Etiological Factors Associated With Conversion Symptoms

The term conversion originates with Freud (1896/1946), who hypothesized that anxiety, via unconscious mechanisms, was converted into somatic symptoms.

Sexual frustration and conflicts about sexual impulses were long believed to be important forces behind the development of conversion (Mace 1992a, 1992b) and, in many patients, continue to play a role (Merskey and Trimble 1979). However, many contemporary scholars would interpret sexual conflicts or abuse as nonspecific stressors or as antecedent vulnerabilities rather than as the primary etiology for conversion.

Psychodynamic Issues

From a psychodynamic perspective, the etiology of conversion disorder is believed to be the conversion of the anxiety related to unconscious conflicts into somatic symptoms.

The symptom symbolically reflects the conflict and provides a solution to it. A classic example is that of a man whose anxiety about his unconscious rage is converted to a paralysis of the arm. As a consequence, the arm cannot be used to strike another person; therefore, the paralysis represents a symbolic condensation of the unconscious conflict.

Interpersonal Issues

A conversion symptom, because it simulates a disease process, elicits attention, sympathy, and nurturance from others; the patient with the symptom assumes the sick role and benefits from a release from usual societal obligations. In addition, the symptom may prevent the departure of another person or provide gratification of the patient's dependency needs. It may provoke guilt in others and thus manipulate their behavior and emotions vis-a-vis the patient. An example might be syncopal spells in a woman whose husband is about to embark on a lengthy business trip. Interpersonal issues in conversion phenomenon are so prominent as to beg the question of whether conversion occurs in the absence of social-interpersonal relationships (Taylor 1986).

Conversion as Communication

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Some contemporary scholars favor the explanation that conversion is a mechanism of signaling distress or communicating emotions that are forbidden by cultural sanctions or that may bring on retaliation (Hollender 1972; Pu et al. 1986; Roy 1980). For example, conversion symptoms (e.g., swooning) reportedly were frequent in Victorian-era women who were culturally suppressed from the display of either sexual or angry affects. Another example is the presentation of pseudoseizures in a sexually abused wife fearful of reporting her husband to the authorities. Consistent with this communication theory are the data that suggest that conversion (at least in its most nonphysiological simulations) appears to be most common in individuals with lower intelligence or poor education or those who come from an unsophisticated cultural background or a nonindustrial country (Folks et al. 1984; Pu et al. 1986; Weinstein et al. 1969). These factors may impede effective verbal articulation of thoughts and feelings. An alternative explanation is that conversion symptoms are common in better educated and more sophisticated persons but their symptoms more closely resemble genuine disease and/or fall into the category of fashionable diagnoses (Ford 1997b).