CONVERSION DISORDER

Conversion disorder, also called functional neurological symptom disorder, is a medical problem involving
the function of the nervous system; specifically, the brain and body’s nerves are unable to send and receive
signals properly. As a result of this “communication” problem, patients with conversion disorders may have
difficulty moving their limbs or have problems with one or more of their senses.

In the past, conversion disorder was thought to be an entirely psychological disorder, where psychological
problems get “converted” into physical symptoms. Today, conversion disorder is recognized as its own
distinct disorder. Psychological issues (for example, trauma, personal conflicts, life stressors) are often seen
in patients with conversion disorder symptoms, but are not always present in all patients.

Care of patients with conversion disorder overlaps the fields of psychiatry and neurology. However, it is
important to note that the symptoms are real; they are not made up and patients are not faking them.

Conversion disorder involves a pattern in which symptoms or deficits affecting sensory or voluntary motor
functions lead one to think that a patient has a medical or neurological condition. However, upon a thorough
medical examination, it becomes apparent that the pattern of symptoms or deficits can't be fully explained
by any known medical condition. A few typical examples include partial paralysis, blindness, deafness and
pseudoseizures. In addition, psychological factors much be judged to play an important role in the symptoms
or deficits because the symptoms usually either start or are exacerbated by proceeding emotional or
interpersonal conflicts or stressors. Finally, the person must not be intentionally providing or faking the
symptoms. (APA, 2000)
Early observation dating back to Freud suggested that most people with conversion disorder showed very
little of the anxiety and fear that would be expected in a person with a paralyzed arm or loss of sight. This
seeming lack of concern in the way the patient describes what is wrong was thought for a long time to be an
important diagnostic criterion for conversion disorder.
The term conversion disorder is relatively recent and historically this disorder was one of several disorders
that were grouped together under the term hysteria.
Freud used the term conversion hysteria for this disorder because he believed that the symptoms were
expression of repressed sexual energy that is, the unconscious conflict that a person felt about his or her
sexual desires was repressed.

ETIOLOGY/ CAUSAL FACTORS

Much of the work on the etiology of somatoform disorder been directed toward understanding conversion
disorder. Although it was generally proposed that conversion disorder could be related to genetic factor,
twin studies do not support this idea (Slater,1961)
1) Psychodynamic perspective
Conversion disorder occupies a central place in psychodynamic theories because the symptoms provide a
clear example of of the unconscious. Freud and his colleague Josef Breue(1985/1992) developed a
psychoanalytical model of conversion disorder. They proposed that a conversion disorder results when a
person experiences an emotionally overwhelming event, but the emotion is not expressed and the memory of
the event is cut off from consciousness.
In addition, they pointed out that the symptoms could let the person avoid an unpleasant life situation or
obtain attention. This theory of conversion disorder is intrguing, but there is no emperical support for it.
A more recent psychodynamic interpretation of one form of conversion disorder is hysterical blindness,
based on a review of two case studies of hysterically blind teenage women (Nordile and Gur, 1979). In one
case, a young woman who reported being blind performed more poorly on a vision test than a person who
was actually blind. (i.e. she performed below chance levels)
In another case, a teenage girl reported that she could not see to read, but test showed that she could readily
identify objects of various sizes and shapes and count fingers at a distance of 15 feet.

2) Biological Causes
Research into the cause of conversion disorder has found that the brain imaging of some individuals with the
disorder shows increased or reduced blood flow to certain areas of the brain. If areas of the brain that are
responsible for communication with other body parts have reduced blood flow, this may cause neurological
symptoms associated with conversion disorder. It is possible that these changes in blood flow may be caused
by the brain receiving information about physical or emotional stressors. Regardless of the cause of the
disorder, it is important to remember that the symptoms are very real; affected individuals aren't faking
symptoms of the disorder.
It's not thought that there is a single gene responsible for the development of conversion disorder. In most
cases, only one person is identified in a single family. However, it is thought that first degree female
relatives of a person with conversion disorder (sister, mother or daughter), have a 14 times higher chance to
develop symptoms than other woman in the general population. This increased risk is likely due to shared
environmental and risk factors for the development of the disorder.

