Conversion Disorder

What Is It?

Conversion disorder is one of the somatoform disorders, in which symptoms suggest a medical illness, yet no medical condition can be found to explain the symptoms. They do cause significant distress and can impair functioning. The patient is not "faking," and the symptoms are not under the person's conscious control.

In conversion disorder, the symptom that cannot be explained medically involves a person's sensations or voluntary muscle (motor) control. For example, the person may have a paralyzed limb or numbness over a portion of the body. There can be blindness, deafness, seizures or even unconsciousness. A good neurological examination often will demonstrate that the problem is unusual and that it does not match the anatomy of the nervous system, and cannot be explained by any known medical illness.

The symptoms of conversion disorder often follow conflict or stress in the person's life. The person is not aware of producing the symptoms and is convinced that the problem is physical. The name of the disorder comes from the idea that psychological distress is being converted into a physical symptom. Experts believe that in conversion disorder, a conflict or painful thought is so unacceptable that it never reaches the person's awareness. In some cases, the person shows little concern about the physical symptom, a phenomenon sometimes called la belle indifference.

Conversion disorder is rare. It is more common in women than men. It also appears more often in places where people know less about medicine and psychology, for example, in developing countries rather than in industrialized ones. When this disorder occurs in a more sophisticated person, the symptoms tend to be subtler, while the symptoms are likely to be more far-fetched in a person who doesn't know as much abut medicine. The disorder occurs most frequently between adolescence and middle age.

Symptoms

Conversion disorder is characterized by one or more symptoms that suggest a neurological condition. Examples include:

• Poor coordination or balance
• Paralysis or weakness
• Difficulty speaking or swallowing
• Retention of urine
• Loss of touch or pain sense
• Blindness or other visual symptoms
• Deafness
• Seizures or convulsions

Psychological factors, such as stress or conflict, are associated with the physical symptoms.

Diagnosis

Conversion disorder usually is diagnosed by a primary-care physician or mental-health professional based on the person's history and a careful neurological examination. In the least plausible cases, the diagnosis of conversion may be obvious to a neurologist because the physical symptom is not part of any known disorder of the nervous system. Sometimes additional tests may be done to clarify the diagnosis. These tests may include an electroencephalogram (EEG), which measures electrical activity in the brain, or an electromyogram (EMG), which measures how well nerve impulses are being conducted through muscle tissue.