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Conversion Disorder

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Definition

Conversion disorder is a neurological/psychiatric disorder. It is physical symptoms that 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 .
Conversion disorder can be difficult to diagnose. It is 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.

Risk Factors

Factors that may increase the chance of developing conversion disorder include:
  • A previous history of personality or psychological disease
  • Physical or sexual abuse, particularly in children
  • Gender: female
  • Age: adolescence
  • Economic difficulties, low socioeconomic status
  • 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, The person affected is not consciously acting out or pretending. Symptoms of conversion disorder are real but lack a 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
  • Inability to speak
  • Difficulty swallowing or a sensation of a lump in the throat
  • Sensory symptoms, such as;
    • Loss of sense of pain
    • Tingling or crawling sensations
  • Vomiting and abdominal pain
  • Seizures
Nervous System
Nervous system posterior 3D
An emotional event may trigger physical symptoms.
Copyright © Nucleus Medical Media, 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.

Diagnosis

Diagnosis of conversion disorder may be difficult. The physical symptoms are most often caused by a physical disorder. It is important for your doctor to carefully consider any physical causes for your symptoms. Your doctor will ask about your symptoms and medical history. A complete physical exam will be done. You may be asked to undergo some of the following tests to rule out an underlying disease:
  • Laboratory testing to rule out irregular blood glucose levels (hypoglycemia or hyperglycemia), kidney failure , or drug-related causes
  • Imaging studies, such as chest x-rays , CT scans , or MRI
  • Electroencephalogram (EEG) —a test that uses sensors to evaluate electrical activity in the brain
  • 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

Psychological disorders can carry a feeling of being stigmatized. It is important that you do not let this prevent you from seeking treatment.
In some cases, you may begin to recover spontaneously. After physical causes for the symptoms have been ruled out, you may begin to feel better and symptoms may begin to fade. In some cases, you 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.
  • Pharmacological therapy—In some cases, antidepressants may be used to speed recovery.
  • Identifying and removing environmental triggers to decrease anything stimulating the conversion disorder.

Physical and/or Occupational Therapy

Therapy may be needed to overcome disuse/paralysis of a limb and to relearn normal behaviors.

Prevention

There are no guidelines to preventing conversion disorder because it occurs after a specific, traumatic event. However, about 25% of patients with conversion disorders have future episodes. Continued counseling will help you learn how to deal with stressors throughout life and perhaps prevent future episodes.

RESOURCES

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

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

CANADIAN RESOURCES

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

Canadian Psychological Association http://www.cpa.ca/

References

Conversion disorder. The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.com/mrkshared/mmanual/section15/chapter186/186c/jsp . Accessed September 8, 2012.

DynaMed Editorial Team. Conversion disorder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated November 3, 2010. Accessed September 8, 2012.

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

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 09/2012 -
  • Update Date: 00/93/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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