CLINICAL PICTURE

Prevalence: The reported incidence of conversion symptoms varies widely depending on the population
studied. Studies have estimated that 20 to 25 percent of patients in a general hospital setting have individual
symptoms of conversion, and five percent of patients in this setting meet the criteria for the full disorder.

Onset and Gender: Although conversion disorder can occur at any age, it tends to develop during
adolescence to early adulthood. Conversion disorder is more common in women. About two-third of patients
have evidence of psychiatric disease, the most common being depression and trauma. Personality disorders
are also commonly seen.

Symptoms: SYMPTOMS:
1) Sensory symptoms or deficits
Conversion disorder can involve almost any sensory modality and it can often be diagnosed as a conversion
disorder because symptoms in the affected area are inconsistent with how known anatomical sensory
pathways operates. Today the sensory symptoms or deficits are most often in the visual system (especially
blindness and tunnel vision). In the auditory system (especially deafness) or in the sensitivity to feeling
(especially the anaesthesia)
With conversion blindness, the person reports that he or she can't see and yet can often navigate about a
room without bumping into furniture or other objects. With conversion deafness, the person report not being
able to hear and yet orients appropriately upon hearing his or her own name.
2) Motor symptoms or deficits
Motor conversion reactions also cover a…………..range of symptoms. Example- Conversion paralysis is
usually…………. to a single limb such as an arm or a leg and the loss of function is usually selective for
certain functions.
Example- a person may not be able to write but may be able to use the same muscles for scratching or a
person may not be able to walk most of the time but maybe able to walk in an emergency such as a fire,
where escape is important.
The most common speech related conversion disturbance is aphonia- in wich a person is able to talk in a
whisper although he or she can usually cough in a normal manner. Another common motor symptom called
globus hysterieus, is difficulty in swallowing or the sensation of a lump in the throat.
3) Seizures
Conversion seizures, another relatively common form of symptoms, involve psedoseizures, which resemble
epileptic seizures in some ways but can usually be............ well differentiated via modern medical
technology. Example- patients with pseudoseizures do not show any EEG abnormalities and do not show
confusion and loss of memory afterward, as patients with true epilepsy seizures do.
Moreover, patient with conversion seizures often show excessive thrashing about and writing not seen with
true seizures and they rarely injure themselves in falls or lose control over their bladder, as patients with true
seizures frequently do.
Conversion disorder is like many other disorders or diseases that have many causes, many risk factors, and a
wide range of symptoms. Also, symptoms vary from person to person. Symptoms of conversion disorder
include:

 Loss of vision, double vision, sensitivity to light

 Limb weakness or paralysis
 Loss of voice, slurred or stuttered speech
 Trouble coordinating movements
 Memory issues, thinking problems
 Headaches, migraines
 Loss of sense of smell
 Chronic pain
 Loss of sense of touch
 Loss of hearing
 Numbness, tingling in limbs, body or face
 Seizures, blackout, fainting
 Tremors, spasms
 Sleep problems
 Overactive bladder
 Hallucinations

Some patients only have a few symptoms; some have many symptoms. Symptoms vary in their intensity and
frequency. In some patients, symptoms are always present; in others, they appear, disappear, and reappear.

Diagnostic criteria: Diagnostic criteria of DSM-IV TR

1) One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a
neurological or other general medical condition.
2) psychological factors are judged to be associated with the symptom or deficits because the initiation or
exacerbation of the symptom or deficit is preceded by conflict or other stressors.
3) The symptom or deficit is not intentionally produced or feigned.
4) The symptom or deficit can't after appropriate investigation be fully explained by a general medical
condition or by the direct effects of a substance or as culturally sanctioned behavior or experience.
5) The symptom or deficit cause clinically significant distress or impairment in social, occupational or other
important areas of functioning or warrants medical evaluation.
6) The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the
course of somatization disorder and is not better accounted for by another mental disorder.