Conversion disorder is a type of somatoform disorder which may occur as an expression of psychological or emotional conflicts.
Conversion disorder involves one or more unexplained physical symptoms. The onset of conversion disorder is usually acute. It may follow a stressful or psychologically traumatic event such as loss of employment, divorce, family dysfunction, or a history of sexual or physical abuse  .
Some common symptoms of conversion disorder include :
Speech abnormalities and dystonia are thought to be due to the patient’s unconscious manifestation of their inability to speak, express their feelings, and communicate their meaning  .
Psychogenic gait abnormalities in conversion disorder can present various ways. Sudden buckling of the knees and ataxia are the most common presentation .
The diagnosis of conversion disorder is one of exclusion or the failure to discover any indication of organic disease. Despite the nonspecific nature of the symptoms and the number of possible differential diagnoses, recent studies have shown that less than 5% of patients are misdiagnosed .
Symptoms of conversion disorder suggest a neurologic disease, but no physical examination or diagnostic testing can find an explanation. It is therefore a diagnosis of exclusion. A complete physical exam must be accompanied by a comprehensive psychosocial history. .
A diagnosis of conversion disorder depends on the following criteria :
Clinical work-up should pay particular attention to a neurologic exam and mental status. The neurologic examination must distinguish between psychogenic and neurologic symptoms. The examination should also include observations when patient is not aware of being observed.
Mental status examination should include assessment of :
Beyond a general physical examination to rule out systemic disease and complete neurological exam, other laboratory and imaging studies may be helpful in determining a physiologic cause of the symptoms such as:
Once all possible neurological diagnoses have been excluded, the diagnosis of conversion disorder is made. Treatment depends on identification of the underlying psychological or emotional stressors. A therapeutic relationship between the patient and the healthcare community is essential in all cases. Where comorbid psychiatric diagnoses are involved these need to be treated adequately. Research suggests that a combination of antidepressants and psychotherapy may be beneficial .
Elimination of the stressors and the internal emotional conflict are potentially effective in removing the symptoms. Also, once the primary and secondary gains the patient receives from the symptoms are removed, the symptoms usually resolve.
Acceptance of the diagnosis is instrumental in the management of the disorder. How the patient is informed of the diagnosis is important and should be by the primary care provider who knows the patient and family well .
The early involvement of the patients’ family may help the discussion but as of now there is no research to establish this fact . Family and friends can be instrumental in the resolution of the condition. Their primary role is to stop reinforcing the symptoms, while accepting the problem as real .
Even when symptoms resolve, patients with conversion disorder still require psychological or psychiatric treatment . It should be remembered that the conversion symptoms are, just that, symptoms of a more serious emotional or psychological disorder.
Although psychotherapy is the recommended, patients with conversion disorder may not comply. The psychiatric diagnosis removes the possibility of a neurologic diagnosis that serves some purpose for the patient. Patients who do not accept the diagnosis will not seek mental health treatment that may influence patient outcomes .
Forms of psychotherapy that may be useful in the treatment of conversion disorder include :
There are no specific medications available for conversion disorder. Medications for associated mood, anxiety, and psychiatric disorders may be helpful. In patients with non-epileptic seizures, tapering and discontinuation of all antiepileptic drugs should be done upon diagnosis .
Regular follow-up with primary care provider, psychiatrist, counselor, and neurologist are necessary Prognosis and patient outcome is dependent on frequent and good communication between these providers of care. A coordinated plan of care may prevent unnecessary interventions, diagnostics, and treatments  .
Conversion disorder symptoms are usually self-limiting with no residual physical effects or disabilities. They do, however, result in decreased quality of life. Spontaneous resolution of symptoms occurs in approximately 75% of patients. Recurrence of symptoms occurs in approximately 25% of patients  .
Conversion disorder does often result in unnecessary diagnostic testing and therapeutic interventions in an attempt to determine a diagnosis for the patient's symptoms.
Misdiagnosis occurs occasionally, with approximately 25% of patients subsequently diagnosed with neurological disease. Multiple sclerosis, neurodegenerative diseases, structural myelopathy, and peripheral neuropathy are the most common.
The following are predictors of a good prognosis  :
Conversion disorder was first identified in the 1880s by Freud and Breuer. They hypothesized that the physical symptoms of conversion disorder were hysterical in nature.
In the 19th century, Pierre Janet described hysteria as a dissociative disorder following psychologically trauma that results in somatoform symptoms  . The theory is that the trauma is converted by the patient’s unconscious into physical symptoms  .
Sigmund Freud, later theorized that these symptoms were due to a psychological defense mechanism and coined the term conversion reaction .
