Conversion Disorder

What is conversion disorder?

Functional neurological symptom disorder — better known as “conversion disorder” — is a mental health condition that causes physical symptoms. The symptoms happen because your brain “converts” the effects of a mental health issue into disruptions of your brain or nervous system. The symptoms are real but don’t match up with recognized brain-related conditions.

It’s important to know that conversion disorder is a real mental health condition. It’s not faking or attention-seeking. It isn't just something in a person’s head or that they’ve imagined. While it’s a mental health condition, the physical symptoms are still real. A person with conversion disorder can’t control the symptoms just by trying or thinking about it.

What is the difference between conversion disorder and somatic symptom disorder?

Conversion disorder and somatic symptom disorder both fall under the same group of conditions, somatic symptom and related disorders, in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Experts group the two conditions because there’s a great deal of overlap between the two, and it’s possible to have both at the same time.

With somatic symptom disorder, you have at least one symptom that severely disrupts or interferes with your life. That causes the following:

• You spend a lot of time thinking about your symptom(s).
• You feel very worried or anxious about your symptom(s).
• You dedicate an unusual amount of time and effort to the symptom(s) in some way.

The key feature of conversion disorder is that you have a brain-related symptom (or multiple symptoms). These disruptive symptoms keep you from functioning as you would under normal circumstances. However, you don’t have a neurological (brain-related) condition to explain the symptom(s).

Who does it affect?

Conversion disorder can affect people throughout their life, including during childhood. Certain symptoms are more likely at different ages. For example, the average age range for seizures is between ages 20 and 29, while the average age range for other movement-related symptoms is between 30 and 39.

Conversion disorder is also much more likely to happen in women and those designated female at birth (DFAB). Available research shows at least twice as many women have conversion disorder compared to men or people designated male at birth (DMAB).

How common is conversion disorder?

Conversion disorder isn’t a common problem. Experts estimate that 4 to 12 people out of every 100,000 receive a diagnosis of conversion disorder each year.

How does conversion disorder affect my body?

Conversion disorder creates disruptions in your brain that cause physical symptoms. Functional MRI — which lets experts see your brain activity — can see the effects of conversion disorder. People who have conversion disorder usually have less activity or unusual activity in parts of their brain related to their symptoms. Those changes in brain activity aren’t something a person can fake.

What are the symptoms of conversion disorder?

The symptoms of conversion disorder can vary widely depending on the part of the brain involved. Some of the most common symptoms include:

• Psychogenic non-epileptic seizures (PNES). Seizures typically happen because of conditions or issues with your brain’s structure or how it’s working. Psychogenic non-epileptic seizures happen because of mental health conditions (the word “psychogenic” means “of mental health origin”).
• Sense-related disruptions. Trouble with senses of vision, hearing, smell, taste and touch are all possible with conversion disorder. Some examples include double or tunnel vision, hearing loss or numbness, and the inability to feel something touching your skin.
• Pain. People with conversion disorder often feel pain, sometimes with other symptoms and sometimes on its own.
• Unusual muscle tension, spasms, twitches and tremors. These all happen because of a disruption in how your brain controls your muscles.
• Muscle weakness or paralysis.
• Trouble swallowing (dysphagia).
• Dizziness.
• Fainting or passing out (syncope).
• Chronic fatigue or lack of energy.

People with conversion disorder often seem like they’re not worried about their symptoms. This phenomenon, “la belle indifference” (which is French for “beautiful ignorance”), happens most commonly with conversion disorder. However, it isn’t necessarily a symptom, and it doesn’t happen with every case of conversion disorder.

What causes conversion disorder?

Experts don’t know exactly why conversion disorder happens. However, they do know that it’s more likely to happen along with certain circumstances and some medical conditions.

Common circumstances seen in people with conversion disorder include:

• A history of childhood abuse.
• Having other mental health conditions, especially depression or anxiety.
• A recent stressful or traumatic event.
• A recent health condition or event acting as a trigger for conversion disorder.

Is it contagious?

Conversion disorder isn’t contagious, so you can’t get it from others or spread it to others.

How is conversion disorder diagnosed?

Your healthcare provider can diagnose conversion disorder using a combination of physical and neurological examinations, diagnostic tests, imaging scans and more.

Diagnosing conversion disorder requires all four of the following:

• You have one or more symptoms related to your brain’s control over your movement or senses.
• Your symptoms aren’t consistent with recognized medical conditions.
• There’s no other explanation for your symptoms, such as another medical condition or mental health issue.
• The symptoms or issues disrupt your life, especially your ability to work, have relationships, etc.

What “inconsistent” means with conversion disorder

A defining characteristic of conversion disorder is that your symptoms are inconsistent with a recognized medical condition. Your healthcare provider has to look for ways that your symptoms aren’t consistent with other conditions. That doesn’t mean they don’t believe you or your symptoms aren’t real. It means they have to find the inconsistency to diagnose conversion disorder.

