What is Conversion Disorder?
Conversion disorder is a condition in which a person experiences temporary neurological symptoms such as weakness or paralysis when there is no medical evidence to support the symptoms.
These symptoms may be due to psychological distress or trauma since they cannot be better explained by a medical condition.
Conversion disorder is basically a physical reaction to mental and/or physical stress.
Anxiety disorders such as panic disorder, depressive disorders, dissociative disorders, and personality disorders often occur at the same time as conversion disorder.
What are the symptoms of conversion disorder?
Symptoms
Weakness or paralysis of the arms or legs
Seizures, sometimes with limited consciousness (aka psychogenic or non-epileptic seizures)
Loss of balance
Episodes of sensory loss or unresponsiveness
Absence of skin sensations
Difficulty swallowing or feeling like there is a lump in the throat
Shaking and tremors
Difficulty walking
Slurred speech or loss of the ability to speak
Difficulty hearing or loss of hearing
Double vision, blurred vision, or episodes of blindness
Numbness or loss of the touch sensation
A person may experience one or more of these symptoms. These symptoms can range from mild to severe.
The occurrence of these symptoms may start, stop, or be continuous.
What causes conversion disorder?
Since there is no direct observable medical cause for conversion disorder, it is thought to be caused by psychological factors.
The symptoms of conversion disorder often show up at the same time as psychological or physical stress or trauma.
Neurologists will often look to see if the neurological symptoms are consistent across different tests. If the symptoms occur during one test and not the other, then it could be conversion disorder.
Even though there is no identified disease or abnormal neurological condition, certain parts of the brain that control your senses and the functioning of your muscles may be affected by strong emotions such as anxiety and panic.
During times of extreme stress our bodies react to the “danger” physically by releases certain hormones and neurotransmitters in the brain. This changes how we function physically and mentally so that we fight or run away from the danger.
With conversion disorder, it’s possible that this system malfunctions and instead improving physical and mental functioning, it actually causes the opposite.
I had a patient who described an episode of blindness during panic attacks. This was transient and never occurred again. This patient also has a tendency to focus on and obsess about any change in physical functioning, often searching the web answers.
What are the risks for developing conversion disorder?
Temperament: Having a maladaptive personality disorder.
Environment: A history of childhood abuse and neglect and stressful life events.
Physical: Having a personal or family history of having a neurological disease or disorder, such as epilepsy, migraines, or a movement disorder.
Emotional: Having a psychological condition such as a mood or anxiety disorder, or a dissociative disorder (aka Multiple Personality Disorder, derealization/depersonalization, dissociative amnesia).
Gender: Women are 3 times more likely to develop conversion disorder.
Age: Conversion disorder can occur at any age.
What is the prognosis for conversion disorder?
The symptoms of conversion disorder are often short in duration with better prognosis with children than with adolescents and adults.
What is the treatment for conversion disorder?
First line treatment
Education
First line treatment for conversion disorder is education about the diagnosis. It is important for the individual to know that:
The symptoms are taken seriously and are real rather than faked.
The problem is result of abnormal functioning of the nervous system and not the neurological system.
Unlike neurological diseases, the symptoms of conversion disorder can potentially be reversible.
Emphasize the importance of treating any symptoms of depression or anxiety as these can make it worse.
Second line treatment
Physical therapy
Physical therapy focuses on the physical motor symptoms of conversion disorder. The individual is encouraged to engage in normal movement and to suppress abnormal movement. Too much attention to the affected or weak limb will only worsen the functioning.
However, exercises using distraction with normal movement may help.
Cognitive behavioral therapy
Cognitive Behavioral Therapy (CBT) is a well-researched and highly effective form of talk therapy that focuses on learning more helpful ways of thinking and behaving.
Cognitive therapy helps challenge and change unhelpful beliefs about the conversion symptoms by restructuring your automatic thinking.
Cognitive Restructuring: Cognitive restructuring is used to identify and dispute unhelpful, automatic, and irrational thinking so that you can create highly effective thoughts with the power to alter your emotions and behavior.
Behavioral Therapy: Behavioral therapy works to change unhelpful behaviors, such as avoidance, and move toward exposing the individual to feared situations with strategies to help cope with the symptoms of anxiety and/or depression that may be associated.
Third line treatment
If conversion disorder symptoms do not respond to first or second line treatments, then individuals are presented with the following options:
Medication
Hypnosis
Brief psychodynamic psychotherapy
Multidisciplinary inpatient treatment
Family therapy
Group therapy
Outlook
Most people experiencing symptoms of conversion disorder will improve with education, treatment time, and reassurance. It is possible for 1 out of 4 people, however, to have a recurrence or develop new symptoms.
Some individuals may have longer lasting symptoms of conversion disorder if they delay seeking treatment, have other severe psychological disorders, have non-epileptic seizures, or the symptoms do not improve with treatment.
