CONVERSION DISORDER

(FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER)

 INTRODUCTION

• Conversion Disorder is a somatoform disorder where somatic

symptoms are prominent and associated with significant distress
and impairment.
• Here, uncomfortable feelings are converted into more tolerable
physical symptoms through somatization . Somatization maybe
startling eg. Immediate loss of sight, or very stuble eg. Developing a
headache.
CONVERSION DISORDER

A condition whereby a person develops physical symptoms

that are not under voluntary control and are not explained by
a neurological disease or another medical condition.
Also called Functional Neurological Symptom Disorder
referring to abnormal central nervous system functioning.
 History
• Conversion disorder can be traced back to the nineteenth century when
it was first referred to as Hysteria which by then was common among
women.
• Those diagnosed with hysteria presented symptoms such as frequent
emotional outbursts, paralysis, fainting spells, convulsions and
temporary loss of sight and hearing.
• Pierre Janet concluded the cause of hysteria as psychological trauma
and coined the term ‘dissociation’ to describe the altered state of
consciousness experienced by many patients diagnosed with hysteria.
 History cotnd….
• During World War 1, a disorder known as combat neurosis was common among
soldiers in battle.
• Research was carried out on this disorder and it was found out that the symptoms
observed in “shell-shocked” soldiers were identical to those of “hysterical”
women.
• Later on in 1952, it was referred to as “conversion Reaction” in the DSM,
“Hysterical Neurosis(conversion type)” in DSM-II(1968), “conversion disorder”
in DSM-III(1980), DSM-III-R(1987) and DSM-IV(1994), and now
“Dissociative(Conversion Disorder)” by ICD-10.
 Diagnostic Criteria as per DSM-5

A. One or more symptoms of altered voluntary motor or sensory function

B. Clinical findings provide evidence of incompatibility between the symptom and
recognized neurological or medical conditions.
C. The symptom or deficit is not better explained by another medical or mental disorder.
D. The symptom or deficit causes clinically significant distress or impairment in social,
occupational , or other important areas of functioning or warrants medical evaluation.
 Presentation of Conversion Disorder
• This disorder may present itself in one or more symptoms of various types.
• This symptoms include;
a) Motor Symptoms
 Abnormal movements such as tremor or dystonic movements
 Gait abnormalities
 Abnormal limb posturing
 Weakness or paralysis of limbs or in some cases, an entire side of the
body(hemiplegia).
 b) Sensory symptoms

These include altered, reduced or loss of;

 vision
 absent skin sensation
 hearing
 c) Other Symptoms
• Psychic pain can also be converted into an aberrant pattern of motor activity such as a tic or
seizure, in this case, a psychogenic seizure.
• A psychogenic seizure is one with a psychological origin whereby the individual experiences
episodes of abnormal generalized limb shaking with apparent impaired or loss of
consciousness that may resemble epileptic seizures.
• Other symptoms also include;
 episodes of unresponsiveness resembling syncope or coma.
 Reduced or absent speech volume( dysphonia/aphonia)
Altered articulation( dysarthria)
 Sensation of a lump in the throat(globus) and diplopia.
 Development and Course
• Onset has been reported throughout the life span.
• Non-epileptic seizures however tend to peak in the third decade( ages
20-29) of life.
• Motor symptoms have their peak onset in the fourth decade.
• Symptoms of these disorder may either be transient(temporary) or
persistent.
• Prognosis is better in children than in adolescents and adults.
 Assessment
• There are no standard tests for assessment of conversion disorder.
• Diagnosis of conversion disorder is based on the elimination of medical disorders
or neurological disease as the cause of presenting symptoms.
• Evaluation may include;
 Physical exam-to rule out possible medical causes for the presenting symptoms
 Psychiatric exam- rules out mental illnesses
 Diagnostic Criteria in the DSM-5
 Differential Diagnosis
• These include;
 Neurological Disease
 Somatic Symptom Disorder
 Factitious Disorder and Malingering
 Dissociative Disorders
Body Dysmorphic Disorder
 Depressive Disorder
 Panic Disorder
Comorbid with personality disorders, anxiety and panic disorders, depressive, somatic symptom
disorder as well as neurological and other medical conditions.
Risk and Prognostic Factors
• Temperamental- maladaptive personality traits
• Environmental- stressful life events, history of abuse and neglect
• Genetic and Physiological- presence of neurological disease that causes
similar symptom eg. epilepsy
Prognosis –Positive- Short duration of symptoms and acceptance of
diagnosis
Negative - Maladaptive personality traits, comorbid physical disease, and
receipt of disability benefits.
 Treatment Modalities
Therapy- Psychotherapy-Insight-Oriented therapy
Cognitive Behavioral Therapy
Physical Therapy-weak limbs, movement problems
Occupational Therapy
Speech Therapy
Hypnotherapy-used in world war 1
Narcotherapy-used in world war 1
Stress management training- help make symptoms more manageable
 Treatment contnd…..
• Pharmacotherapy- There isn’t much data on independent use of
medication to counter conversion disorder.
• However, there has been reported success with the following;
 Selective Serotonin Reuptake Inhibitors(SSRIs), betablockers, Benzodiazepines,
tricyclic antidepressants(TCAs), Haloperidol.
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