Conversion Disorder

Conversion disorder is a condition in which an individual presents psychological distress in the form of physical symptoms. The individual could experience motor symptoms or disturbance in sensory functioning that appear to be a result of neurological problems, but for which no physical cause can be established.

History of conversion disorder

This disorder has been in existence for several centuries now and continues to be a conundrum to psychologists, psychiatrists, as well as neurologists. It was formerly referred to as hysteria, a term drawn from the Greek word “hystera” which means uterus.  Hippocrates, an ancient philosopher, postulated that this disorder only affected women and that it was caused by a wondering of the uterus throughout the body in search of a child.  During that era, marriage was considered the ultimate cure for hysteria.

Hysteria was replaced by the term conversion in the modern classification of mental disorders and draws its roots from Freud’s psychosexual theory. Freud hypothesized that the symptoms presented as a result of repressed anxiety which was then re-channeled and converted into physical symptoms. The main distinct feature of this disorder is its distortion of neural functioning.

Classification of conversion disorder

Conversion disorder is divided into three sub-categories; motor, sensory, and visceral. Sensory symptoms include anesthesia (loss of sensitivity), hyperesthesia (excessive sensitivity) and, paresthesia (bizarre sensations such as tingling, burning, pricking, etc).  Motor symptoms comprise of paralysis (usually restricted to one limb or side of the body), tremors, ticks, and aphonia (the inability to talk above a whisper). Visceral symptoms include a feeling of constant “lump in the throat,” chocking, coughing, belching, as well as nausea.

Diagnosis of conversion disorder

The diagnosis of conversion disorder remains a clinical challenge to practitioners and early in a patient’s presentations, physical tests should be conducted to eliminate any other general medical condition. An elaborate psychiatric history should be taken in order to screen for any psychiatric ailments and if discovered accorded necessary treatment. The psychiatric history is also vital because it gives pointers about the onset and nature of symptoms as well as existence of any stressors. Still, a psychological reason is hard to pin-point as a patient with this disorder is often unable to explain their psychological factors themselves and hence, explain through physical symptoms.

Although containing only a small degree of significance as a diagnostic tool, historic information such as childhood experiences, illness, and personality types can contribute to the patient’s experience and need to be considered. These considerations will not only enable the practitioner make positive diagnosis from the very onset, but also help eliminate uncertainty and extra costs incurred during clinical investigations.

According to DSM-IV, conversion disorder must cause clinical, social, and occupational consequences to the patient. Fictitious disorder (intentional production of false psychological or physical symptoms in order to receive medical attention and care), or malingering (conscious production of symptoms for financial or material gain), are clearly disparate from conversion disorder. In clinical practice however, a distinction between conversion disorder and fictitious disorder can only be arrived at via covert surveillance of the patient or through a confession. Also, according to DSM-IV, the symptoms must have been preceded by a stressful situation and that the patient must present at least one symptom that is beyond their control that affects their motor or sensory capacities. These symptoms should not be a result of a neurological or any other medical condition. The symptoms however, lack full explanation of a general medical condition, drug use, or a culturally accepted behavior. Moreover, these symptoms should not be limited to pain or sexual problems, and aren’t better accounted for by another medical condition.

Management of conversion disorder

Several management strategies can be employed for this disorder depending on the symptoms presented by the patient although some of the ones suggested need more trial.

         i.            Counseling and psychotherapy

This approach is applied where appropriate. The loss of function may symbolize the underlying conflict associated with it. Psychodynamic theory asserts the cause of the symptom as a defense mechanism that absorbs and neutralizes the anxiety generated by an unacceptable impulse or wish.

       ii.            Physical therapy

Mental healthcare providers may underplay the role of physical therapy in the management of patients with conversion disorder. Albeit numerous reports emphasizing the importance of physical therapy in the management of conversion disorder, they fall short in elaborating specific kinds of therapy  to be applied especially to patients with movement impairments as a result of the disorder. For instance, in some successful physical therapy cases, behavioral modification and shaping techniques were central to the formation of the physical therapy treatment approach. Patterns of abnormal movements were ignored while those of correct movements were reinforced using feedback and praise. The patients then proceeded to an advanced treatment program founded upon approaches implemented alongside analogous neurological conditions. The patients conditions improved and they displayed complete resolution of their symptoms. This resolution enabled them return to their previous state of independent mobility and living as well as work or school.

      iii.            Psycho-education

This approach is highly recommended because it educates the patients, enabling them understand their underlying psychological conflict. It is crucial that the patient comprehends that their symptoms lack an organic cause and that there is need to maintain the integrity of the affected part or function until the underlying conflict is resolved for the symptoms to disappear.

     iv.            Medication

Even though there is little evidence indicating successful treatment of conversion disorder through the use of medication, there exist case reports showing success with haroperidol, ECT, and tricyclic anti-depressants. Neuro-imaging findings that show alterations in brain regions related to the disorder’s symptoms after medication, suggest that these brain regions may be responsive to medication.

In conclusion, a multi-disciplinary approach geared towards reducing the patients’ distress while at the same time improving their functionality is the best form treatment and should be adopted in the management of conversion disorder.