Conversion disorder

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Conversion disorder Definition

It is a mental health issue that is characterized by paralysis, blindness or other neurological symptoms that cannot be medically explained. It is also known as Hysterical neurosis.

Conversion disorder Types

DSM-IV has listed four subtypes of conversion disorder:

  1. Conversion disorder with motor symptom or deficit
  2. With sensory symptom or deficit
  3. With seizures or convulsions
  4. With mixed presentation

Conversion disorder belongs to the cluster of Somatoform disorders that were specified as a class of psychiatric disorders in DSM-III of American Psychiatric Association.

Conversion disorder Symptoms

The disease may arise at any age. The peak age of onset is in the mid-to-late 30s. It is rare in older people and kids less than 10 years of age. Young children hardly suffer from the condition. It has a greater prevalence in women than men (ratio between 2:1 and 10:1).

The exact prevalence statistics for this disease is not available.

Conversion disorder is characterized by the loss of one or more physiological functions, such as:

  • Blindness [1]
  • Hallucinations
  • Paralysis
  • Inability to speak
  • Loss of balance
  • Difficulty in walking
  • Inability to feel pain
  • Loss of touch sensation or numbness
  • Urinary retention

Common symptoms include:

  • Deafness
  • Poor coordination or balance
  • Paralysis in an arm or leg
  • Inability to speak
  • Swallowing difficulties or “lump in the throat” sensation
  • Eye problems, including double vision and blindness
  • Convulsions or seizures
  • Abrupt development of debilitating symptoms
  • Lack of concern associated with an acute symptom
  • History of a psychological issue that improves after the onset of problems

Conversion disorder Causes

Conversion disorder symptoms generally almost appear always due to:

  • Any stressful event [2]
  • Another mental condition, like depression

The exact cause is unknown. However, doctors suspect the brain sections controlling the senses and muscles to be involved. This can be a brain mechanism to cope with a real threat. The etiology of the disease is believed to mostly include psychological, as well as neurological and biological factors.

Conversion disorder Risk Factors

The risk factors include:

  • History of sexual or physical abuse
  • Acute emotional trauma or stress in recent days
  • Being women (susceptibility is higher in females)
  • A family history of the condition
  • Financial problems
  • Being a young adult or adolescent (susceptibility is higher in these stages)
  • Having some other mental condition, like dissociative disorder and some personality disorders

Dissociative disorder and Conversion disorder comprise of what used to be known as “hysteria.”

Conversion disorder Diagnosis

Doctors may carry out a physical examination and recommend certain diagnostic tests; as such tests can help confirm the absence of any underlying physical cause and avoid rash determination.

Some important exams for the disorder include:

  • Simple bedside tests
  • Electroencephalogram (EEG) scan
  • X-rays, or other imaging exams

DSM Criteria

The DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria for this disorder mentions:

  • Patients must have one or multiple uncontrollable symptoms that affect movement of the senses or some body part. These symptoms can result from some neurological or medical disease.
  • The symptoms must arise after a stressful event.
  • The symptoms are not being produced on purpose.
  • The symptoms are not fully explained by some medical issue, drug use or behaviors that are culturally accepted (like a sacred ritual)
  • The symptoms must result in acute stress or social or professional difficulties
  • The symptoms must not be limited to sexual problems or aches, and cannot be accounted for better by some other mental disorder.

Conversion disorder Differential Diagnosis

It involves distinguishing the signs of Conversion disorder from those of the following conditions:

  • Spinal cord injury
  • Lupus
  • Stroke
  • HIV/AIDS
  • Myasthenia gravis, a muscle weakness disease
  • Neurological disorders, such as epilepsy, multiple sclerosis and Parkinson’s disease
  • Guillain-Barre syndrome, a rare disease characterized by the immune system attacking the nerves

Conversion disorder Treatment

A reassurance of absence of an acute health disorder can help the symptoms improve in most sufferers. In case of persistent or recurring symptoms, or due to presence of other physical or mental disorders, treatment may be needed to ensure recovery.

Treatment protocol depends on specific symptoms and can involve any of the following:

  • Psychotherapy, which includes counseling and can benefit patients of mental issues like depression
  • Physical therapy, involving exercises and other processes that can reduce muscle rigidity and improve mobility
  • Use of medications (prescribe anti-anxiety drugs [3], antidepressants etc) to cure associated stress and other conditions
  • Hypnosis, which can detect and resolve problems associated to psychology, and be used with Psychotherapy
  • Transcranial magnetic stimulation, involving brain stimulation through weak electrical currents

Conversion disorder Prognosis

The signs generally persist for a few days to weeks [4] and resolve abruptly. The signs are not generally fatal, although patients may suffer from debilitating complications.

Conversion disorder Complications

The symptoms may worsen over time, or recur after a year or so. Hence, immediate treatment is necessary to improve long-term outcome.

Can Conversion Disorder Kill You?

The disorder itself is not usually responsible for death. However, it can increase suicidal tendencies in sufferers and increase the risk of life-threatening complications.

Conversion disorder Prevention

As the condition is triggered by stress, practicing yoga, meditation and other stress-management techniques can help patients. If other mental disorders are present, proper treatment in the form of medicines and counseling can be useful for prevention of Conversion disorder.

 Conversion disorder History

The term “Conversion” was used for the first time by Freud and Breuer. At that time, it was called La belle indifference. Sigmund Freud, the founder of psychoanalysis, believed that conflicts and painful emotions are repressed during acute emotional stress and converted into physical problems as a natural mechanism for relief from anxiety. The theory is somewhat agreed upon by many modern healthcare providers.

Famous People with Conversion disorder

They include personalities like:

  • Albert Einstein
  • Donald Trump
  • Leonardo DiCaprio

Conversion disorder ICD-9 Code

The ICD-9 code for this disease is 300.11.

 

References:

[1] Conversion Disorder (nlm.nih.gov)

[2] Conversion Disorder (Mayo Clinic)

[3] Conversion Disorder in Emergency Medicine Medication (emedicine.medscape)

[4] Conversion Disorder (Wikipedia)

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