The conversion disorder is characterized by having a physical malfunction without there being a neurological or medical illness. In psychopathology, very strange cases are known, such as people who stop walking or become blind without apparent physical cause.
For example, someone may become temporarily blind due to the stress of losing a close family member.
People with this disorder usually can act normally, although they say no. There is a dissociation between sensory experience and consciousness.
For example, paralysis could run in emergencies and blindness can overcome obstacles.
Some conversion symptoms are:
- Total mutism.
- Loss of sense of touch.
In many cases, stress is experienced before the onset of conversion symptoms. In cases where there is no stress, a physical cause is more likely to occur.
Although the term of conversion has been used since the Middle Ages, it was with Freud that he became popular; He thought that unconscious conflicts became physical symptoms.
Symptoms of conversion disorder
The conversion disorder can occur with sensory or motor symptoms.
- Problems of coordination or balance
- Weakness or paralysis of a part of the body or of the whole body.
- Loss of voice or aphonia.
- Difficulty swallowing or feeling knotty in the stomach.
- Urinary retention.
- Psychogenic seizures or non-epileptic seizures.
- Persistent dystonia.
- Blindness, vision problems or double vision.
- Deafness or hearing problems.
- Loss of touch.
Causes of Conversion Disorder
Although the exact causes of conversion disorder are unknown, it seems that the symptoms are related to the occurrence of a psychological conflict or a stressful event.
There are also people who are considered at risk for developing this disorder, such as those who have a disease, people with personality disorders or people with dissociative disorder .
One explanation from evolutionary psychology is that the disorder has been advantageous during the war.
A fighter with symptoms may nonverbally show that he is not dangerous to another person speaking another language.
This could explain that conversion disorder can develop after a threatening situation, that there may be a group that develops the disorder and gender difference in prevalence (more occurs in women).
Diagnostic criteria according to DSM-IV
- A) One or more symptoms or deficits that affect voluntary or sensory motor functions and which suggest a neurological or medical illness.
- B) Psychological factors are considered to be associated with the symptom or deficit because the onset or exacerbation of the condition is preceded by conflicts or other triggers.
- C) The symptom or deficit is not produced intentionally and is not simulated (unlike what happens in factitious disorder or in simulation).
- D) After an adequate clinical examination, the symptom or deficit is not explained by the presence of a medical illness, by the direct effects of a substance or by a culturally normal behavior or experience.
- E) The symptom or deficit causes clinically significant discomfort or social, labor, or other important areas of the subject’s activity, or require medical attention.
- F) The symptom or deficit is not limited to pain or sexual dysfunction, it does not appear explicitly in the course of a somatization disorder and is not better explained by the presence of another mental disorder.
Sometimes it is difficult to distinguish people with conversion disorder from people who are really simulators (pretending symptoms with some goal).
If they are discovered, the simulators have reasons to simulate the symptoms. They can range from economic reasons to family or emotional interests.
There is also factitious disorder, in which the person simulates the symptoms but does not have a good reason, more than receiving care or get rid of responsibility.
On the other hand, Munchausen syndrome by power, in which an affected father uses ways to cause an apparent illness in his son.
Exclusion of neurological disease
Conversion disorder usually presents with symptoms that resemble a neurological disorder such as stroke, multiple sclerosis, or epilepsy.
The neurologist should carefully exclude the disease, through appropriate research and examination.
However, it is not uncommon for patients with neurological diseases to also have conversion disorder.
For example, poor awareness or concern about symptoms can also occur in people with neurological disorders. Likewise, the agitation
Treatment for conversion disorder
A key strategy of action is to eliminate the sources of stress or stressful events that exist in the life of the patient, whether present in real life or in their memories.
In addition, it is important that the professional therapist does not maintain the secondary gains, that is, the patient’s consequences for showing the symptoms.
Examples of secondary gains may be:
- Avoid responsibilities.
- Get more attention.
- Positive consequences for family members.
It is important to note that it may be a relative who is benefiting from the conversion symptoms.
For example, there is the case of a girl who without physical cause stopped walking. It was in the mother’s interest for her daughter to spend much time in one place while she worked.
In these cases it is more complicated to eliminate the consequences and relapses can occur if the family member is not aware of the problem or finds other ways to receive the positive reinforcements.
Although occasionally the symptoms disappear on their own, the patient may benefit from a variety of treatments.
They may be:
- Explanation: it must be clear, since the attribution of physical symptoms to psychological causes is not well accepted in Western culture. It should be emphasized the genuineness of the disorder, which is common, does not indicate psychosis and is potentially reversible.
- Psychotherapy in certain cases.
- Occupational therapy to maintain autonomy in daily life.
- Treatment of comorbid disorders, such as depression or anxiety.
- Treatments such as cognitive behavioral therapy, hypnosis, eye movement reprocessing or psychodynamic therapy need more research.
- Risk factors for developing the disorder may include:
- Significant recent stress or emotional trauma.
- To be a woman; Women are more likely to develop the disorder.
- Having a mental disorder such as anxiety, dissociative disorder or personality disorders.
- Having a neurological disease that causes similar symptoms, such as epilepsy .
- Have a family member with conversion disorder.
- A history of physical or sexual abuse in childhood.