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Conversion Disorder

Synonyms of Conversion Disorder

  • Briquet's Syndrome
  • Hysterical Neurosis, Conversion Type

Disorder Subdivisions

  • No subdivisions found.

General Discussion

Conversion disorder is a mental illness characterized by the loss or alteration of physical functioning without any physiological reason. These physical symptoms are the result of emotional conflicts or needs. The symptoms usually appear suddenly and at times of extreme psychological stress. A lack of concern over the debilitating symptoms (la belle indifference), which commonly accompanies this illness, may be a clue to distinguishing it from the physiological disorder it may mimic.

Symptoms

Patients with conversion disorder usually exhibit one symptom only. However, if episodes reoccur, the symptom may reappear but in a different location or intensity.

The most common symptoms of conversion disorder are similar to those associated with neurological disease. These include paralysis, loss of voice (aphonia), disturbances in coordination, impaired or jerky movements, temporary blindness, tunnel vision, loss of the sense of smell (anosmia) or touch (anesthesia), or a tingling sensation to the skin (paranesthesia).

Conversion disorder is suspected if the onset of the debilitating symptom is sudden, if a recent psychological conflict is resolved as a consequence of the onset of the symptom, and if the patient demonstrates a lack of appropriate concern in facing a serious symptom.

Some psychiatrists and/or psychotherapists believe that the symptoms of conversion disorder may be symbolic resolutions of psychological conflicts. For example, in some cases vomiting may represent revulsion and disgust, or blindness may represent the inability to accept the witnessing of a traumatic event. It is important that physiological diseases be ruled out before a diagnosis of conversion disorder is made.

Causes

Conversion disorder is thought to be caused by an "internal" conflict that creates extreme psychological stress. Conversion symptoms represent a partial solution to a conflict. A soldier who subconsciously wishes to avoid firing a gun or who may be frightened but ashamed or afraid of showing it, may develop a paralyzed hand. A person who wishes to prevent desertion by a spouse may suddenly exhibit paralysis. In each case the cause is psychological rather than physical.

The onset of symptoms of a conversion disorder is usually sudden and they disappear just as suddenly. Other disorders must be ruled out since the symptoms of many neurological diseases may wax and wane without apparent reason, and in this way mimic those of conversion disorder.

Affected Populations

True conversion disorder is thought to be rare, with reports of an incidence rate of 14-22 cases per 100,000 population. It may be more common in rural settings, and/or among poorer people and/or among military personnel. The comparative incidence among men and women is not known. Some scientists believe it occurs significantly more often among females than among males, but this is not generally concurred upon at this time. Conversion disorder sometimes occurs among children but is more common among adolescents and young adults.

Related Disorders

Symptoms of the following disorders can be similar to those of conversion disorder. Comparisons may be useful for a differential diagnosis:

Somatization Disorder is a psychological disorder characterized by frequent and numerous physical complaints that are not due to any physical disorder. The disorder begins before the age of 30 and complaints are usually vague, dramatic and exaggerated. The patient is usually found to be under the care of several physicians simultaneously.

Hypochondria is a psychological disorder in which there is a preoccupation with having a serious disease without any physical disorder. This fear continues despite medical reassurance that there is no physical problem.

Neurological disorders that can cause similar waxing and waning symptoms, but have a physiological basis include multiple sclerosis, Tourette syndrome, Wilson's disease, demylinating polyneuropathy, and many, many more disorders affecting the central nervous system.

Standard Therapies

Treatment of conversion disorder varies with the individual. Psychotherapy, individual, for couples or family may be helpful. In some instances specific life changes, such as a job change or homemaking assistance, may be all that is needed. Hypnosis may remove specific symptoms, but a substitute symptom often arises. Certain symptoms may disappear with the use of antidepressant and antipsychotic drugs.

Conversion disorder manifest as temporary paralysis may be treated by electromyographic (EMG) biofeedback.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

Organizations related to Conversion Disorder

References

TEXTBOOKS
Ford CV, Conversion disorder and somatoform disorder not otherwise specified. In: Gabbard GO, ed. Treatment of Psychiatric Disorder. 2nd ed. Washington, DC: American Psychiatric Press, Inc; 1995:1735-54.

Barsky AJ, Somatoform disorders. In: Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry. 5th ed. Baltimore, MD: Williams & Wilkins; 1989:1009-27.

JOURNAL ARTICLES
Kotagal P, Costa M, Wyllie E, et al. Paroxysmal nonepileptic events in children and adolescents. Pediatrics. 2002;110:e46.

Bourgeois JA, Chang CH, Hilty DM et al. Clinical manifestations and management of conversion disorders. Curr Treat Options Neurol. 2002;4:487-97.

Allanson J, Bass C, Wade DT. Characteristics of patients with persistent severe disability and medically unexplained neurological symptoms: a pilot study. J Neurol Neurosurg Psychiatry. 2002;73:307-09.

Teasell RW, Shapiro AP. Misdiagnosis of conversion disorders. Am J Phy Med Rehabil. 2002;81:236-40.

Pehlivanturk B, Unal F. Conversion disorder in children and adolescents: a 4-year follow-up study. J Psychosom Res. 2002;52:187-91.

Syed EU, Atiq R, Effendi S, et al. Conversion disorders: difficulties in diagnosis using DSM-IV/ICD-10. J Pak Med Assoc. 2001;51:143-45.

Henningson M, Sundbom F. Conversion disorder and multiple chemical sensitivity: a comparative study of psychological defense strategies. Percept Mot Skills. 2000;91(3 Pt 1):803-18

Benbadis SR, Allen-Hauser W. An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure. 2000;9:280-81.

Zeharia, A, et al., Conversion reaction: management by a paediatrician. Eur J Pediatr. 1999;160-64.

Bowman ES, et al., The contribution of life events to pseudoseizure occurrence in adults. Bull Menninger Clin. 1999;63:70-88.

Binzer M, Kullgren G. Motor conversion disorder: A prospective 2-to-5 year follow-up study. Psychosomatics. 1998;39:519-27

Binzer M, Andersen PM, Kullgren G. Clinical characteristics of patients with motor disability due to conversion disorder: a prospective control group study. J Neurol Neurosurg Psychiatry. 1997;63:83-88.

Parobek VM, Distinguishing conversion disorder from neurologic impairment. J Neurosci Nurs. 1997;29:128-34.

FROM THE INTERNET
Ballas C. MEDLINEplus. Medical Encyclopedia. Last Update; 10 January 2003:2pp.
www.nlm.nih.gov/medlineplus/ency/article/000954.htm

Dufel S. Conversion Disorder. eMedicine. Last Update; June 4, 2001:9pp.
www.emedicine.com/emerg/topic112.htm

Dissociative (conversion) disorder - F44. WHO Guide to Mental Health in Primary Care. 2pp.
www.psychiatry.ox.ac.uk/cebmh/whoguidemhpcuk/disorders/f44.html.

Conversion and somatization disorders. Vanderbilt Medical Center. Adolescent Medicine. 1998:3pp.
www.mc.vanderbilt.edu/peds/pidl/adolesc/convreac.htm

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Report last updated: 2008/03/04 00:00:00 GMT+0

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