Conversion Disorder

Clinical Symptoms of Conversion Disorder

Patients with conversion disorder present with neurological symptoms affecting their voluntary motor system or sensory functions that cannot be fully explained physiologically.

Conversion disorder (also called functional neurological disorder) is marked by the presence of deficits in voluntary motor or sensory functions, including paralysis, blindness, movement disorder, gait disorder, numbness, paresthesia (tingling or burning sensations), loss of vision or hearing, or episodes resembling epilepsy.

Conversion disorder is a clinical problem that requires the application of multiple perspectives—biological, psychological, and social—to fully understand the symptoms of individual patients. Patients with conversion disorder symptoms may be found to have “no neurological disorder” by the neurologist and “no psychiatric disorder” by the psychiatrist (Stone et al., 2010).

Conversion disorder is attributed to channeling of emotional conflicts or stressors into physical symptoms; however, some MRI studies suggest that patients with conversion disorder have an abnormal pattern of cerebral activation.

Many patients show a lack of emotional concern about the symptoms (la belle indifferenceOpens in new window) although others are quite distressed. Imagine someone casually discussing sudden blindness.

Care providers should assume there is an organic cause to the symptoms until physical pathology has been ruled out. Patients truly believe in the presence of the symptoms; they are not fabricated or under voluntary control.

Childhood physical or sexual abuse is common in patients with conversion disorder, and comorbid psychiatric conditions include depressionOpens in new window, anxietyOpens in new window, posttraumatic stress disorderOpens in new window, other somatic disorders, and personality disorders.

There are also cases in which a comorbid medical or neurological condition exists, and the conversion disorder is an exaggeration of the orginal problem (Nicholson et al, 2011).

The course of the disorder is related to its acuity. In cases with acute onset during stressful events, remission rate is high; in cases with a more gradual onset, the disorder is not readily treated. Cases generally remit by themselves 95% of the time (Sadock & Sadock, 2008). Recurrence is as high as 25%, often within the first year.