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Conversion Disorder

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(Functional Neurological Symptom Disorder)

by Joel E. Dimsdale, MD

In conversion disorder, physical symptoms that resemble those of a nervous system (neurologic) disorder develop. The symptoms are commonly triggered by mental factors such as conflicts or other stresses.

  • An arm or leg may be paralyzed, or people may lose their sense of touch, sight, or hearing.

  • Many physical examinations and tests are usually done to make sure symptoms do not result from a physical disorder.

  • Reassurance from a supportive, trusted doctor can help, as can hypnosis and cognitive-behavioral therapy.

Conversion disorder is thought to be caused by mental factors, such as stress and conflict, which people with this disorder experience as (convert into) physical symptoms.

Although conversion disorder tends to develop during late childhood to early adulthood, it may appear at any age. The disorder appears to be more common among women.

Symptoms

The symptoms—such as paralysis of an arm or leg or loss of sensation in a part of the body—suggest nervous system dysfunction. Other symptoms may resemble a seizure or involve problems with thinking, difficulty swallowing, or loss of one of the special senses, such as vision or hearing.

Often, symptoms begin after some distressing social or psychologic event. Symptoms are not intentional. They are severe enough to cause substantial distress and to interfere with functioning.

People may have only one episode in their lifetime or episodes that occur sporadically. Usually, the episodes are brief.

Diagnosis

Doctors first check for physical, particularly neurologic, disorders that can account for the symptoms by taking a thorough medical history, doing a thorough physical examination, and doing tests. The key to the diagnosis is that symptoms do not match those caused by any neurologic disorder. For example, the person may tremble and think that the trembling is caused by a seizure disorder. But when the person is distracted, the trembling disappears. If people have a seizure disorder, distractions do not stop the trembling.

Once doctors determine that the symptoms do not match those caused by any neurologic disorder, doctors consider the diagnosis of conversion disorder. The diagnosis is made based on all the information from the evaluation.

Treatment

A supportive, trustful doctor-patient relationship is essential. The most helpful approach may involve collaboration of a primary care doctor with a psychiatrist and a doctor from another field, such as a neurologist or internist.

After the doctor rules out a possible physical disorder and reassures the person that the symptoms do not indicate a serious underlying disorder, the person may begin to feel better, and the symptoms may fade.

The following treatments may help:

  • Hypnosis may help by enabling people to control how stress and other mental states affect their bodily functions.

  • Narcoanalysis is a rarely used procedure similar to hypnosis except that people are given a sedative to make them drowsy.

  • Psychotherapy, including cognitive-behavioral therapy, is effective for some people.

Any other psychiatric disorders (such as depression) should be treated.