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CONVERSION
DISORDER
 Formerly known as "hysteria", the disorder
has arguably been known for millennia,
though it came to greatest prominence at the
end of the 19th century, when the neurologist
Jean-Martin Charcot, and psychiatrists Pierre
Janet and Sigmund Freud made it the focus
of their study.
 The term "conversion" has its origins in
Freud's doctrine that anxiety is "converted"
into physical symptoms.
Definition
 DSM-IV defines conversion disorder as follows:
 One or more symptoms or deficits are present that affect
voluntary motor or sensory function suggestive of a neurological
or other general medical condition.
 Psychological factors are judged, in the clinician's belief, to be
associated with the symptom or deficit because conflicts or
other stressors precede the initiation or exacerbation of the
symptom or deficit. A diagnosis where the stressor precedes the
onset of symptoms by up to 15 years is not unusual.
 The symptom or deficit is not intentionally produced or feigned
 The symptom or deficit, after appropriate investigation, cannot be
explained fully by a general medical condition, the direct effects of a
substance, or as a culturally sanctioned behavior or experience.
 The symptom or deficit causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning or warrants medical evaluation.
 The nature of the association between the
psychological factors and the neurological symptoms
remains unclear. Earlier versions of the DSM-IV
employed psychodynamic concepts, but these have
been incrementally removed from successive
versions. The ICD-10 classifies conversion disorder
as dissociative (conversion) disorder, which suggests
the symptoms arise through the process of
dissociation
History
 The term "Conversion disorder" originated with Freud. He
viewed these apparently neurological symptoms as a result of
the conversion of intrapsychic distress in to physical symptoms.
 The affected body part was seen as a symbolic infantile sex
organ.
Presentation
 Conversion disorder can present with any motor or sensory symptom
including any of the following:
 Weakness/paralysis of a limb or the entire body (hysterical paralysis
or motor conversion disorders)
 Impaired hearing or vision
 Loss/disturbance of sensation
 Impairment or loss of speech (hysterical aphonia)
 Psychogenic non-epileptic seizures
 Fixed dystonia unlike normal dystonia
 Tremor, or other movement disorders
 Gait problems
 Syncope (fainting)
Diagnosis
 The diagnosis of conversion disorder involves
three elements:
 the exclusion of neurological disease,
 the exclusion of feigning,
 and the determination of a psychological
mechanism
Epidemiology
Prevalence
 Large scale psychiatric registers in the US and Iceland found rates
of 22 and 11 per 100000 per year, respectively,[34] but it is unclear
what proportion of unexplained symptoms these represent.
Culture
A community survey of urban Turkey found a rate of 5.6%.
Many authors have found rates to be higher in rural and lower
socio-economic groups where technological investigation of
patients is limited
Gender
 'Hysteria' was originally understood to be a condition
exclusively affecting women, though it has increasingly
been recognized in men.
 In recent, larger studies women continue to predominate,
with between 2 and 6 female patients for every male.
Age
 Conversion disorder may present at any age but is rare
in children younger than 10 years or in the elderly.
 Studies suggest a peak onset in the mid-to-late 30s.
Symptom Groupings:
 Sensory Symptoms:
These include anesthesia, excessive sensitivity to strong simulation
loss of sense of pain (analgesia), and unusual symptoms such as
tingling or crawling sensations.
Motor Symptoms:
In motor symptoms, any of the body's muscle groups may be
involved: arms, legs, vocal chords. Included are tremors, tics
(involuntary twitches), and disorganized mobility or paralysis.
Visceral Symptoms:
Examples are trouble swallowing, frequent belching, spells of
coughing or vomiting, all carried to an uncommon extreme. In both
sensory and motor symptoms
Specify type of symptom or deficit:
 With Motor Symptom or Deficit.
With Seizures or Convulsions.
With Sensory Symptom or Deficit.
With Mixed Presentation.
Associated Features:
 Depressed Mood.
Somatic or Sexual Dysfunction.
Guilt or Obsession.
Anxious or Fearful or Dependent Personality.
Treatment
 Explanation. This must be clear and coherent as attributing physical
symptoms to a psychological cause is not accepted by many
educated people in western cultures. It must emphasize the
genuineness of the condition, that it is common, potentially
reversible and does not mean that the sufferer is a "psycho".
 Physiotherapy where appropriate;
 Treatment of comorbid depression or anxiety if present.
 There is little evidence-based treatment of conversion disorder.
Other treatments such as cognitive behavioral therapy, hypnosis,
and psychodynamic psychotherapy need further trials.