A conversion disorder is a relatively uncommon mental disorder in which a person has physical symptoms that no medical condition, physical examination or testing can explain. The person is not "faking." The symptoms do not appear to be under the person's conscious control and they can cause significant distress. Examples of symptoms are a loss of muscle control, blindness, deafness, seizures or even apparent unconsciousness.
The term "conversion" comes from the idea that psychological distress is being converted into a physical symptom. The cause is not known.
A long-standing theory has been that a person with conversion disorder must block out the source of the distress -- be it a conflict or stress -- because it is too unacceptable for the person to remain aware of it. There is, however, little formal evidence to support this theory.
The symptoms of this disorder often involve muscle control, but there is usually no abnormality in the motor systems in the brain. Nonetheless, patients appear to experience a loss of motor control. Research suggests that some of these individuals have abnormalities in parts of the brain that register and regulate emotion and interact with the core motor network.
Conversion disorder is more common in women than in men. It occurs most frequently between adolescence and middle age. Although relatively rare in the general population, conversion symptoms may be found in up to 14% of patients in general hospitals. In some reviews, they accounted for about 30% of symptoms among neurology outpatients.
A significant percentage of people with conversion disorder have another psychiatric problem, such as generalized anxiety, obsessive-compulsive disorder or some form of depression. There may have been a recent stress or trauma. People with the disorder also report a higher than average frequency of emotional or physical abuse during childhood.
Conversion disorder is characterized by one or more symptoms that suggest a neurological condition. Examples include:
Poor coordination or balance
Paralysis or weakness
Difficulty speaking or swallowing
Retention of urine
Loss of touch or pain sense
Blindness or other visual symptoms
Seizures or convulsions
Psychological factors, such as stress or conflict, are associated with the appearance of the physical symptoms.
Usually, a doctor or a mental health professional makes a diagnosis of conversion disorder based on the person's health history and a neurological examination. In the most obvious cases, a neurologist makes this diagnosis when the physical symptoms are not part of any known disorder of the nervous system. Sometimes additional tests can clarify the diagnosis. These tests may include an electroencephalogram, which measures electrical activity in the brain, or an electromyogram, which measures how well nerve impulses are being conducted through muscle tissue.
The doctor also tries to determine if any stress or conflict is at the root of the symptoms or if there are symptoms of another mental health problem, such as a mood disorder or a personality disorder.
The symptoms of conversion disorder usually do not last long. Generally, the more quickly the symptoms start, the more rapidly they go away. If the symptoms came about in response to a clearly defined stress, the symptoms are likely to last only a short time. More severe symptoms, such as paralysis or blindness, also may not last a long time because it is harder to sustain symptoms that interfere significantly with daily activities. A less severe symptom (such as tremor) or a symptom that is repeated and limited (such as seizure) can continue or come and go, depending on the person's circumstances.
There is no known way to prevent this disorder.
There is no single best treatment for a conversion disorder. A physician is likely to be supportive and reassuring and will adjust treatment goals to the specific situation. Most physicians will explain the limits of what physical examination and testing was able to show about the symptoms. They try to avoid confronting the individual with the idea that the symptoms are "false," because the symptoms are usually distressing and not within the person's control. It is helpful to avoid overly intrusive, uncomfortable medical testing, while continuing to monitor the symptoms.
Symptoms sometimes go away on their own after stress has been reduced, conflict has been resolved or the family or community has responded with a show of concern and support.
If symptoms do not improve relatively quickly, more vigorous rehabilitation may be required. Physical or occupational therapy can be helpful.
Psychotherapy can provide relief although there is no evidence that one type of therapy is more effective than another. Many therapists will focus on encouragement and motivational interviewing, with the aim of improving functioning. If the source of conflict or stress can be determined, it may be helpful to gain insight into what triggered the symptoms. For example, the person may be in conflict about leaving home, starting a new job or having a first child. In psychotherapy, the person may either learn to deal with the conflict or retreat from the source of distress. In either case, the physical symptoms may stop. Functioning remains a higher priority than insight.
As with psychotherapy, there is no single medication that is best for this disorder. Medication may be helpful to treat an underlying problem with anxiety or depression.
The person should be evaluated as soon as physical symptoms emerge. If the person is indifferent to the symptoms, a supportive family member or friend may need to guide the person to seek treatment.
The outlook for conversion disorder varies. It depends on the nature of the stress and on the symptoms.
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