Conversion Disorder

What Is It?

A conversion disorder is a rare form of mental illness in which a person has physical symptoms that no medical condition can explain. The person is not "faking," and the symptoms do not appear to be under the person's conscious control. The symptoms, such as a loss of muscle control, blindness, deafness, seizures or even unconsciousness, can cause significant distress.

Conversion disorder often appears after conflict or stress, though the person is not aware of this connection. The person believes the problem is physical. The name of the disorder comes from the idea that some sort of psychological distress is being converted into a physical symptom. Some experts believe that 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 more common in women than in men. It occurs most frequently between adolescence and middle age. It appears more often in places where people know less about medicine and psychology, such as in developing countries. When the disorder occurs in a more sophisticated person, the symptoms tend to be subtler; symptoms are likely to be more severe in a person who doesn't know as much about medicine.

A very high percentage of people with conversion disorder have another psychiatric problem, such as generalized anxiety, obsessive-compulsive disorder or some form of depression. They also report a higher than average frequency of emotional or physical abuse during childhood.

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 appearance of the physical symptoms.

Diagnosis

Usually, a doctor or a mental health professional diagnoses conversion disorder based on the person's health history and a neurological examination. In the most obvious cases, a neurologist diagnoses conversion disorder when the physical symptoms are not part of any known disorder of the nervous system. Sometimes additional tests can clarify the diagnosis. These tests may include an electroencephalogram, which measures electrical activity in the brain, or an electromyogram, which measures how well nerve impulses are being conducted through muscle tissue.

The doctor also tries to determine if any stress or conflict is at the root of the symptoms.

Conversion disorder can be very hard to detect, even with testing. Also, the person may have another psychiatric problem, such as a mood disorder or a personality disorder.

Expected Duration

The symptoms of conversion disorder usually do not last long. Generally, the more quickly the symptoms start, the more rapidly they go away. Symptoms are more likely to last only a short time if the stress is clearly defined. More severe symptoms, such as paralysis or blindness, are less likely to last a long time because it is harder to sustain symptoms that interfere significantly with daily activities. A less severe symptom (such as tremor) or a symptom that is repeated and limited (such as seizure) can continue or come and go, depending on the nature of the stress.

Prevention

There is no way to prevent this disorder.

Treatment

Sometimes symptoms go away on their own after stress has been reduced, conflict has been resolved or the family or community has responded with a show of concern and support. If the person experiences anxiety (an alteration of mood or disordered thinking), medication may help.

If the source of conflict or stress can be determined, it may be possible to provide relief through psychotherapy. For example, the person may be in conflict about leaving home, starting a new job or having a first child. With the help of psychotherapy, the person may learn to deal with the conflict and proceed with the new experience or retreat from the dilemma. In either case, the physical symptoms may stop.

When To Call a Professional

The person should be evaluated as soon as physical symptoms emerge. If the person is indifferent to the symptoms, a supportive family member or friend may need to guide the person to seek treatment.

Prognosis

The outlook for conversion disorder varies. It depends on the nature of the stress and on the symptoms.

Most symptoms of conversion disorder last a relatively short time. The more severe the symptoms, the more quickly they tend to disappear. However, the disorder may indicate that the person has trouble coping with stress and conflict. The same symptoms or other symptoms might appear later, or the person might develop anxiety or depression.

Additional Info

National Institute of Mental Health

Office of Communications

6001 Executive Blvd.

Room 8184, MSC 9663

Bethesda, MD 20892-9663

Phone: 301-443-4513

Toll-Free: 1-866-615-6464

TTY: 301-443-8431

Fax: 301-443-4279

Email: nimhinfo@nih.gov

http://www.nimh.nih.gov/

National Alliance for the Mentally Ill

Colonial Place Three

2107 Wilson Blvd.

Suite 300

Arlington, VA 22201-3042

Phone: 703-524-7600

Toll-Free: 1-800-950-6264

TTY: 703-516-7227

Fax: 703-524-9094

http://www.nami.org/

National Mental Health Association

2001 N. Beauregard St., 12th Floor

Alexandria, VA 22311

Phone: 703-684-7722

Toll-Free: 1-800-969-6642

TTY: 1-800-433-5959

Fax: 703-684-5968

http://www.nmha.org/

American Psychiatric Association

1000 Wilson Blvd.

Suite 1825

Arlington, VA 22209-3901

Phone: 703-907-7300

Toll-Free: 1-888-357-7924

Email: apa@psych.org

Web site: http://www.psych.org/Public information site: http://www.healthyminds.org/

American Psychological Association

750 First St., NE

Washington, DC 20002-4242

Phone: 202-336-5510

Toll-Free: 1-800-374-2721

TTY: 202-336-6123

http://www.apa.org/