Conversion Disorder

Conversion disorder, also called functional neurological symptom, is a condition in which a person's psychological stress is shown in physical ways. It is a psychological condition in which a person loses physical abilities such as seeing, hearing, or speaking, or becomes paralyzed, but doctors can find no physical cause to explain the symptoms. Symptoms of conversion disorder often begin after some stressful experience, and the medical community traditionally has considered them an expression of emotional conflict or need.

Conversion disorders are a family of mental disorders in which psychological symptoms are converted to physical symptoms, such as blindness, paralysis * , or seizures * . Seizures may involve sudden episodes of eye staring; twitching or thrashing of arms or legs; and may or may not involve loss of consciousness. Unlike malingering, in which a person fakes an illness or injury, a person with conversion disorder does not intentionally produce symptoms.

Conversion disorder is rare, occurring in 22 out of 100,000 people. It is even less common in children younger than 10 years of age or in the elderly. Conversion disorder can be triggered by extreme psychological stress, such as injury, death of a loved one, or enduring a dangerous situation. For example, in wartime, some soldiers who experience heavy bombardment but are not wounded are hospitalized because they cannot walk or speak after the combat experience. Conversion disorder under these circumstances has been called shell shock and battle fatigue. In this case and for those people facing other highly stressful situations, conversion disorder appears to occur as a way to help the individual avoid or escape from life-threatening, tension-filled conditions.

An earlier term for conversion disorder is hysteria. Physicians in ancient Greece believed that hysteria only occurred in females and that it was caused by the uterus * wandering in the body (the Greek word for uterus is hystera). For centuries thereafter, people with hysteria were regarded as fakers or as imagining their symptoms. In the 17th century, some people thought that people with hysteria were involved with witchcraft and burned the supposed witches at the stake.

The term conversion disorder came into use only in the late 20th century. It is derived from the early work of the Austrian physician Sigmund Freud (1856–1939), the founder of psychoanalysis * . Freud believed that in times of extreme emotional stress, painful feelings or conflicts are repressed (kept from awareness or consciousness) and are converted into physical symptoms to relieve anxiety. Even in the 21st century, mental health experts do not all agree on the precise psychological mechanisms underlying conversion disorder. Many mental health professionals, however, see the benefits associated with the symptoms of conversion disorder, such as sympathy, care, and the avoidance of stressful situations, as significant to the disorder.

Sometimes people with conversion disorder have tremors or symptoms that resemble fainting spells or seizures. An individual may also experience loss of feeling in various parts of the body or loss of the sense of smell, and symptoms may occur together. For instance, following an automobile accident a person may be unable to move or feel sensation in an arm or leg, even though no injury to the limb is apparent. Other people may have difficulty swallowing or feel like they have a lump in their throat. Interestingly, some people with conversion disorder may seem quite comfortable with their symptoms, even though they may be greatly handicapped by them.

To diagnose conversion disorder, a doctor must first rule out any possible physical causes of a patient's symptoms. To discount some of the physical disorders, the doctor may use special instruments that measure electrical activity in the muscles and the brain. In addition, experienced physicians using close observation can often discover important diagnostic clues. For example, without realizing it, a patient may momentarily use an arm or a leg that is supposed to be paralyzed. This clue would indicate that the symptom is psychological rather than physical and might indicate conversion disorder. To make sure that the patient is not just pretending to be ill, a mental health professional conducts a clinical interview to learn about the history of the individual and family, stressors that may be present, benefits the patient derives from the symptoms, and what factors may be sustaining the symptoms.

Conversion disorder is typically treated with psychotherapy * . The therapist attempts to help the patient understand whatever unconscious emotional conflicts, needs, or gains may have given rise to the symptoms. In some instances, symptoms of the disorder may last for years. With treatment, however, the symptoms of conversion disorder frequently last for only brief periods.

See also Factitious Disorder • Hypochondria • Malingering • Munchausen Syndrome • Somatoform Symptom Disorder • Stress and Stress-Related Illness

* paralysis (pah-RAH-luh-sis) is the loss or impairment of the ability to move some part of the body.

* seizures (SEE-zhurs) are sudden bursts of disorganized electrical activity that interrupt the normal functioning of the brain, often leading to uncontrolled movements in the body and sometimes a temporary change in consciousness.

* uterus (YOO-teh-rus) is the muscular, pear-shaped internal organ in a woman where a baby develops until birth.

* psychoanalysis (sy-ko-a-NAL-isis) is a method of treating a person with psychological problems based on the theories of Dr. Sigmund Freud. It involves sessions in which a therapist encourages a person to talk freely about personal experiences, and the psychoanalyst interprets the patient's ideas and dreams.

* psychotherapy (sy-ko-THER-apea) is the treatment of mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personality growth.