Conversion Disorder

The Merck Manual of Medical Information
Second Home Edition

In conversion disorder, physical symptoms that resemble those of a neurologic disorder develop. The symptoms are triggered by mental factors such as conflicts or other stresses.

• An arm or leg may be paralyzed, or people may lose their sense of touch, sight, or hearing.
• Many physical examinations and tests are usually done to make sure symptoms do not result from a physical disorder.
• Reassurance from a supportive, trusted doctor is important.

Conversion disorder, once referred to as hysteria, is thought to be caused by mental factors, such as stress and conflict, which people with this disorder experience as (convert into) physical symptoms.  Although conversion disorder tends to develop during late childhood to early adulthood, it may appear at any age.  The disorder appears to be more common among women.

Symptoms

The symptoms – such as paralysis of an arm or leg or loss of sensation in a part of the body – suggest nervous system dysfunction. Other symptoms may include seizures and loss of one of the special senses, such as vision or hearing.

Often, symptoms begin after some distressing social or psychological event.

People may have only one episode in their lifetime or episodes that occur sporadically. Usually, the episodes are brief. Most people with conversion symptoms who are hospitalized improve within 2 weeks. However, in 20 to 25% of people, symptoms recur within a year and, for some people, become chronic.

Diagnosis

The diagnosis tends to be initially difficult for a doctor to make because people believe that the symptoms stem from a physical problem and may resist being seen by a psychiatrist or other mental health practitioner.  Also, doctors take great care to be certain no physical disorder is causing the symptoms.  Thus, the diagnosis is usually considered only after extensive physical examinations and tests fail to detect a physical disorder that can fully account for the symptoms.

Last full review/revision June 2008 by Katharine A. Phillips, MD

Conversion Disorder

NYU School of Medicine & NYU Hospital Center
by Maria Borowski, MA

Definition

Conversion disorder is a neurological disorder in which physical symptoms are unconsciously caused by a stressful or traumatic event.  An example of this is a person who loses his voice following a situation in which he was afraid to speak.  Conversion disorder is one of a group of psychological disorders called somatoform disorders.

Somatoform disorders are psychological disorders which are characterized by physical symptoms that have no apparent physical cause.  While potentially difficult to diagnose, conversion disorder is readily treatable.

Causes

The direct cause of conversion disorder is usually experiencing a very stressful or traumatic event.  The disorder can be considered the way someone copes, or as a psychological expression of the event.  Depression and other psychological disorders are commonly seen in patients with conversion disorder.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.  Conversion disorder may affect people at any age.  While some studies have suggested that conversion disorder occurs more frequently in women, it can affect both men and women.  Conversion disorders occur more commonly in rural areas, among individuals with fewer years of education and of lower socioeconomic status.

Everyone who develops conversion disorder was exposed to a traumatic event.  However, there are other factors that may increase the likelihood of developing the disorder, including:

• A previous history of personality or psychological disease
• Physical or sexual abuse, particularly in children
• Family members with either conversion disorder or chronic illness
• Co-existing psychiatric conditions such as depression or anxiety
• Co-existing personality disorders, such as histrionic, passive-dependent, or passive-aggressive personality disorder

Symptoms

It is important to understand that the symptoms of conversion disorder are involuntary, that is, the person does not consciously act out, or pretend that they have the symptoms.  A hallmark of these symptoms is their lack of connection to any known organic medical diagnoses.  Some of the most common symptoms include:

• Impaired coordination and balance
• Paralysis of an arm or leg
• Loss of sensation in a part of the body
• Loss of a sense, such as blindness or deafness
• Difficulty swallowing or a sensation of a lump in the throat
• Sensory symptoms, such as;

• • Loss of sense of pain
  • Tingling or crawling sensations

Nervous System – An emotional event may trigger physical symptoms, sometimes through peripheral nerves.

To be diagnosed with conversion disorder you must have at least one symptom, but you may also have many. The appearance of symptoms is linked to the stressful event, and typically occur suddenly (eg, seeing something extremely unpleasant and suddenly going blind). If you experience any of these symptoms, do not assume it is due to conversion disorder. These symptoms may be caused by other, less serious health conditions.

Diagnosis

Diagnosis of conversion disorder may be difficult initially because physical symptoms are most often caused by a physical disorder. It is important for the physician to consider a physical cause for the symptoms carefully. Your doctor will ask about your symptoms and medical history, and perform a complete physical exam. Patients will often be asked to undergo the following testing to rule out an underlying disease.

• Laboratory testing to rule out hypoglycemia or hyperglycemia, kidney failure , or drug-related causes
• Imaging studies, such as chest x-rays or CT scans
• Electrocardiogram (ECG, EKG) —a test that records heart activity by measuring electrical currents through the heart muscle
• Spinal fluid examination to check for neurological causes

Treatment

In some cases, patients may begin to recover spontaneously.  After physical causes for the symptoms have been ruled out, patients may begin to feel better and symptoms may begin to fade.  In some cases, patients may need assistance in recovering from their symptoms.

Prevention

There are no guidelines to preventing conversion disorder because it occurs after a specific, traumatic event. However:

• Psychological disorders can carry a feeling of being stigmatized. It is important that you do not let this prevent you from seeking treatment.
• Somatoform disorders are very common, and treatment is very effective.

Last reviewed November 2008 by Theodor B. Rais, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Copyright © 2010 EBSCO Publishing. All rights reserved.

Conversion Disorder

Conversion disorder consists of symptoms or deficits that develop unconsciously and nonvolitionally and usually involve motor or sensory function.  Manifestations resemble a neurologic or other physical disorder but rarely conform to known pathophysiologic mechanisms or anatomic pathways.  Onset, exacerbation, or maintenance of conversion symptoms is typically attributed to mental factors, such as stress.  Diagnosis is based on history after excluding physical disorders as the cause.  Treatment begins by establishing a consistent, supportive physician-patient relationship; psychotherapy can help, as may hypnosis.

Conversion disorder tends to develop during late childhood to early adulthood but may occur at any age. It is more common among women.

Symptoms and Signs

Symptoms often develop abruptly, and onset can often be linked to a stressful event. Symptoms involve apparent deficits in voluntary motor or sensory function and sometimes include seizures, thus suggesting a neurologic or general physical disorder. For example, patients may present with impaired coordination or balance, weakness, paralysis of an arm or a leg, loss of sensation in a body part, seizures, blindness, double vision, deafness, aphonia, difficulty swallowing, sensation of a lump in the throat, or urinary retention.

The symptoms are severe enough to cause significant distress or impair social, occupational, or other important areas of functioning. Patients may have a single episode or sporadic repeated ones; symptoms may become chronic. Typically, episodes are brief.

Diagnosis

The diagnosis is considered only after a physical examination and tests rule out physical disorders that can fully account for the symptoms and their effects.

Last full review/revision June 2008 by Katharine A. Phillips, MD
Content last modified June 2008