Conversion Disorder

Conversion disorder is a psychological condition in which a person loses abilities such as seeing, hearing, or speaking or becomes paralyzed, but no medical explanation can be found to explain the symptoms. Symptoms of conversion disorder often begin after some stressful experience, and they have traditionally been thought of as an expression of emotional conflict or need.

What Is Conversion Disorder?

Conversion disorder is a mental disorder in which psychological symptoms are converted to physical symptoms, such as blindness, paralysis, or seizures. Unlike malingering, in which a person fakes an illness or injury, a person with conversion disorder does not intentionally produce symptoms.

Conversion disorder is rare, occurring in only about 1 to 3 out of 10,000 people. It is even less common in children younger than 10 years of age. Conversion disorder can be triggered by extreme psychological stress, such as injury, death of a loved one, or a dangerous situation. For example, in wartime, some soldiers undergoing heavy bombardment but not wounded were hospitalized because they could not walk or speak after the battle. Conversion disorder under these circumstances has been called shell shock and battle fatigue. In other circumstances, the purpose of conversion disorder appears to be to help the individual avoid or escape from a highly stressful situation.

What Causes Conversion Disorder?

The old term for conversion disorder was hysteria. Physicians in ancient Greece believed that hysteria only occurred in females and that it was caused by the uterus ^* wandering in the body (the Greek word for uterus is hystera). For centuries thereafter, people with hysteria were regarded as fakers or as imagining their symptoms. In the seventeenth century, some people with hysteria were thought to be involved with witchcraft and were burned at the stake.

The term conversion disorder came into use only in the late twentieth century. It is derived from the early work of the Austrian physician Sigmund Freud, the founder of psychoanalysis ^* . Freud believed that in times of extreme emotional stress, painful feelings or conflicts are repressed (kept from awareness or consciousness) and are converted into physical symptoms to relieve anxiety. Even in the twenty-first century, mental health experts do not all agree on the precise psychological mechanisms underlying conversion disorder. However, many mental health professionals see the benefits associated with the symptoms of conversion disorder, such as sympathy, care, and the avoidance of stressful situations, as significant to the disorder.

What Are the Symptoms of Conversion Disorder?

Sometimes people with conversion disorder have tremors or symptoms that resemble fainting spells or seizures ^* . There also may be loss of feeling in various parts of the body, or loss of the sense of smell, and symptoms may occur together. For instance, following an automobile accident a person may be unable to move or feel sensation in an arm or leg, even though no injury to the limb is apparent. Other people may have difficulty swallowing or feel like they have a lump in their throat. Interestingly, some people with conversion disorder may seem quite comfortable with their symptoms, even though they may be greatly handicapped by them.

How Is Conversion Disorder Diagnosed
and Treated?

Possible medical, or physical, causes of a patient's symptoms need to be ruled out to establish the diagnosis of conversion disorder. Special instruments that measure electrical activity in the muscles and the brain can rule out some physical disorders. In addition, experienced physicians

using close observation can often discover important diagnostic clues. For example, without realizing it a patient may momentarily use an arm or a leg that is supposed to be paralyzed. This clue would indicate that the symptom is psychological rather than physical, and might indicate conversion disorder. To rule out that the patient is just pretending to be ill, a mental health professional would need to perform a clinical interview to learn about the history of the individual and family, stressors that may be present, benefits the patient derives from the symptoms, and what factors may be sustaining the symptoms.

Conversion disorder is typically treated with psychotherapy ^* . The therapist attempts to help the patient understand whatever unconscious emotional conflicts or needs or gains may have given rise to the symptoms. In some instances, symptoms of the disorder may last for years. With treatment, however, the symptoms of conversion disorder frequently last for only brief periods.