What is conversion disorder?
Conversion disorder, also called functional neurological symptom disorder, is a medical problem involving the function of the nervous system; specifically, the brain and body’s nerves are unable to send and receive signals properly. As a result of this “communication” problem, patients with conversion disorders may have difficulty moving their limbs or have problems with one or more of their senses.
In the past, conversion disorder was thought to be an entirely psychological disorder, where psychological problems get “converted” into physical symptoms. Today, conversion disorder is recognized as its own distinct disorder. Psychological issues (for example, trauma, personal conflicts, life stressors) are often seen in patients with conversion disorder symptoms, but are not always present in all patients.
Care of patients with conversion disorder overlaps the fields of psychiatry and neurology. However, it is important to note that the symptoms are real; they are not made up and patients are not faking them.
How common is conversion disorder?
The number of people with conversion disorder is not well known. Some researchers have estimated the number of patients with ongoing symptoms to be 2 to 5 individuals per every 100,000 patients per year.
Who is affected by conversion disorder?
Although conversion disorder can occur at any age, it tends to develop during adolescence to early adulthood. Conversion disorder is more common in women. About two-third of patients have evidence of psychiatric disease, the most common being depression and trauma. Personality disorders are also commonly seen.
Symptoms and Causes
What are the causes of conversion disorder?
There is no specific cause of conversion disorder. Instead, researchers believe there are many risk factors and/or triggers that may lead to the development of conversion disorder. One of the more commonly reported scenarios is that conversion disorder may be triggered by the body’s reaction to psychological trauma or a stressful event. Other doctors and researchers believe that a physical injury, infection, migraine, or panic attacks might trigger the development of conversion disorder. Many researchers are beginning to believe that regardless of the trigger, the symptoms seem to “get stuck” instead of getting better. Then functional problems emerge.
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
- Seizures, blackout, fainting
- Tremors, spasms
- Sleep problems
- Overactive bladder
Some patients only have a few symptoms; some have many symptoms. Symptoms vary in their 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?
Conversion disorder is very complex and difficult to diagnose, because the problem is with the functioning of the nervous system and not due to a disease of the nerves or brain. The following tests are commonly used to investigate a diagnosis of conversion disorder:
- Medical history and physical exam. This helps both rule out other existing illnesses as possible causes and/or identifies conditions that may play a role in the symptoms of conversion disorder.
- CT and MRI scans. These tests provide detail on possible head injuries, strokes, brain tumors and brain diseases that may be causing symptoms. In addition, newer research is providing evidence that structural changes are seen in the brains of patients with conversion disorder.
- EEG (electroencephalogram). This tests looks for evidence of seizures or other electrical changes in the brain.
Technically, a diagnosis of conversion disorder is made based on the following criteria.
The patient has:
- One or more symptoms that alter voluntary motor (muscle movement) or sensory function (affecting the five senses: vision, hearing, touch, taste, smell)
- No physical findings that may explain the symptoms.
- No other disease or mental disorder is present to explain the symptoms.
- Symptoms that cause significant distress or impairment.
Once positive findings from the exam indicate a diagnosis of conversion disorder, the next step to screen the patient for psychiatric risk factors that may play a role in contributing to or complicating the disorder.
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, physiotherapists (help with movement symptoms, such as muscle spasms, tremors, and/or weakness), psychiatrists/psychologists, physical and occupational therapists.
As the patient, the first step to your successful treatment is to understand your diagnosis. Although it is comforting to know that your concerns are not the sign of some rare neurological disease, it is equally important to understand how your doctors determined the diagnosis of conversion disorder. Many of the physical neurologic tests you likely took showed that the nerves to the affected limbs were actually fully intact. Ask your physician to further explain these tests. The more you understand about your condition, the greater the likelihood that treatment will be a success.
Much of the focus of treatment is on “retraining the brain.” Since the nervous system is intact and the problem is in the signaling exchange between the brain and nerves, the goal of treatment is to relearn normal functions. Some of the more commonly recommended treatments include:
- Psychological therapy, such as cognitive behavioral therapy (CBT). CBT involves learning about the disorder, recognizing triggers and symptoms, and learning new ways to respond and control them.
- Stress management training to make symptoms more manageable
- Physical therapy for weak limbs, walking problems, other movement problems
- Occupational therapy
- Speech therapy
- Medications to treat the medical conditions that may co-exist in patients affected with conversion disorder
Outlook / Prognosis
What is the prognosis/outlook for patients who have conversion disorder?
There is reason for hope: most people who experience functional symptoms get better. Factors that are associated with a positive outcome include:
- Patient received a good explanation of the condition and accepted the treatment recommendations.
- Patient was diagnosed early.
- Patient had a good response to treatments.
The good news is that there is the potential to get significantly better. Following recommended physical and behavior management help achieve this goal.
What other resources are available to learn more about conversion disorder?
Connecting with support and advocacy groups can help you find other patients to share information. Also, the groups can provide services, research, resources, and expert medical advisors. Groups which may be of interest include:
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