FUNCTIONAL NEUROLOGICAL SYMPTOM

DISORDER
PATRICK JUDE L., PH. D.
FREUD’S IDEA ABOUT FNSD/CONVERSION DISORDER

Unconscious
conflicts Anxious states
Physical
symptoms to
find expression
FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER

“Functional” refers to a symptom without an organic cause

(Stone, LaFrance, Levenson, & Sharpe, 2010).
“Neurological symptom”
It is likely that the old term “conversion” will be dropped in
future editions of the DSM.
 Conversion disorders generally have to do with physical
malfunctioning, such as paralysis, blindness, or difficulty speaking
(aphonia), total mutism, loss of sense of touch without any
physical or organic pathology to account for the malfunction.
 Most conversion symptoms suggest that some kind of neurological
disease is affecting sensory–motor systems, although conversion
symptoms can mimic the full range of physical malfunctioning.
 Eloise sat on a chair with her legs under her, refusing to put her feet on the floor. Her mother sat close
by, ready to assist her if she needed to move or get up. Her mother had made the appointment and,
with the help of a friend, had all but carried Eloise into the office. Eloise was a 20-year-old of
borderline intelligence who was friendly and personable during the initial interview and who readily
answered all questions with a big smile. She obviously enjoyed the social interaction. Eloise’s
difficulty walking developed over 5 years. Her right leg had given way and she began falling.
Gradually, the condition worsened to the point that 6 months before her admission to the hospital
Eloise could move around only by crawling on the floor. Physical examinations revealed no physical
problems. Eloise presented with a classic case of conversion disorder. Although she was not
paralyzed, her specific symptoms included weakness in her legs and difficulty keeping her balance,
with the result that she fell often. This particular type of conversion symptom is called astasia-abasia.
Eloise lived with her mother, who ran a gift shop in the front of her house in a small rural town.
Eloise had been schooled through special education programs until she was about 15; after this, no
further programs were available. When Eloise began staying home, her walking began to deteriorate.
LA BELLE INDIFFERENCE

La belle indifference is defined as a paradoxical absence

of psychological distress despite having a serious
medical illness or symptoms related to a health
condition. This is also a conversion disorder.
DIAGNOSTIC CRITERIA FOR CONVERSION DISORDER
(FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER) (APA,
2013)

A. One or more symptoms of altered voluntary motor or sensory function.

B. Clinical findings provide evidence of incompatibility between the
symptom and recognized neurological or medical conditions. C
. The symptom or deficit is not better explained by another medical or
mental disorder.
D. The symptom or deficit causes clinically significant distress or
impairment in social, occupational, or other important areas of functioning
or warrants medical evaluation.
CHRONIC Conversion
STRESS symptoms
 Although people with conversion symptoms can usually function normally, they
seem truly unaware either of this ability or of sensory input.
 For example, individuals with the conversion symptom of blindness can usually
avoid objects in their visual field, but they will tell you they can’t see the objects.
 Similarly, individuals with conversion symptoms of paralysis of the legs might
suddenly get up and run in an emergency and then be astounded they were able to
do this.
 It is possible that at least some people who experience miraculous cures during
religious ceremonies may have been suffering from conversion reactions.
CAUSES

 Freud described four basic processes in the development of conversion disorder.

 First, the individual experiences a traumatic event—in Freud’s view, an unacceptable,
unconscious conflict.
 Second, because the conflict and the resulting anxiety are unacceptable, the person represses the
conflict, making it unconscious.
 Third, the anxiety continues to increase and threatens to emerge into consciousness, and the
person “converts” it into physical symptoms, thereby relieving the pressure of having to deal
directly with the conflict. This reduction of anxiety is considered to be the primary gain or
reinforcing event that maintains the conversion symptom.
 Fourth, the individual receives greatly increased attention and sympathy from loved ones and
may also be allowed to avoid a difficult situation or task. Freud considered such attention or
avoidance to be the secondary gain, the secondarily reinforcing set of events
ILLNESS ANXIETY DISORDER (HYPOCHONDRIASIS-STUDENT
EFFORT HOURS)
HAVE A NICE DAY