Conversion Disorder: Let’s Learn!

A loyal chipur reader, Prudence, commented on an article I wrote two days ago about psychogenic non-epileptic seizures. In my reply, I said I’d do a piece on conversion disorder. They’re related, and it’s captivating stuff.

Conversion Disorder is a fascinating emotional/mental health situation. Categorized as a Somatoform Disorder (somatic – of the body), here’s my recap of its diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) (why do they have to make that so long – WDTHTMTSL???).

  • One or more of the symptoms affect voluntary motor or sensory function, suggesting a neurological disorder.
  • The diagnosing clinician believes psychological factors are associated with the symptoms, because a stressor(s) preceded their onset or reduction/cessation. Actually, the stressor could have occurred years before.
  • The symptoms aren’t being intentionally produced or faked.
  • No explanations for symptoms have been found after a thorough medical evaluation
  • The symptoms aren’t attributable to the direct effects of a substance or culturally sanctioned behavior or experience.
  • The symptoms are causing significant distress, or impairment in key areas of life functioning.
  • The symptoms aren’t limited to pain or sexual dysfunction, and can’t be accounted for by another emotional/mental disorder.

Now that we have the psychobabble out of the way, let’s talk. Conversion disorder is all about an individual presenting neurological symptoms – e.g. blindness, numbness, paralysis – but nothin’s cookin’ medically. And the symptoms are beyond the individual’s control.

Conversion disorder typically appears suddenly after a stressful event. For example, one’s leg may become paralyzed after falling from a horse  – even though there was no physical injury. Other triggers may be intense emotional conflict and the presence of other emotional/mental health disorders, such as depression.

Conversion disorder presents in two to six women for every man. It’s very rare in children under 10, as well as the elderly.

Interestingly, the term, conversion, was first used by Sigmund Freud (Uncle Siggy). He believed intense internal conflict was converted into physical symptoms.

So what kind of physical symptoms might we see with conversion disorder? Here are just a few examples…

  • Weakness or paralysis of a limb – or the entire body
  • Compromised vision/hearing
  • Loss or disturbance of sensation/speech
  • Psychogenic non-epileptic seizures (at one time known as pseudoseizures)
  • Tremor or other movement disorders
  • Gait problems
  • Fainting
  • Fixed dystonia (e.g. clenched hand or ankle turned in – with no voluntary movement of muscles)

Diagnosing conversion disorder is really a process of good old-fashioned common sense and elimination. First of all, neurological/medical factors are excluded. Then it’s a matter of ruling-out intention and faking. And when those two are handled, a psychological angle has to be proposed.

Remember, the diagnosing clinician has to believe a stressor(s) preceded the onset, reduction, or cessation of symptoms.

Unfortunately, there isn’t a whole lot known about cause. In fact, it’s all pretty much a matter of conjecture. Researchers do believe the portion of the brain that controls our muscles and senses is likely involved. But that sure leaves the door wide-open to a bunch of things.

How ’bout this? Like so many inexplicable emotional/mental disorders, it may be the brain’s way of coping with a perceived threat.

But we do have some risk factors to hang our hats on…

  • Recent intense stress or emotional trauma
  • Being female (sorry ladies)
  • Adolescence or early adulthood
  • Having a current mood, anxiety, dissociative, or personality disorder diagnosis
  • Having a family member with conversion disorder
  • History of physical or sexual abuse
  • Financial hardship

The first step in treating conversion disorder is always a clear and calm explanation of the emotional and mental foundation of the presenting symptoms. Of course, by this time everyone knows there’s no medical cause. The message must be clear that the disorder is not uncommon, may be reversible, and the sufferer is certainly not a psychofreak. Actually, if this is handled properly, the symptoms often disappear in several weeks.

Other treatment considerations – neurological follow-up just in case something develops, physical and occupational therapy if indicated, transcranial magnetic stimulation (TMS), and treatment of comorbid emotional/mental health disorders.

Within the realm of psychotherapy, often employed are cognitive behavioral therapy, hypnosis, eye movement desensitization and reprocessing (EMDR), and psychodynamic therapy.

Medications often used are the benzodiazepines (e.g. Valium, Xanax, Ativan) and the beta blockers (e.g. Corgard, Tenormin). Psychotropic medications may be prescribed to treat comorbid disorders.

And since conversion disorder presents subsequent to some sort of stressor(s), keeping levels of stress in check is a darned good idea. So how ’bout exercise, relaxation techniques, meditation, yoga, etc.?

Alrighty, then – the scoop on conversion disorder. A nice bit of learning on this Tuesday evening, don’t you think?