometimes known as functional neurological symptom disorder) can affect people who are dealing with particularly stressful situations. Conversion disorder involves a sense of disorientation and anxiety which also can include blindness, paralysis, numbness, panic, or fits. Conversion disorder has been known as "hysteria" before. It is classified in the Diagnostic and Statistical Manual of Mental Disorders as a disorder in which psychological problems manifest themselves as physical symptoms.

Contents

Definition & Facts

Conversion disorder can affect those who have experienced a sudden life change or trauma such as a move, or other transition. For those with this disorder, heightened emotional experiences impair psychological and neurological processing.

There is much debate about how to classify conversion disorder. Conversion disorder has been referred to by many different terms and can be very difficult to prove or disprove. Because of the generally temporary nature of conversion disorder, it can be difficult to diagnose and treat. Conversion disorder has both psychological and neurological symptoms that cannot be explained by other mental disorders or neurological disease.

Symptoms & Complaints

Conversion disorder is generally diagnosed through motor symptoms and sensory symptoms. Motor symptoms will include weakness, paralysis, potential lack of balance, and potential loss of speech or otherwise impaired speech. These symptoms are usually something the patient has never experienced before. Other motor symptoms can include seizures or convulsions and a loss of consciousness.

Sensory symptoms are more difficult to determine. The individual may have impaired vision, impaired hearing, or a loss of other sensations such as pain and touch. In general, the individual will have difficulty recognizing different stimuli and may not be able to respond to things such as pain. In general, conversion disorder can closely resemble a stroke

Those with conversion disorder may report feeling panicked, anxious, or a sense of impending doom. They may also feel overwhelmed and they can potentially become paranoid

Causes

Conversion disorder occurs most commonly in children and young adults. The most common age for conversion disorder is between 10 to 35. While conversion disorder has been shown to occur in men as well, it occurs in women far more frequently. Women are anywhere from twice to six times more likely than men to experience conversion disorder.

Conversion disorder can be caused by a sudden emotional trauma that overwhelms a person's capacity to cope. Conversion disorder is more likely to be experienced by those who have pre-existing psychological issues. Those who have anxiety disorders are particularly prone to conversion disorders, as are those who have lifestyles involving high levels of stress.

Diagnosis & Tests

There are two significant and competing concerns regarding the diagnosis of conversion disorder: feigning and alternate disorders. Feigning occurs when a patient is consciously faking physical symptoms. A patient can simply say they are panicked and have gone blind. Though a patient can have a number of reasons for doing this, it can be difficult for the doctor to determine whether or not they are lying.

The other concern -- which is arguably more important -- is the potential for another type of diagnosis. Conversion disorder could also be another serious disorder, such as a stroke or other health issue. Because of this, all of the other potential issues need to be dismissed before conversion disorder can be diagnosed. Thus, conversion disorder becomes a diagnosis of exclusion. If a person has these symptoms and has not had a stroke, concussion, or other similar occurrence happen to them, then it is possible that they may have conversion disorder. 

Treatment & Therapy

Conversion disorder is usually a disorder with a sudden onset. It happens very quickly. It also stops very quickly. Treatment for a conversion disorder may include psychotherapy (talk therapy) including a type called cognitive behavioral therapy and mild sedatives such as Valium® (diazepam). Conversion disorder does not generally necessitate long-term treatment and it usually doesn't last very long. 

Sometimes conversion therapy could have some lasting neurological issues, such as a prolonged loss of balance, vision loss, or hearing loss. If this is the case, occupational therapy is usually used to reduce the impact of these issues. Most conversion disorders will resolve on their own and there are very few treatments that are known to be effective for those with conversion therapy. 

Conversion disorder often occurs in tandem with depression and anxiety. Depression and anxiety may be treated in order to either remove or reduce the symptoms of the conversion disorder itself. Sometimes it is believed that the conversion disorder may be a symptom of anxiety or depression.

Prevention & Prophylaxis

There is no known way to prevent conversion disorder. Because conversion disorder often occurs alongside depression and anxiety, patients who have depression and anxiety may want to seek treatment before an issue such as this can arise.

High levels of anxiety do appear to make conversion disorder a higher risk. Stress management and other therapy techniques can be used to reduce the chances that a patient could experience an issue such as this or a panic disorder.