Conversion Disorder in Children & Adolescents

Overview

What is conversion disorder?

Conversion disorder, also called functional neurological disorder, is a condition in which abnormal movements or sensations (spells, weakness, tremors) are not due to injury or disease, but rather a result of a miscommunication of the nervous system and the body. These symptoms are biological in nature and are not voluntary or “fake.” Your child may feel extremely distressed about his or her health symptoms and it may be interfering with daily life such as missing school, not wanting to be with peers, or avoiding typically enjoyed activities.

Other terms that you may hear related to conversion disorder includes psychogenic non-epileptic seizures (PNES), pseudoseizures, spells, numbness, paresthesia, and functional gait disorder.

How common is conversion disorder?

Conversion disorder in young children is rare. It typically emerges in adolescent to early adulthood. Although no general childhood prevalence figures are available, it has been reported in about 1 to 2 percent of children in the inpatient psychiatric setting and in about 5 to 6 percent of children in neurological clinics.

Who is affected by conversion disorder?

Conversion disorder is more common in females. About two-thirds of patients have evidence of co-existing psychiatric condition, (anxiety, depression, trauma), although this is not necessary for a diagnosis in children or adolescents.

Symptoms and Causes

What are the causes of conversion disorder?

Researchers believe there are biological and psychosocial factors (learned ways of thinking in the context of a person’s social environment) involved in the development of conversion disorder, which may include:

  • Continuing, unresolved symptoms after an illness or injury
  • Stress or struggles that a child has not been able to communicate verbally
  • Indications/signs of emotional distress, including excessive attention to bodily processes and possible signs of illness; low pain threshold; increased anxiety about good health.

What are the symptoms of conversion disorder?

Conversion disorder is like many other disorders or diseases that have many causes, many risk factors, and a wide range of symptoms. Also, symptoms vary from person to person. Symptoms of conversion disorder include:

  • Loss of vision, double vision, sensitivity to light
  • Limb weakness or paralysis
  • Loss of voice, slurred or stuttered speech
  • Trouble coordinating movements
  • Memory issues, thinking problems
  • Headaches, migraines
  • Loss of sense of smell
  • Chronic pain
  • Loss of sense of touch
  • Loss of hearing
  • Numbness, tingling in limbs, body or face
  • Seizure-like episodes, blackout, fainting
  • Tremors, spasms
  • Sleep problems
  • Overactive bladder
  • Hallucinations

Some patients only have a few symptoms; some have many symptoms. Symptoms vary in intensity and frequency. In some patients, symptoms are always present; in others, they appear, disappear, and reappear.

Diagnosis and Tests

How is conversion disorder diagnosed?

Your child will likely be seen by a multidisciplinary team consisting of various professionals, including: primary care provider, pediatric subspecialist (neurology), and psychiatry/psychology.

The evaluation typically includes:

  • A physical exam with medical tests as needed (possible lab work, imaging, EEG, etc.)
  • Meeting with psychiatry/psychology to assess emotional, physical, and behavioral functioning.

Management and Treatment

What are the treatments for conversion disorder?

Since the symptoms of each patient with conversion disorder are different, treatments must be tailored to each individual patient. Doctors from many specialties can be involved in treatment. These include neurologists, psychiatrists/psychologists, and physical and occupational therapists.

Much of the focus of treatment is on “retraining the brain.” Since the nervous system is intact (no evidence of illness or disease) and the cause of the symptom is in the signaling exchange between the brain and nerves, the goal of treatment is to relearn typical functions. Some of the more commonly recommended treatments include:

  • Psychological therapy, such as cognitive behavioral therapy (CBT). Cognitive behavioral therapy is psychotherapy (talk therapy) that involves learning about conversion disorder, recognizing triggers and symptoms, and learning new ways to respond and control them.
  • Physical therapy for weak limbs, walking problems, other movement problems
  • Occupational therapy

Outlook / Prognosis

What is the prognosis/outlook for patients who have conversion disorder?

With cognitive behavioral therapy (CBT), children diagnosed with conversion disorder have a good prognosis. Conversion disorder is not a disease and does not have to be a life-long disorder. The primary goal of treatment is for your child to return to typical functioning, including attending school and engaging in typically enjoyed activities.

Resources

What other resources are available to learn more about conversion disorder?

Last reviewed by a Cleveland Clinic medical professional on 10/03/2018.

References

  • O’Neal, MA, Baslet, G. Treatment for Patients With a Functional Neurological Disorder (Conversion Disorder): An Integrated Approach. (https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2017.17040450?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed) Am J Psychiatry 2018 Apr 1;175(4):307-314.
  • Soares NS. Pediatric Conversion Disorder. (https://emedicine.medscape.com/article/917864-overview#a2) Medscape October 3, 2016. Accessed 10/3/18.
  • Somatic Symptom and Related Disorders. Conversion Disorder (https://doi.org/10.1176/appi.books.9780890425596.dsm09) (Functional Neurological Symptom Disorder).Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition American Psychiatric Association.
  • National Organization for Rare Disorders. Functional Neurological Disorder. (https://rarediseases.org/rare-diseases/fnd/) (https://rarediseases.org/rare-diseases/conversion-disorder/) Accessed 10/3/18.
  • Genetic and Rare Diseases Information Center. Conversion Disorder. (https://rarediseases.info.nih.gov/diseases/6191/conversion-disorder) Accessed 10/3/18.
  • Reuber M. Psychogenic nonepileptic seizures: Answers and Questions. (https://www.sciencedirect.com/science/article/pii/S1525505007004301?via%3Dihub) Behav. 2008 May;12(4):622-35.
  • Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. (https://academic.oup.com/brain/article/133/5/1537/544131) Brain 2010 May;133(Pt 5):1537-51.

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