Conversion disorder

Mariam Ajibike
 Table of contents
• Introduction
• Definition
• Epidemiology
• Etiology
• Risk factors
• Clinical features
• DSM-5 diagnostic criteria
• Differential diagnoses
• Management
• Course
• Prognosis
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 Introduction
• Conversion disorder, also called functional
neurological symptom disorder, is a medical
problem involving the function of the nervous
system; specifically, the brain and body's
nerves are unable to send and receive signals
properly.
• Previously known as hysteria

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 Introduction
• Starts as a mental or emotional crisis and converts
to a physical problem. Symptoms are not faked
• An illness of symptoms or deficits affecting voluntary
motor or sensory functions, suggesting another
medical condition, but judged due to psychological
factors because of preceding conflicts or other
stressors.
• Symptoms or deficits are not intentionally produced,
not due to substance, and not limited to pain or
sexual symptomatology.

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 Definition
• Conversion disorder refers to a condition in
which there are isolated neurological
symptoms that cannot be explained in terms
of known mechanisms or pathology and in
which there has been a significant
psychological stressor.

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 Epidemiology
• Conversion disorder can occur at any age but
onset is rarely before age 10years
• Range in general population of 11-300/100,000
• Ratio of women to men; 6:1
• Symptoms in women more common on left
side of body
• Women with conversion symptoms more likely
to subsequently develop somatization disorder
• Association in men between conversion
disorder and antisocial personality disorder
• Men with conversion disorder often involved in
occupation or military accidents
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 Etiology
• Psychodynamic theories: use the explanatory
concept of conversion of emotional distress into
physical symptoms. which often have a symbolic
meaning
• Social factors: appear to be major determinants of
the onset and development of conversion
symptoms
• Cognitive explanations: Brown (2002) suggested
that the symptoms are caused by the chronic
activation of
representations of the symptoms stored within
memory, the process being driven by attention
directed to these representations
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 Etiology
• Neurophysiological mechanisms: little is known of
the neural basis of conversion disorder. Functional
neuro imaging shows alterations in brain activation
related
to how adverse events are processed, and in the
links
between emotion, memory, and body schema.
• Cultural explanations: some of the phenomena
classified as conversion disorder in western
countries may, in some other cultures, be accepted
as possession states

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 Risk factors
• Rural populations
• Developing nations and regions
• Persons with limited education and medical
knowledge, or decreased IQ
• Lower socioeconomic groups
• Military personnel exposed to combat
• Increased Frequency
• Relatives of patients with conversion disorder

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 Clinical features
Motor symptoms or deficits:
• Impaired coordination or balance
• Weakness/paralysis of a limb or the entire body
• Impairment or loss of speech
• •Difficulty swallowing or a sensation of a lump
in the throat
• Urinary retention
• Psychogenic non-epileptic seizures or
convulsions
Tremor
• Gait problems
• Fainting
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 Clinical features
Sensory symptoms:
• Impaired vision
• Double vision
• Impaired hearing (deafness)
• Loss or disturbance of touch or pain sensation
• Numbness

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 DSM-5 diagnostic criteria
• One or more symptoms that affect body movement or
your senses
• Symptoms can't be explained by a neurological or
other medical condition or another mental health
disorder
• Symptoms cause significant distress or problems in
social, work or other areas, or they're significant
enough that medical evaluation is recommended

• ICD-10 are often not used because many patients

with the disorder do not fulfil all of the criteria.
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 Differential diagnoses
• Neurologic and general medical disorders (eg,
multiple sclerosis, myasthenia gravis,
movement disorders, stroke, spinal disorders,
and epilepsy)
• Psychiatric disorders (eg, somatic symptom
disorder, factitious disorder)
• Malingering

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 Management
• Non pharmacological
• Pharmacological

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 Non pharmacological
• Psychotherapy
1. Cognitive behavioural therapy
2. Individual psychotherapy
3. Group therapy
• Hypnosis
• Trans cranial magnetic stimulation
• Rehabilitation therapy
• Relaxation therapy
• Prognosis

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 Pharmacological
• Anxiolytics
• Antidepressants

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 Course
• Initial symptoms resolve within a few days to <
a month in 90 to 100%
• 75% have no further episodes, with 20-25%
recurring within a year during periods of
stress
• 25 to 50% present symptoms later of
neurological disorders or non psychiatric
medical conditions affecting the nervous
system

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 Prognosis
Predictors of good prognosis:
• Sudden onset
• Easily identifiable stressor
• Good coping skills
• No additional psychiatric or medical disorders
• Short duration
• Short interval between onset and initiation of
treatment
• Above average intelligence

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 Prognosis
Not so good prognosis:
• Paralysis
• Aphonia
• Blindness
Poor prognosis:
• Tremor
• Seizures

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 References
• Shorter Oxford Textbook of Psychiatry
• Ahuja N, Vyas JN. Textbook of postgraduate
psychiatry. Second edition. Jaypee
publication. 2013.
• Gelder M G, Juan J L. new oxford textbook of
psychiatry. Volume 1, oxford university
publications, New York.

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