It is common that, occasionally, healthy people experience some episode of somatization throughout their lives. Somatization is the unconscious capacity to convert psychic afflictions or conflicts into physical, organic and functional symptoms.
However, in the health sciences, when this somatization becomes pathological one can speak of conversion disorder. Likewise, there is a wide categorization of the different types of conversion disorder according to the accepted physical or psychological functions.
What is conversion disorder?
Conversion disorder, or dissociative disorder, was formerly known as conversion hysteria, and it was with the renowned psychiatrist Sigmund Freud that it gained greatest popularity; he claimed that unresolved internal conflicts became physical symptoms.
This disorder is distinguished by the presence of a series of symptoms at the neurological level that impair sensory and motor functions . However, the most characteristic feature of all is that there is not really any underlying disease that causes or justifies them.
As the name suggests, the person suffering from conversion disorder unconsciously transforms his or her psychological worries or conflicts into symptoms , difficulties or deficits on a physical level, such as blindness, paralysis of a limb, insensitivity, etc.
Usually, patients affected by this disorder tend to deny all those conflicts or problems that are evident to others.
Types of conversion disorder
According to the ICD-10 Manual, there are different types of conversion disorders depending on which functions or abilities are affected.
1. Dissociative amnesia
In this subtype of disorder, the person suffers from memory loss in which** he or she forgets all recent events**. This loss has no organic origin or cause and is too pronounced to be due to stress or fatigue factors.
This loss of memories mainly affects traumatic or highly emotionally charged events and tends to be partial and selective.
This amnesia is usually accompanied by various affective states , such as anguish and bewilderment, but on many occasions the person accepts this disorder in a very peaceful way.
The keys to the diagnosis are:
- Appearance of partial or complete amnesia from recent events of a traumatic or stressful nature .
- No organic brain disease, possible intoxication or extreme tiredness.
2. Dissociative leakage
In this case the disorder meets all the requirements of a dissociative amnesia, but also includes an intentional transfer away from the site where the patient is usually located, this displacement tends to be to places already known by the subject.
It is possible that even a change of identity may be made by the patient, which can last from days to long periods of time, and with an extreme level of authenticity. Dissociative leakage can become a seemingly common occurrence for anyone who does not know them.
In this case the rules for diagnosis are:
- To present the properties of dissociative amnesia.
- Intentionally moving out of the everyday context .
- Preservation of basic care skills and interaction with others
3. Dissociative stupor
For this phenomenon, the patient presents all the symptoms typical of the state of stupor but without an organic basis to justify it. Furthermore, after a clinical interview, the existence of some traumatic or stressful biographical event, or even relevant social or interpersonal conflicts, is revealed,
Stuporous states are characterized by a decrease or paralysis of voluntary motor skills and a lack of response to external stimuli. The patient remains immobile, but with muscle tone present, for a very long time. Likewise, the ability to speak or communicate is also practically absent.
The diagnostic pattern is as follows:
- Presence of stuporous states.
- Absence of a psychiatric or somatic condition justifying the stupor.
- Emergence of recent stressful events or conflicts
4. Trance and possession disorders
In trance and possession disorder, there is a forgetfulness of one’s personal identity and awareness of one’s surroundings. During the crisis the patient behaves as if he were possessed by another person, by a spirit or by a higher force.
As far as movement is concerned, these patients usually manifest a set or combination of very expressive movements and displays.
This category comprises only those states of involuntary trance that occur outside of culturally accepted ceremonies or rites.
5. Dissociative disorders of voluntary motility and sensibility
In this alteration the patient represents suffering from some somatic ailment to which no origin can be found. Usually the symptoms are a representation of what the patient thinks the disease is , but they do not have to be adjusted to the real symptoms of the disease.
In addition, as with all other conversion disorders, a psychological evaluation reveals some or a number of traumatic events. Likewise, in most cases secondary motivations are discovered , such as a need for attention or dependence, avoidance of responsibilities or unpleasant conflicts for the patient.
In this case, the keys to diagnosis are:
- There is no evidence of the existence of a somatic disease.
- Precise knowledge of the environment and psychological characteristics of the patient that lead to the suspicion that there are reasons for the appearance of the disorder.
6. Dissociative Motility Disorders
In these cases the patient manifests a series of difficulties in mobility, in some cases even suffering a total loss of mobility or paralysis of some limb or limbs of the body.
These complications can also manifest themselves in the form of ataxia or difficulties in coordination, as well as shaking and small tremors that can affect any part of the body.
7. Dissociative seizures
In dissociative seizures, the symptoms may mimic those of an epileptic seizure. However, in this disorder there is no loss of consciousness , but rather a small state of blinding or trance.
8. Anesthesia and dissociative sensory losses
In dissociative sensory deficits, the problems of lack of skin sensitivity, or alterations in any of the senses cannot be explained or justified by a somatic or organic condition . Furthermore, this sensory deficit may be accompanied by paresthesias or skin sensations without apparent cause.
9. Mixed dissociative disorder
This category includes patients who have a combination of some of the above disorders .
10. Other dissociative disorders
There are a number of dissociative disorders that cannot be categorized in the above classifications:
- Ganser syndrome
- Multiple Personality Disorder
- Transient conversion disorder of childhood and adolescence
- Other specified conversion disorders
Finally, there is another category called Unspecified Conversion Disorder , which includes those people with dissociative symptoms but who do not meet the requirements for the above classifications.