The incidence of conversion disorder varies significantly from one population group to another. Rates have been reported to be as high as 11 to 22 cases per 100,000  .
Research shows conversion disorder is more common in rural, lower socioeconomic and education groups , as well as an increased in patients with a history of sexual or physical abuse is  .
The female-to-male ratio for conversion disorder is higher in females. In many studies the incidence is report as 2 to 5:1 female to make .
The onset of symptoms may occur at any age, but the peak onset appears to be from 20 to 40 years of age .
Conversion disorder presents as a physical symptom or complaint to which no physical cause can be found and so is determined to be the result of psychological factors. Symptoms are thought to be due to an internal emotional conflict that the patient has repressed into the unconscious  .
Behavioral psychology’s attachment theory gives a developmental explanation for conversion disorder. It theorizes defense mechanisms, the ‘freeze response’ and ‘appeasement defense’, are to blame. Symptoms occur when the individual feels threatened. In this context the symptoms are self-protective . This theory explains, in part, why conversion disorder occurs with more frequency in individuals who have a history of emotional or physical abuse  .
Patients with conversion disorder receive both primary and secondary gains from the symptomatology. The symptoms allow them to express suppressed emotional conflict unconsciously that they are unable admit openly. Secondary gains include avoidance of disagreeable situations, support from family and friends and attention from the medical community. Conversion symptoms are a learned behavior that are maladaptive but supported by the environment  .
Recent advances in neuroimaging may provide another hypothesis. Several studies have indicated a physical connection related to cerebral blood flow. Individuals with organic disease show an abnormally increase in blood flow to the primary motor cortex and thalamus and decreases to the cerebellum. In conversion disorder the opposite is seen with increased blood flow to the cerebellum and basal ganglia and decreases to the primary motor cortex  . As yet, no determination of the meaning and effect of these findings are available.
There is no clear way to prevent the incidence of conversion disorder as the cause of the disease remains unknown. This condition may be viewed as a cry for help from individuals unable to express deep emotional issues. Therefore, early detection and treatment of psychiatric and emotional problems may go a long way in preventing such conditions leading to conversion reactions.
The other way of preventing this disturbing and disabling disorder is to identify, prevent, and treat emotional and physical abuse.
Conversion disorder refers to the occurrence of one or more sensory or motor neurological symptoms that have no identifiable organic cause, either neurologic or systemic   . Some common symptoms of conversion disorder include blindness, paralysis, speech anomalies, non-epileptic seizures, amnesia, dementia, swallowing difficulties, tics, hallucinations, and abnormal gait  .
Conversion disorder is thought to be a somatic disorder in that physical symptoms are an expression of psychological or emotional conflicts. The symptoms of conversion reactions are not under conscious control or intention  and have no identified precipitating or alleviating factors. Studies have shown a connection between conversion disorder and emotional or physical abuse  .
Conversion disorder can occur at any age past early childhood with a mean age of 30 years. There is a higher incidence in women than in men.
Since the neurobiological basis of conversion disorder is poorly understood, its management is difficult .
What is conversion disorder?
Conversion disorder refers to a condition in which one or more physical, usually neurological, symptoms are experiences where there is no organic or physical cause. The presentation of conversion disorder varies widely and may include motor, sensory, speech, or seizure like symptoms. In the absence of identifiable pathology it is believed that conversion disorder has a psychological source.
What are the symptoms?
The symptoms of conversion disorder vary widely from person to person. They may include:
What causes conversion disorder?
The cause of conversion disorder is not known. However it is felt to have a psychological or emotional basis. It may appear as a result of an unrecognized physical or emotional trauma.
Who gets conversion disorder?
Conversion disorder can occur at any age, but is most common in individuals 20 to 40 years of age. It occurs in all ethnic groups.
It is more frequent in women than men, 2-5 to 1.
Its incidence is higher in people who have been the victims of physical, sexual, or emotional abuse.
How is it diagnosed ?
There is no specific diagnostic test for conversion disorder. It is a diagnosis of exclusion. It is made when all possible physical or medical causes for the symptoms cannot be found.
How is conversion disorder treated ?
There is no specific treatment for conversion disorder. There are no medications or treatments that are curative.
Treatment involves psychiatric and psychological interventions such as individual, group, or family counseling, and possibly hypnosis.
What are the complications?
Conversion disorder interferes with the individual’s ability to interact successfully with others and with their environment. It may decrease the person’s functioning and quality of life.
What can we do to prevent conversion disorder?
The incidence of conversion disorder may be prevented by early identification and treatment of emotional and psychological trauma and abuse.