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Conversion Disorder - Conversion Disorder Symptom, Cause, Treatment
Conversion disorder is a rare psychiatric illness in which emotional stress or conflict is expressed through physical symptoms, such as blindness or paralysis. nversion Disorder is a DSM-IV diagnosis which describes neurological symptoms such as weakness, sensory disturbance and attacks that look like epilepsy but which can not be attributed to a known neurological disease. The presence of a psychological factor usually is not apparent initially but becomes evident in the history when a cause-effect relationship between an environmental event or stressor and the onset of the symptom is discovered. Symptoms are not intentionally produced but are the result of unintentional motives.
Symptoms of Conversion Disorder
The DSM-IV definition, which is by no means agreed upon by all those working in the field, is as follows:-
- One or more symptoms or deficits are present that affect voluntary motor or sensory function suggestive of a neurologic or other general medical condition.
- Psychological factors are judged, in the clinician's opinion, to be associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit. A diagnosis where the stressor precedes the onset of symptoms by up to 15 years is not unusual.
- The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering).
- The symptom or deficit, after appropriate investigation, cannot be explained fully by a general medical condition, the direct effects of a substance, or as a culturally sanctioned behavior or experience.
- The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
- The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder.
Causes of Conversion Disorder
- True etiology is unknown. Most clinicians presume conversion reactions are caused by previous severe stress, emotional conflict, or an associated psychiatric disorder.
- Many studies confirm high incidence of depression in patients with conversion disorder. As many as half of these patients have personality disorders or display hysterical traits.
- In children, conversion disorder often is observed following physical or sexual abuse.
- Children who have family members with a history of conversion reactions are more likely to suffer from conversion disorder. In addition, if family members are seriously ill or in chronic pain, children are more likely to be affected.
- Alcohol and drug abuse are common in patients with somatoform disorders. Patients may attempt to treat their somatic pain with alcohol or other drugs.
Treatment of Conversion Disorder
A trusting physician-patient relationship is essential. A physical examination is performed to rule out physical cause for loss of function. Treatment may include the following
- Explanation - This must be clear and coherent. It must emphasise the genuineness of the condition, that it is common, potentially reversible and does not mean that the sufferer is a 'psycho'. Taking an aetiologically neutral stance by describing the symptoms as functional may be helpful but further studies are required. Ideally the patient should be followed up neurologically for a while to ensure that the diagnosis has been understood
- Physiotherapy where appropriate
- Treatment of comorbid depression or anxiety if present
- Treatment of conversion disorder in the emergency room: Conversion disorder may be interpreted by the patient and family as a sign of an acute and potentially catastrophic medical condition. ER personnel should quickly rule out potential life-threatening, disabling, or treatable causes for the symptoms.
- Another treatment technique is suggestive therapy: an authoritative, not confrontative, pronouncement that "this problem usually resolves in a few hours" is often successful, especially with children.
- The integrity of the affected body part or function must be maintained until the conflict is resolved and the symptoms usually disappear.
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