Finding an inconsistency might not feel like a good thing, but in this case, it is. Finding inconsistencies between your symptoms and known conditions means your healthcare provider can rule out other — and often more-serious — brain-related problems.

What tests will be done to diagnose this condition?

The tests that your provider recommends depend strongly on the symptoms you have. In general, diagnostic imaging and neurological tests are most likely. These include:

• Blood tests (these can look for anything from immune system issues to toxins and poisons, especially certain metals like copper).
• Computerized tomography (CT) scan.
• Electroencephalogram (EEG).
• Electromyogram.
• Evoked potentials test.
• Magnetic resonance imaging (MRI).

How is conversion disorder treated, and is there a cure?

Conversion disorder is a mental health condition that causes physical symptoms. Because of that, treating the mental health component with some form of psychotherapy (mental health therapy) is usually the first approach. It’s also usually the most successful approach. The most common types of psychotherapy include:

• Cognitive behavioral therapy (CBT). This is the most common type of therapy recommended. Experts also consider it the most likely to work.
• Hypnotherapy. This is usually a second option for types of therapy. It may be especially helpful when the symptoms of conversion disorder affect your ability to speak or any of your senses.
• Group or family therapy. Shared therapy experiences can help people with conversion disorder. Group therapy can help people with this condition connect with others who have similar struggles. Family therapy can help loved ones understand the condition and offer support.

Other treatments that may help include:

• Physical therapy. The symptoms of conversion disorder may start with mental health, but the physical effects are still real. Physical therapy can help people with conversion disorder recover from or adapt to the physical symptoms.
• Medication. When conversion disorder happens alongside other conditions, such as depression or anxiety, medications for those conditions can help conversion disorder symptoms also. This is especially true when conversion disorder causes pain symptoms, as antidepressants can often positively affect pain levels.
• Biofeedback. Biofeedback is an alternative medicine approach that teaches people to change the way their bodies function. It’s a mind-body therapy that may improve your physical and mental health. During a biofeedback session, your provider uses monitoring equipment and instruments to measure your body’s functions. Based on feedback from the instruments, your provider suggests how you can create physiologic changes. With education and practice, you can learn to make those bodily changes without equipment.

Complications/side effects of these treatments

The complications and side effects of treatments for conversion disorder, especially medications, depend strongly on the treatments themselves. Your healthcare provider is the best person to tell you more about the possible symptoms and side effects that you might experience.

How to take care of myself/manage symptoms?

Conversion disorder is difficult for even an experienced healthcare provider to diagnose. The symptoms that happen with conversion disorder are very difficult to tell apart from other conditions that affect your brain. Some of the symptoms look very much like those that happen with conditions like stroke, which is a life-threatening medical emergency. Because of that, you shouldn’t try to self-diagnose or self-treat this condition.

How soon after treatment will I feel better?

Because conversion disorder is a mental health condition, the time it takes to feel better and recover depends on many different factors. Your healthcare provider is the best person to tell you more about when you can expect to see changes in how you feel.

How can I reduce my risk of developing conversion disorder or prevent it?

Conversion disorder is a mental health condition that happens unpredictably. Because of that, there’s no way to prevent it or reduce your risk of developing it.

What can I expect if I have conversion disorder?

Conversion disorder is a condition that can have major effects on your life, depending on the symptoms you have. Many people who have it experience severe symptoms that keep them from working or doing activities they enjoy.

Many people with conversion disorder also struggle with how they feel about their condition and how others treat them. It’s common for people with conversion disorder to feel as if nobody believes them or that people think they’re faking or lying. Often, feeling that nobody believes them or accusations of lying — especially when this involves healthcare providers — keep people from seeking care that could help them.

How long does conversion disorder last?

Conversion disorder can last different lengths of time, depending on several factors. Those factors include when it happens in your life, how severe it is and whether or not you receive care for the condition. An acute case is one where you’ve had symptoms for under six months. A persistent case is one where symptoms last for more than six months.

In some cases, conversion disorder is a temporary, short-lived problem. This is most likely in children but can also happen with adults who get effective care and follow their provider’s guidance on managing the condition.

For other people, conversion disorder can be a problem that lasts for years or the rest of their life. This is most likely when a person has severe symptoms, doesn’t seek care or doesn’t follow through with treatment.

What’s the outlook for conversion disorder?

Conversion disorder isn’t a life-threatening or outright dangerous condition. However, it can greatly affect your overall mental health and well-being. People with conversion disorder often have severe problems that keep them from working or participating in enjoyable activities.

