Conversion Reaction

Conversion reaction is a mental illness that causes bodily symptoms, including pain. The symptoms that exist cannot be traced to a medical condition nor are they the result of substance abuse or another mental illness.

Conversion reaction is an outdated term for what was subsequently labeled somatoform disorder. The term conversion reaction was itself an update; Sigmund Freud (1856–1939) originally called the disorder conversion hysteria. Freud believed there was a direct correspondence between a repressed emotional problem and its expression in a physiological form.


Sigmund Freud's 1905 paper, “Fragment of an Analysis of a Case of Hysteria,” is an analysis of an 18-year-old woman named Ida Bauer (1882–1945), whom he calls Dora. What was then called hysteria is now referred to as conversion disorder, so called because it is believed that certain psychological anxieties and neuroses may be converted into physical symptoms with no organic basis. Dora's symptoms presented when she was a child and included chronic dysponea (difficulty breathing), migraine headaches, a nervous cough, and the loss of her voice. She was depressed and suicidal throughout this period. Dora and Freud began meeting in October of 1900 but the treatment was stopped abruptly three months later and was considered by Freud to be a therapeutic failure.

Freud's case study on Dora was written not long after the publication of his seminal work, Interpretation of Dreams, and it also involves his analysis of two of her dreams. Dora lived with her parents, Philip and Katherina Bauer. She told Freud of a couple named Herr K. and Frau K., with whom her father had become close. She learned that her father was having an affair with Frau K. and was very distressed by this discovery. Freud interpreted this distress as jealousy of their erotic relationship, and the root of some of her dreams. While Freud attributed Dora's symptoms to repressed sexual desires, many researchers now believe that her conversion disorder was actually an expression of trauma resulting from an attempted sexual assault by Herr K. On a walk in the woods, Herr K. attempted to kiss her, but she resisted his advances and slapped him. Herr K. denied this accusation and Dora's father did not believe her. On another occasion, Herr K. invited her to his office and when she arrived, forced himself on her, embracing and kissing her. Rather than interpreting her disgust as reaction to a traumatic event, Freud ascribed it to repressed desire for Herr K. He also asserted that, in addition to Herr K., she had repressed erotic attachment to both her father and Frau K. Freud related her nervous cough to repressed thoughts of fellatio being performed on her father. Dora did not accept Freud's interpretations and stopped treatment with him after three months.

This case study of Dora remains one of Freud's most controversial, even among his followers. Janet Malcolm, who has written extensively about psychoanalysis and Freud, asserted that in his treatment of Dora, Freud was “more like a police inspector interrogating a suspect than like a doctor helping a patient.” Many have criticized Freud for unrelentingly pursuing sexual meaning in all of Dora's symptoms and trying to push or suggest these ideas too forcefully. Freud is often criticized by feminists, in part for what they see as his fallocentric interpretations of patients’ situations (such as his interpretation of Dora's nervous cough as being related to repressed thoughts of fellatio). Some critics also say that the effects of countertransference were not given enough attention, and that Freud may not have been aware of his own countertransference and erotic/paternal feelings in relation to Dora. Freud did attribute the failure of treatment to Dora's transference, believing that she had transferred feelings towards Herr K. onto him and stopped analysis out of vengeance.

Freud's case study on Dora is among his most famous. It offers a detailed description of a young woman's symptoms of conversion disorder (hysteria). It also identifies and describes the phenomenon of transference, a key component of psychoanalysis.

Conversion reaction is actually rare, but it has garnered a great deal of attention due to its dramatic nature. Conversion reaction only accounts for approximately 2% of all psychiatric diagnoses and usually first appears during adolescence or early adulthood, generally when a person is under severe stress. Symptoms of this disease are both specific and severe, such as intense headaches or paralysis of a hand and generally interfere with daily activities. Theories of why conversion disorders exist differ widely.

A conversion disorder may serve as a way for individuals to avoid activities or situations associated with a source of emotional conflict. These persons may, through their attention to physical pain, be able to shut down conscious awareness of the conflict itself. Some theorists believe in the concept of secondary gain; through a conversion reaction individuals may garner the attention, sympathy, and support that they need but are unable to obtain otherwise.



Freud, Sigmund. The Standard Edition of the Complete Psychological Works of Sigmund Freud. London, UK: Hogarth Press, 1962.

Morgan, Joel E., et al. Casebook of Clinical Neuropsychology. New York: Oxford University Press, 2011.

Schoenberg, Mike R., and James G. Scott. The Little Black Book of Neuropsychology: A Syndrome-Based Approach. New York: Springer, 2011.

Smith, W. Lynn, Patrick W. Conway, and Jonathan O. Cole. The Mind-Body Interface in Somatization: When Symptom Becomes Disease. Lanham, MD: Jason Aronson, 2009.