Previously known as hysteria, conversion disorder became famous in the late 19th century , with most people diagnosed as women, who were thought to be repressed by the society around them.

On the other hand, Sigmund Freud himself proposed that this disorder had its origin in a repressed feeling of anger or in unresolved internal conflicts , using hypnosis as the main remedy for this disorder.

At present, it has been researched much more thoroughly, and is also called dissociative disorder, a mental disorder in which the person unconsciously abandons control when integrating emotions or experiences and manifests the discomfort through physical symptoms.

What is conversion disorder?

Conversion disorder refers to a whole set of symptoms that interfere with human behavior and apparently take the form of a neurological condition. However these symptoms do not correspond to any diagnosed physical disorder nor can they be justified by any other disease.

Currently, the main characteristic of this disorder is the appearance of symptoms or difficulties that interfere with the normal activity of the person, both at a motor and sensory level. These difficulties are not voluntary and are associated with psychological factors or alterations.

The term conversion is used to refer to the patient’s ability to involuntarily transform a psychological disturbance into a physical disorder or difficulty. These abilities can range from simple difficulty or inability to operate some body parts to the use of the senses. For example, it has been documented that in some cases an apparent blindness is experienced .

As mentioned above, people suffering from this condition do not fake the symptoms, but suffer real distress, so it is not advisable to state in front of the patient that all their difficulties and ailments are inside their head.

Symptoms of conversion disorder

This complex disorder can have two types of symptoms, both motor and sensory:

Motor symptoms

  • Difficulties in coordination or balance
  • Aphonia or impaired ability to emit sound
  • Urinary Containment Problems
  • Paralysis or weakening of some body area , affecting the whole body
  • Swallowing problems
  • Fades
  • Dystonia
  • Psychogenic seizures or convulsions

Sensory symptoms

  • Deficits in vision: ablepsia or double vision
  • Hearing impairment
  • Loss of touch perception

Causes and risk factors

Although the causes of conversion disorder are not established in a concise way, it is theorized that the previous symptoms are related to the appearance of some psychological conflict or some stressful event .

The signs usually appear suddenly after a person has had a stressful or traumatic experience. It has been observed that patients with this disorder usually also have a history of traumatic or stressful experiences:

  • Physical diseases
  • Dissociative disorders
  • Personality disorders

However, conversion disorder can also occur in apparently healthy people, and there are a number of risk factors that make these subjects an easy target for this disorder.

  • Excessive stress
  • Emotional trauma
  • Belonging to the female sex
  • Family members with conversion disorders
  • Experiences of both physical and sexual abuse

Diagnosis

There are several steps to take to make a proper conversion disorder diagnosis. First, a distinction must be made as to whether the person actually has a conversion disorder or is faking the symptoms.

Although it can be a complicated task, people with tendencies to fake symptoms often seek to obtain some benefit from pretending, this motivation can be financial, emotional, need for attention, etc.

Then, the possibility of the impact of a neurological disease must be excluded, since this disease usually takes on forms similar to that of a neurological disorder such as headache, epilepsy or sclerosis.

It is therefore of vital importance that the clinical staff rule out one hundred percent any possibility of an underlying neurological disease, for which the neurological specialist must perform a thorough examination of the patient.

It is also necessary to eliminate the possibility of another type of disorder, such as factitious disorder or Munchausen’s syndrome by proxy. In the former, the person fakes the symptoms with the intention of avoiding obligations or being the center of attention; and in the latter, a parent or caregiver creates fictitious symptoms or provokes some real ones in the child.

Finally, and with the aim of making the most accurate diagnosis possible, it is necessary for the patient to present the following diagnostic criteria present in the Diagnostic and Statistical Manual of Mental Disorders (DSM):

  • Presence of one or more difficulties that interfere with motor or sensory functions that suggest the presence of a neurological or medical disorder.
  • Existence of previous events, experiences or conflicts that may be associated with the symptomatology
  • The set of symptoms are not consciously or voluntarily provoked.
  • The symptomatology is not justified by the presence of another medical alteration or condition , nor by the consumption of substances.
  • The symptomatology originates a clinically significant, interfering in the different areas of the patient’s daily life and needing medical attention.
  • With symptom set it is not restricted to pain or deficits in sexual function , does not appear during a somatization disorder and is not due to the appearance of another sexual disorder.

Treatment and prognosis

The fundamental point in the treatment of conversion disorder is to suppress or diminish the origin of the stress, or on the other hand to work with the traumatic events that the patient has lived through , in order to reduce the level of stress in the patient.

On the other hand, it is necessary to eliminate secondary gains or benefits that the patient may be obtaining from this behavior, even if he is not fully aware of it.

Usually, the symptomatology can automatically remit , lasting from days to weeks and even remitting automatically. However, there are a series of resources and interventions which can favour the patient. These are:

  • Explanation of the disease
  • Psychotherapy
  • Occupational therapy
  • Treatment of other disorders present such as depression or anxiety