Conversion Disorder Symptoms, Causes, Treatments

The conversion disorder It is a mental disorder characterized by physical malfunction without the existence of a neurological or medical disease. Very strange cases are known in psychopathology, such as people who stop walking or become blind without apparent physical cause. For example, someone may become temporarily blind due to the stress of the loss of a close family member.. 

People with this disorder are usually able to act normally, although they say they cannot. There is a dissociation between sensory experience and consciousness. For example, in paralysis they could run in emergencies and in blindness they can overcome obstacles.

Some conversion symptoms are blindness, paralysis, aphonia, total mutism or loss of the sense of touch. On many occasions, stress occurs before the onset of conversion symptoms. In cases where there is no stress, a physical cause is more likely.

Although the term conversion has been in use since the Middle Ages, it was with Sigmund Freud that it became popular; thought that unconscious conflicts turned into physical symptoms.

Article index

• 1 Symptoms
  • 1.1 Motor symptoms
  • 1.2 Sensory symptoms
• 2 Causes
• 3 Diagnosis
  • 3.1 Diagnostic criteria according to DSM-IV
  • 3.2 Differential diagnosis
  • 3.3 Exclusion of neurological disease
• 4 Treatment
• 5 Risk factors
• 6 References

Symptoms

Conversion disorder can present with sensory or motor symptoms.

Motor symptoms

• Coordination or balance problems.
• Weakness or paralysis of a part of the body or the whole body.
• Loss of voice or hoarseness.
• Difficulty swallowing or a feeling of a knot in the stomach.
• Urinary retention.
• Psychogenic seizures or non-epileptic seizures.
• Persistent dystonia.
• Fainting.

Sensory symptoms

• Blindness, vision problems, or double vision.
• Deafness or hearing problems.
• Loss of touch.

Causes

Although the exact causes of conversion disorder are unknown, it appears that the symptoms are related to the occurrence of a psychological conflict or stressful event.

There are also people who are considered at risk of developing this disorder, such as those with a disease, people with personality disorders, or people with dissociative disorder..

One explanation from evolutionary psychology is that the disorder could have been advantageous during the war. A fighter with symptoms could nonverbally show that he is safe to another person who speaks another language.

This could explain that conversion disorder can develop after a threatening situation, that there may be a group that develops the disorder and the gender difference in prevalence (it occurs more in women).

Diagnosis

Diagnostic criteria according to DSM-IV

A) One or more symptoms or deficits affecting voluntary or sensory motor functions and suggesting a neurological or medical disease.

B) Psychological factors are considered to be associated with the symptom or deficit because the onset or exacerbation of the condition is preceded by conflicts or other triggers.

C) The symptom or deficit is not produced intentionally and is not simulated (unlike what occurs in factitious disorder or in simulation).

D) After a proper clinical examination, the symptom or deficit is not explained by the presence of a general medical condition, by the direct effects of a substance, or by culturally normal behavior or experience.

E) The symptom or deficit causes clinically significant discomfort or deterioration in social, occupational or other important areas of the subject's activity, or requires medical attention.

F) The symptom or deficit is not limited to pain or sexual dysfunction, does not appear exclusively in the course of a somatization disorder and is not better explained by the presence of another mental disorder.

Differential diagnosis

Sometimes it is difficult to distinguish people with conversion disorder from people who are really simulators (they fake symptoms with some goal). If discovered, simulators have reasons to simulate symptoms. They can be from economic reasons to family or emotional interests.

There is also factitious disorder, in which the person simulates the symptoms even though they do not have a good reason, other than to receive care or get rid of responsibility. On the other hand, there is the Munchausen syndrome by proxy, in which an affected parent uses ways to cause an apparent illness in their child..

Neurological disease exclusion

Conversion disorder usually presents with symptoms that resemble a neurological disorder such as stroke, multiple sclerosis, or epilepsy..

The neurologist must carefully exclude the disease, through proper investigation and examination. However, it is not uncommon for patients with neurological diseases to also have conversion disorder..

For example, low awareness or concern about symptoms can also occur in people with neurological disorders. Also, the agitation 

Treatment

A main action strategy is to eliminate sources of stress or stressful events that exist in the patient's life, whether they are present in real life or in her memories..

In addition, it is important that the professional therapist does not maintain the secondary gains, that is, the consequences to the patient for showing symptoms. Examples of secondary earnings can be:

• Avoid responsibilities.
• Get more attention.
• Positive consequences for family members.

It is important to note that it may be a family member who is benefiting from conversion symptoms. For example, there is the case of a girl who without physical cause stopped walking. It was in the mother's interest if her daughter spent a lot of time in one place while she worked.

In these cases, it is more difficult to eliminate the consequences and relapses may occur if the family member is not aware of the problem or does not find other ways to receive positive reinforcement.

Although symptoms occasionally go away on their own, the patient can benefit from a variety of treatments. They may be:

• Explanation: must be clear, as the attribution of physical symptoms to psychological causes is not well accepted in Western culture. The genuineness of the disorder, that it is common, that it does not indicate psychosis, and that it is potentially reversible should be emphasized..
• Psychotherapy in certain cases.
• Occupational therapy to maintain autonomy in daily life.
• Treatment of comorbid disorders, such as depression or anxiety.
• Treatments such as cognitive behavioral therapy, hypnosis, eye movement reprocessing, or psychodynamic therapy need more research.

Risk factor's

Risk factors for developing the disorder can be:

• Recent significant stress or emotional trauma.
• To be a woman; women are more likely to develop the disorder.
• Having a mental disorder, such as anxiety, dissociative disorder, or personality disorders.
• Having a neurological disease that causes similar symptoms, such as epilepsy.
• Having a family member with conversion disorder.
• A history of physical or sexual abuse in childhood.

References

1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association.
2. Halligan PW, Bass C, Wade DT (2000). "New approaches to conversion hysteria". BMJ 320 (7248): 1488-9. PMC 1118088. PMID 10834873.
3. Roelofs K, Hoogduin KA, Keijsers GP, Näring GW, Moene FC, Sandijck P (2002). "Hypnotic susceptibility in patients with conversion disorder". J Abnorm Psychol 111 (2): 390-5. PMID 12003460.
4. Nicholson TR, Kanaan RA (2009). "Conversion disorder". Psychiatry 8 (5): 164. doi: 10.1016 / j.mppsy.2009.03.001.