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Conversion Disorder
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Conversion Disorder

En Español (Spanish Version)

Definition

Conversion disorder is a neurological disorder in which physical symptoms are unconsciously caused by a stressful or traumatic event. An example of this is a person who loses his voice following a situation in which he was afraid to speak. Conversion disorder is one of a group of psychological disorders called somatoform disorders .

Somatoform disorders are psychological disorders which are characterized by physical symptoms that have no apparent physical cause. While potentially difficult to diagnose, conversion disorder is readily treatable. Contact your doctor if you think you may have this disorder.

Causes

The direct cause of conversion disorder is usually experiencing a very stressful or traumatic event. The disorder can be considered the way someone copes, or as a psychological expression of the event. Depression and other psychological disorders are commonly seen in patients with conversion disorder.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Conversion disorder may affect people at any age. While some studies have suggested that conversion disorder occurs more frequently in women, it can affect both men and women. Conversion disorders occur more commonly in rural areas, among individuals with fewer years of education and of lower socioeconomic status.

Everyone who develops conversion disorder was exposed to a traumatic event. However, there are other factors that may increase the likelihood of developing the disorder, including:

  • A previous history of personality or psychological disease
  • Physical or sexual abuse, particularly in children
  • Family members with either conversion disorder or chronic illness
  • Co-existing psychiatric conditions such as depression or anxiety
  • Co-existing personality disorders, such as histrionic, passive-dependent, or passive-aggressive personality disorder

Symptoms

It is important to understand that the symptoms of conversion disorder are involuntary, that is, the person does not consciously act out, or pretend that they have the symptoms. A hallmark of these symptoms is their lack of connection to any known organic medical diagnoses. Some of the most common symptoms include:

  • Impaired coordination and balance
  • Paralysis of an arm or leg
  • Loss of sensation in a part of the body
  • Loss of a sense, such as blindness or deafness
  • Difficulty swallowing or a sensation of a lump in the throat
  • Sensory symptoms, such as;
    • Loss of sense of pain
    • Tingling or crawling sensations

Nervous System

Nervous system posterior 3D

An emotional event may trigger physical symptoms, sometimes through peripheral nerves (yellow).

© 2008 Nucleus Medical Art, Inc.

To be diagnosed with conversion disorder you must have at least one symptom, but you may also have many. The appearance of symptoms is linked to the stressful event, and typically occur suddenly (eg, seeing something extremely unpleasant and suddenly going blind). If you experience any of these symptoms, do not assume it is due to conversion disorder. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.

Diagnosis

Diagnosis of conversion disorder may be difficult initially because physical symptoms are most often caused by a physical disorder. It is important for the physician to consider a physical cause for the symptoms carefully. Your doctor will ask about your symptoms and medical history, and perform a complete physical exam. Patients will often be asked to undergo the following testing to rule out an underlying disease.

  • Laboratory testing to rule out hypoglycemia or hyperglycemia, kidney failure , or drug-related causes
  • Imaging studies, such as chest x-rays or CT scans
  • Electrocardiogram (ECG, EKG)—a test that records heart activity by measuring electrical currents through the heart muscle
  • Spinal fluid examination to check for neurological causes

If no physical cause is detected, the patient may either be referred to a neurologist or for a psychiatric consultation.

Treatment

In some cases, patients may begin to recover spontaneously. After physical causes for the symptoms have been ruled out, patients may begin to feel better and symptoms may begin to fade. In some cases, patients may need assistance in recovering from their symptoms. Treatment options may include the following:

  • Counseling and psychotherapy—Discussing the stressful event with a counselor may help you cope with the underlying cause of the physical symptoms. Continued work to learn how to deal with stressors throughout life will also be important, as about 25% of patients with these disorders often have future episodes.
  • Pharmacological therapy—In some cases, antidepressants may be used to speed recovery. Studies have shown that antidepressants may be helpful for patients with conversion disorder.

Physical and/or Occupational Therapy

Patients may require therapy to overcome disuse of a limb, for example, and to relearn normal behaviors.

Prevention

There are no guidelines to preventing conversion disorder because it occurs after a specific, traumatic event. However:

  • Psychological disorders can carry a feeling of being stigmatized. It is important that you do not let this prevent you from seeking treatment.
  • Somatoform disorders are very common, and treatment is very effective. Do not hesitate to call your doctor if you have symptoms suggestive of conversion disorder.

RESOURCES:

American Psychiatric Organization
http://www.psych.org

American Psychological Organization
http://www.apa.org

CANADIAN RESOURCES:

Canadian Psychiatric Association
http://www.cpa-apc.org

Canadian Psychological Association
http://www.cpa.ca/cpasite/home.asp

References:

Conversion disorder. MedlinePlus. US National Library of Medicine and the National Institutes of Health. Available at: http://www.nlm.nih.gov.medlineplus/print/ency/article.000954.htm. Accessed July 5, 2005.

Conversion disorder. The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.com/mrkshared/mmanual/section15/chapter186/186c/jsp . Accessed July 5, 2005.

Dufel S. Conversion disorder. EMedicine website. Available at: http://www.emedicine.com/emerg/topic112.htm/ . Accessed July 5, 2005.

Heller M. Conversion disorder. In: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment . 8th ed. Philadelophia, PA: Mosby; 2006.



Last reviewed January 2008 by Theodor B. Rais, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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