Conversion disorder

Symptoms of conversion disorder can include a variety of neurological symptoms. Common symptoms of the disorder include sudden blindness, paralysis, loss of the voice, trouble coordinating movements (ataxia), loss of the sense of smell (anosmia), loss of sense of touch, or tingling in the extremities.^[5] Some people with conversion disorder may experience seizures or hallucinations.^[2]

People are more at risk for a conversion disorder if they also have a mental illness, dissociative disorder, or personality disorder. Conversion disorder is more common in women, people of lower socioeconomic status, and people in the military. Most affected individuals first develop symptoms of conversion disorder during adolescence or adulthood.^[5]

The exact cause of conversion disorder is not well understood. Some researchers believe that conversion disorder is most common after instances of physical or psychological stressors. It may be that symptoms of the disorder allow affected individuals to provide a physical outlet to the stress in their lives.^[1][2] In other instances, affected individuals do not seem to have a stressor that is causing the symptoms. In these cases, the cause of conversion disorder is unknown.^[3]

Research into the cause of conversion disorder has found that the brain imaging of some individuals with the disorder shows increased or reduced blood flow to certain areas of the brain.^[4] If areas of the brain that are responsible for communication with other body parts have reduced blood flow, this may cause neurological symptoms associated with conversion disorder. It is possible that these changes in blood flow may be caused by the brain receiving information about physical or emotional stressors.^[6] Regardless of the cause of the disorder, it is important to remember that the symptoms are very real; affected individuals are not faking symptoms of the disorder.^[5]

It is not thought that there is a single gene responsible for the development of conversion disorder. In most cases, only one person is identified in a single family. However, it is thought that first-degree female relatives of a person with conversion disorder (sister, mother, or daughter), have a 14-times higher chance to develop symptoms than other women in the general population.^[2] This increased risk is likely due to shared environmental and risk factors for the development of the disorder.  

The diagnosis of conversion disorder is based on a healthcare provider observing symptoms consistent with the disorder. Other causes of similar symptoms should be ruled out to avoid a misdiagnosis. It is best for a neurologist and a psychiatrist to work together on making the diagnosis of the disorder. Current diagnostic criteria for conversion disorder include:^[2]

• One or more symptoms of neurological dysfunction
• No physical findings that may explain the symptoms
• No other disease is known that better explains the symptoms
• The symptom causes significant distress or impairment so that medical evaluation is desired

In some cases, people who are diagnosed with conversion disorder are later found to have another neurological disease. In these cases, treatment and management should be based off of recommendations established for that disease.^[2]

For some people, the symptoms of conversion disorder may improve with time, even without treatment. This can occur after they receive a diagnosis of the disorder, reassurance that the symptoms aren’t caused by an underlying problem, and validation that the symptoms are real.^[2]

Individuals with severe symptoms, symptoms that linger or keep coming back, or other mental or physical health problems may require treatment. The specific type of treatment depends on the particular signs and symptoms of the disorder and may include:^[2][7]

• Counseling (psychotherapy)
• Hypnosis
• Physical therapy
• Occupational therapy
• Treatment of related physical or psychological stressors

 

Symptoms of conversion disorder usually last for days to weeks and may suddenly go away. Usually the symptom itself is not life-threatening, but complications of the symptoms or unnecessary medical tests can be debilitating.^[1][2]

For most people, symptoms of conversion disorder get better with reassurance and time. However, up to one in four people may show a recurrence or new symptoms later.^[2] Individuals may be more likely to have long-lasting symptoms or develop a new conversion disorder if:

• They delay seeking treatment
• The symptoms come on slowly or don’t improve quickly
• They have serious psychiatric disorders
• They have tremors or seizures not caused by epilepsy

If it is later discovered that a separate underlying disorder is causing a person’s signs or symptoms, the long-term outlook and treatment recommendations for this person is dependent upon the underlying disorder.^[2]