INTRODUCTION

Conversion disorder, also called functional neurological symptom disorder, it is defined as a

psychiatric illness in which symptoms and signs affecting voluntary motor or sensory function
cannot be explained by a neurological or general medical condition. Psychological factors, such
as conflicts or stress, are judged to be associated with the deficits. The term conversion disorder
was coined by Sigmund Freud, who hypothesized that the occurrence of certain symptoms not
explained by organic diseases reflect unconscious conflict. The word conversion refers to the
substitution of a somatic symptom for a repressed idea (Ballmaier M Schmidt R.,2015)
Symptoms of Conversion Disorder
Blindness, paralysis, dystonia, psychogenic no epileptic seizures (PNES), anesthesia, swallowing
difficulties, motor tics, difficulty walking, hallucinations, anesthesia, and dementia.
In patients with conversion disorder, these symptoms are not caused directly by a physiological
effect; rather these symptoms are caused by a psychological conflict. Patients diagnosed with
conversion disorder are not feigning the signs and symptoms. Despite the lack of a definitive
organic diagnosis, the patient’s distress is very real and the physical symptoms the patient is
experiencing cannot be controlled at will (i.e., the patient is not malingering an illness).
(Marshall S, Bienenfeld D.,2013)
Example
According to the Medline Medical Dictionary, “a woman who believes it is not acceptable to
have violent feelings may suddenly feel numbness in her arms after becoming so angry that she
wanted to hit someone. Instead of allowing herself to have violent thoughts about hitting
someone, she experiences the physical symptom of numbness in her arms.”
Hypothetical case
A girl of age 25year has brought to hospital in mute condition, having symptoms of headache,
swallowing difficulties, motor tics, difficulty walking, weakness, unresponsiveness.
Summary
IK was 25 years old unmarried female. She has 4 step siblings. She belongs to middle class
family. She has presenting complaints like low speech, fatigue, headache, stuck body parts, fits.
The primarily investigation was examined through formal and informal assessment. Informal
assessment was done through clinical interview, baseline, for headache and fits and mental state
examination. Formal assessment symptoms were from checklist. According to DSM-v,formal
and informal assessment, she was diagnose with conversion disorder 300.11. The management
plan devised based on her presenting complaints. it includes psychoeducation, deep breathing,
CBT, REBT, problem solving techniques, assertive techniques, pleasure and mastery, anger
stress management. All the treatment plans were consisted on 12 sessions.

.
Session Model
Weeks Sessions Goal

1 1 Rapport building,

History taking

Behavioral observation

Deep breathing, Home work

2 2 Feedback from the previous

session

Detailed History Taking

Mental status examination

Progressive Muscle Relaxation

Homework task

3 3 Feedback from the previous

session

Psycho education

Pre-Assessment (SCL-R & DSM-5

checklist)

Family counseling

homework task

4 4 Feedback from the previous

session

coping statements

Daily Activity Scheduling

5 5 Feedback from previous session

Sleep Hygiene Tips

Baseline chart for fits

6 6 Feedback from previous session

Anger Management Tips

Baseline chart for anger

Extinction Guidelines

7 7 Feedback from previous session

 Baseline chart review

cost benefit analysis for anger

8 8 Feedback from the previous

session

Cost benefit analysis for fits

ABC model

9 9 Feedback from the previous

session

Headache management

covert Extinction

Master and pleasure Activities

10 10 Feedback from the previous

session

Contingency management plan

homework

11 11 Feedback from the previous

session

Assertiveness technique

problem solving

12 12 Feedback from previous session

Post assessment

Relapse prevention

Therapy blue print

Bio data
Name: IK
Age: 25 years
Gender: female
Education: matric
Occupation: N\A
Siblings: 5
Birth order: 1st
Marital status: unmarried
Religion: Muslim
Residential area: Chakwal
Reason:
The client was brought for psychological assessment
Source of referral:
Client refer by Psychiatrist because she is unable to speak.
Presenting complain: weakness, abnormal movement, swallowing symptoms, speech
symptoms, muscle pain, unresponsiveness, Limb weakness, slurred or stuttered speech,
headache, fits, Double vision.
Duration
She is suffering with this disorder from past six months.

Background History
History of client reveals that a young a girl of 25 years old brought up to psychiatric ward with
mute condition for her immediate treatment.
A night before her mute condition she was busy in the household chores till late at night. The
next morning, she developed the mute condition and for three days she did not talk nor did she
have any food. When she was brought to the psychiatric ward, the doctors suggested him to
psychologist. she was the eldest in the family and had two step sisters and two step brothers. Her
real mother was died when she was just two years old. Her father got married again. She has the
responsibility of all the household chores. She wanted to study after class 5 but her mother did
not allow her.
She was in love with her cousin but her step mother did not like it. She used to meet her cousin at
her aunt’s home. When her mother came to know about her meetings with her cousin, she had a
severe fight with her. That was the day when had her first attack. She became unconscious and
after that she became mute and could not open her mouth. Ms. IK was admitted in a psychiatric
ward and she was shown to several different doctors, neurologist and examined for all possible
cause of her severe condition. She was stayed in this condition for three days but time duration
was about 6 months. The Psychiatrist at this time asked the psychologist to come and see the
patient. The Psychologist visited IK and called her father.
Her father gave the entire history and after that her step mother was called by the psychologist
separately, who gave her view of the whole thing. The step mother seemed to be over powered
and authoritative woman and father as submissive. Her father was not happy with her position in
the house and he also wished for her wedding. However, her step mother did not want her
wedding as she had the responsibilities of the entire household.

Personal History
Her birth was normal, no any complexities in her birth. Her developmental period was also
normal no any kind of developmental delay first walk, first cry etc. School going age is
according to cultural and family norms. Self-centered personality, introvert personality, Friend
circle was very small.
Educational History:
Client started school at age of 4 in Govt. school. she was very shy and a very quiet student. She
was average student and never have very good grades. She used to get passing marks and that
was also very hard for his to achieve. She had least interest in studies and leave school after
matric and so she had to face a lot of critics and was scolded by her family.
Mental State Examination:
Client having low tone, poor eye contact, confusing thoughts, unresponsive attitude
Rationale of Study
The rationale behind the treatment plan is much focus of treatment is on “retraining the brain.”
Since the nervous system is intact and the problem is in the signaling exchange between the brain
and nerves, the goal of treatment is to relearn normal functions. Some of the more commonly
recommended treatments include:Psychological therapy, such as cognitive behavioral therapy
(CBT). Rational Emotive Behavioral Therapy(REBT), Primary Relaxation Technique(PMR),
Psychoeducational Therapy, Problem Solving Technique.

This treatment is helpful for understanding the problem of client, and also explore the client’s
thoughts and beliefs about their symptoms. The evidence for and against beliefs can be reviewed
by treatment. The desired behavior is practiced daily until it is mastered, and then the next goal is
undertaken. Relaxation technique can aid coping with unpleasant symptoms and Distraction
techniques may help to generate a sense of control over attacks or exacerbations of symptoms.
Problem solving can be used to help patients address obstacles to recovery, such as difficulties
with relationships, work, finances, and legal issue.
The study has been aimed to investigate how treatment plan is helpful for the client who is
suffering from conversion disorder.

References
1.Ballmaier M, Schmidt R. Conversion disorder revisited. May 23, 2005. [May 30, 2015].
http://www.functionalneurology.com/materiale_cic/99_XX_3/892_convers ion/index.html
2.Marshall S, Bienenfeld D. Conversion disorder. Medscape. Drugs and diseases. June 26, 2013.
[May 30, 2015]. http://emedicine.medscape.com/article/287464-overview