In this series, I dig a little deeper into the meaning of psychological terms. This week’s term: Conversion disorder
Not to be confused with conversion therapy, conversion disorder is a psychiatric diagnosis that involves neurological symptoms with a psychiatric cause. The symptoms can involve motor or sensory functions and can include blindness or other sensory loss, paralysis, seizure-like attacks, speech disturbance, and abnormal movements. True conversion disorder does not involve malingering (the fabrication of symptoms).
Similar conditions have been documented since ancient Egyptian times. The term hysteria was used by ancient Greeks, and such luminaries as Plato, Aristotle, and Hippocrates thought symptoms were due to the uterus wandering around in the body. In the 13th century, physical symptoms without an identifiable cause were thought to be due to possession by the devil. In the Salem witch trials of 1692, the women thought to be witches were presenting with symptoms similar to conversion disorder.
Conversion disorder was studied more carefully in the 19th century by Sigmund Freud and some of his contemporaries. The term conversion disorder stems from Freud’s belief that anxiety was being converted into physical symptoms. In the current DSM-5, conversion disorder is categorized as a functional neurological symptom disorder.
There is no identifiable physiological cause for the symptoms, and an extensive medical workup would be conducted to rule out any physical cause before diagnosing someone with conversion disorder. It is possible, though, to have conversion disorder in addition to an established neurological disorder.
Conversion disorder is rare, affecting 0.01 and 0.5% of the population. It is most commonly seen in people between the ages of 10 and 35, and is more common in females than males. The risk may be elevated in people with personality disorders or dissociative identity disorder.
Symptoms often will come on suddenly in response to a psychological stressor. Symptoms are usually more prominent on the non-dominant (i.e. non-handed) side of the body. The mechanism by which psychological stress is transformed into neurological symptoms is unknown.
While a variety of treatments are used for conversion disorder, there is no particular treatment that stands out as being clearly effective.
I’ve seen a few patients with conversion disorder over the course of my nursing career. One patient that stands out from multiple admissions was a woman who was in her late 20s or so. She also had a diagnosis of borderline personality disorder (BPD), and she had a significant trauma history. She was physically capable of walking, but when things were bad enough to require a hospital stay she needed a wheelchair and was frequently incontinent. She had never gotten any effective treatment for her BPD, so she displayed a lot of the “difficult” behaviours that tend to be stereotypically associated with BPD, and that made treatment even more challenging. We really weren’t able to do a heck of a lot for her other than give her some time to stabilize in a supported environment.
From an intellectual perspective this is a truly fascinating condition. The power of the human brain really is astounding.
You can find the rest of my What Is series here.