People with conversion disorder are less likely to have a good outcome when the following happen:

• If they delay seeking medical care.
• If they refuse to believe they have this condition.
• If they don’t have a good relationship and communication with their healthcare provider.
• If they don’t follow the treatment plan their healthcare provider recommends.

The best-case outcome with conversion disorder is a complete recovery. As a person improves their mental health and well-being, the disruptions in their brain should improve and become less noticeable until they’re gone entirely.

How do I take care of myself?

While it may feel difficult to understand how your mental health can cause physical symptoms, it’s important to remember that there are many other conditions where this happens. Stress, worry, anxiety and other negative emotions can worsen conditions like stomach ulcers, blood pressure and heart problems.

If you have conversion disorder, the best thing you can do is work with your healthcare provider and follow their guidance on treatment. Many people struggle with accepting this diagnosis, so you’re not alone if you feel that way.

If you struggle with accepting the diagnosis, talk to your healthcare provider about your concerns. Building a strong relationship with your provider, where you can communicate openly and honestly, is one of the most important things you can do to help yourself.

Other important things you can and should do include:

• Seeing your provider as recommended.
• Attending and participating in therapy sessions (including physical therapy, psychotherapy, etc.).
• Taking your medications, if any, as prescribed.

Progress is progress

Recovery and improvement with mental health conditions are rarely a straight line. It’s common to go through periods where recovery is difficult. You may even experience times where your issues or symptoms get worse instead of better. This is very common, and it isn’t a sign that you’re failing or your situation is hopeless.

If you feel like you’re struggling in this way, you should tell your healthcare provider. They can offer feedback from a medical perspective about the road to recovery. Often, they can also recommend strategies or ways you can help yourself overcome these obstacles and rough patches.

When should I go to ER or get emergency care?

People with conversion disorder often struggle with other mental health problems like depression and anxiety. They also have a higher risk of attempting suicide.

You should get emergency care if you have disturbing thoughts about harming yourself, including thoughts of suicide or harming others. If you have thoughts like this, you can call any of the following:

• Suicide and Crisis Lifeline (United States). To call this line, dial 988.
• Local crisis lines. Mental health organizations and centers in your area may offer resources and help through crisis lines.
• 911 (or your local emergency services number): You should call 911 (or the local emergency services number) if you feel like you’re in immediate danger of harming yourself. Operators and dispatchers for 911 lines can often help people in immediate danger because of a severe mental crisis and send first responders to assist.

How can I help a loved one who has conversion disorder?

If you have a loved one who has conversion disorder, your support can make a major difference in their recovery and the outcome of their care.

Here are some helpful “DOs” and “DON’Ts” to keep in mind:

DO:

• DO validate them. Conversion disorder is a legitimate medical condition. People with it often feel like others don’t believe them, a belief that can make them resistant to seeking help. Knowing that someone believes them can be a major encouragement for them to seek care.
• DO ask how you can help. People with conversion disorder can feel very isolated and alone. Knowing that someone wants to help can make a big difference. You can also help by encouraging them to continue receiving care, especially if they’re struggling.
• DO be open to learning more about their condition and how to support them. Your loved one's provider may want to meet with you to talk about the condition. Your loved one or their provider might also ask if you’re willing to participate in a therapy session. Consider attending because what you learn could help you support your loved one better.

DON’T:

• DON’T accuse them of faking. Accusing someone of faking the symptoms of conversion disorder — which is a true, recognized condition — can cause extreme pain and stress for your loved one. Only a trained healthcare provider who has considered all the evidence and investigated the symptoms thoroughly should ever make that statement (and healthcare providers should only say that if they have enough evidence to back it up).
• DON’T say it’s all in their head. The effects of your mental health don’t just stay in a person’s head. Researchers and experts have proven that mental health issues affect a person’s entire body and can easily cause physical symptoms, some of which are severe and frightening.
• DON’T forget to take care of yourself. Like many other conditions, conversion disorder can cause stress for the loved ones of people with the condition. Don’t forget to take care of your own health and well-being. You can’t support someone effectively if you’re struggling to stay afloat.

A note from Cleveland Clinic

Functional neurological symptom disorder, better known as “conversion disorder,” is a condition where a mental health issue causes physical symptoms. This condition is real, and the symptoms aren’t something a person can control. Unfortunately, many people with this condition feel as if others — especially medical professionals — don’t believe them. This can cause them to avoid medical care that could help them, which usually leads to worsening symptoms.

If you have conversion disorder or your healthcare provider tells you they suspect it, it’s common to feel scared or worried about what that means. If you feel anxious about this or whether or not your provider believes you, it’s best to tell your provider about this concern. Your provider’s job isn't to judge you. Their job is to determine what’s happening to you, why it’s happening and then try to treat it. If your provider knows about your worries and fears, they can try to help set your mind at ease by listening to you and offering support, advice or solutions.