Conversion disorder

Alternative names 
Hysterical neurosis

Definition
Conversion disorder is a psychiatric condition in which emotional distress or unconscious conflict are expressed through physical symptoms.

Causes, incidence, and risk factors

Conversion disorder is one of several types of somatoform disorders, in which psychological problems produce physical symptoms.

These disorders have typically been highly stigmatized, with physicians telling patients that the problem is “all in your head.” Research on the connection between mind and body is steadily increasing our understanding of these disorders and should reduce the stigma, as it becomes clear that these conditions are real, cause real distress, and cannot just be turned on and off at will.

The onset of symptoms in this disorder is usually very sudden and follows a stressful experience. Loss of function, such as in inability to move a limb, may unconsciously symbolize the underlying conflict associated with the experience. Risk factors include a history of histrionic personality disorder or dependent personality disorder.

Symptoms

The symptoms of conversion disorder involve the loss of one or more bodily functions. These may include blindness, paralysis or the inability to speak. The loss of physical function is involuntary and diagnostic testing does not show a physical cause for the dysfunction.

Signs and tests

Some of the common signs of conversion disorder include:

     
  • The sudden onset of a debilitating symptom  
  • A history of a recent psychological conflict that is resolved through the development of the symptom  
  • A lack of concern that is usually associated with a severe symptom

A physical examination is performed to rule out physical causes for the loss of function. Specific diagnostic testing related to the symptom is warranted to rule out a physical cause.

Treatment

Psychiatric treatment is recommended to help the person understand the underlying psychological conflict. The integrity of the affected body part or function must be maintained until the conflict is resolved and the symptoms usually disappear. For example, paralyzed limbs must be exercised to avoid muscle wasting.

Expectations (prognosis)

Symptoms usually last for days to weeks and may resolve spontaneously. Usually the symptom itself is not life-threatening, but the development of complications as a result of the symptom can be debilitating.

Calling your health care provider

Call for an appointment with your health care provider if you or someone you know has symptoms suggestive of conversion disorder.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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