Conversion Disorder And Trauma

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Introduction

Conversion disorder and trauma are closely linked, with trauma often serving as a causative factor for the development of conversion symptoms. The association between trauma and conversion disorder has been supported by research and clinical observations. 

Definition of conversion disorder

Conversion disorder, also known as functional neurological symptom disorder (FND), falls under the category of dissociative disorder in the ICD-11 (International Classification of Diseases). Conversion disorder involves neurological symptoms that cannot be fully explained by any known medical or neurological condition.

The defining feature of conversion disorder is the conversion of psychological distress into physical symptoms, resulting in disruptions in movements and senses. These symptoms may resemble those of neurological conditions, such as paralysis, tremors, blindness, seizures, or difficulty speaking or swallowing. However, unlike neurological disorders, no neurological or medical cause can be identified.

Overview of the relationship between trauma and conversion disorder

Several studies have highlighted the association between trauma and conversion disorder. Traumatic events, especially those involving physical or sexual abuse, emotional neglect, or significant psychological distress, have been identified as potential triggers for conversion symptoms. 

It is important to note that not everyone who experiences trauma develops conversion disorder, but there appears to be a higher prevalence of conversion symptoms among those with a history of trauma.1

It is worth noting that the relationship between trauma and conversion disorder is complex. Additional factors, such as personality traits, individual vulnerability, and social support, can also influence the development and course of conversion symptoms in individuals exposed to trauma.

Understanding conversion disorder

Symptoms of conversion disorder

The symptoms of conversion disorder can vary widely among individuals and may affect different body systems. Some common symptoms include:

  1. Motor symptoms: These involve abnormal movements or loss of control over voluntary movements. Examples include weakness or paralysis of limbs, difficulty walking, tremors, jerking movements, uncoordinated movements, or even apparent seizures
  1. Sensory symptoms: These involve disturbances in the senses. Examples include blindness, double vision, hearing loss or impairment, tingling or numbness, loss of sensation, or abnormal sensations such as burning or electric shocks
  1. Speech and swallowing difficulties: Some individuals may experience speech-related symptoms, such as slurred speech, stuttering, or even the complete inability to speak. Swallowing difficulties, also called dysphagia, can occur
  1. Non-epileptic seizures: Also referred to as psychogenic seizures or dissociative seizures, these resemble epileptic seizures but are not caused by abnormal brain activity. They may involve convulsions, loss of consciousness, shaking, or spells of staring
  1. Functional movement disorders: These involve abnormal movements that are not associated with a specific neurological condition. Examples include dystonia (involuntary muscle contractions), tremors, or tics
  1. Sensory disturbances: These may include abnormal sensitivity to light, sound, or touch, as well as altered perception of pain or temperature

It is important to note that the symptoms of conversion disorder are not intentionally produced. They can have a significantly negative impact on a person’s day-to-day life. 

Diagnosis of conversion disorder

Diagnosing conversion disorder requires careful assessment and exclusion of any underlying medical conditions that may account for the symptoms. 

Medical and neurological evaluations, including laboratory tests, scans, and consultations with specialists, are crucial in ruling out other possible explanations for the symptoms. 

A comprehensive psychiatric evaluation is also necessary to identify any psychological factors contributing to the development or maintenance of the conversion symptoms.2

For the diagnosis to be made, the symptoms described earlier in this article must be present alongside: 

  • The symptoms having a sudden onset 
  • The symptoms being debilitating 
  • A history of mental health problems that improve when the physical symptoms manifest 
  • A possible lack of concern regarding the symptoms that would normally be associated with a serious illness3 

It is a relatively rare disorder with an estimated prevalence of 0.011- 0.5% in the general population.4 Additionally, many doctors are uncomfortable giving a diagnosis of conversion disorder due to possible angry reactions from the patient. 

People with conversion disorder may feel that their illness is purely physical and feel abandoned by their doctor. Previous experience of being abandoned or abused may exacerbate conversion disorder symptoms. As such, care needs to be given to this potentially sensitive situation when diagnosing conversion disorder to maintain the therapeutic relationship.5

Causes of conversion disorder

The exact cause of conversion disorder remains unclear. It is believed to involve a complex interplay of psychological, social, and biological factors. 

Psychological factors, such as trauma, stress, or emotional conflicts, are often a major factor in the development of conversion symptoms. Some individuals with conversion disorder may have a history of childhood abuse, neglect, or significant life stressors. 

Personality traits, such as a tendency to suppress emotions or a high level of suggestibility (a tendency to be easily influenced by others), may also contribute to the manifestation of symptoms.

Trauma and conversion disorder

The impact of trauma on the body and mind

One of the proposed explanations for the relationship between trauma and conversion disorder is the concept of dissociation. Dissociation is a defence mechanism that involves a disruption in the normal integration of thoughts, memories, and emotions, causing someone feeling ‘disconnected’ from their body or the world. Traumatic experiences can overwhelm your capacity to cope, leading to dissociative episodes. 

Conversion symptoms are thought to manifest as a way for the mind to express distress and to protect you from overwhelming emotions or memories associated with the trauma.

The connection between trauma and conversion disorder

Research has shown that individuals with conversion disorder often have higher rates of co-occurring post-traumatic stress disorder (PTSD) and other dissociative disorders. Conversion symptoms may present as unresolved trauma or as a means of avoiding distressing memories or emotions related to the traumatic event.1

Several studies have provided evidence for the association between trauma and conversion disorder. For example, a study published in the Journal of Traumatic Stress examined a group of patients with conversion disorder and found that 68% of them had a history of physical or sexual abuse.1  

The role of childhood trauma in the development of conversion disorder

A study published in the Journal of Nervous and Mental Disease investigated a sample of children and adolescents with conversion disorder and found that 64% of them had experienced traumatic events.6 

Whilst more research is needed into this relationship, it is generally thought that the reason for this high prevalence is linked to differences in brain development and function after experiencing trauma, along with primed cognitive emotional responses which amplify the response to triggers.6

Treatment for conversion disorder and trauma

Treatment approaches for conversion disorder typically involve a multidisciplinary approach, including psychiatric interventions, psychological therapies, and physical rehabilitation. 

Psychotherapy

Psychotherapy, particularly cognitive behavioural therapy (CBT), is often recommended to address the underlying psychological factors and promote adaptive coping strategies. CBT is the most common type of therapy recommended for the treatment of conversion disorder and is considered the most likely to work.

CBT works by helping you identify and learn to change the behavioural, physical and cognitive responses associated with stressors that may be at the root of the conversion disorder. CBT is most helpful when the underlying issue causes low self-esteem, depression or anxiety.7

CBT has also been found to be helpful as part of the treatment for non-epileptic seizures. Patients showed improvements through graded exposure, problem solving and reframing their beliefs about their own illness and perceived powerlessness.5

Medications

Psychiatric medications may be prescribed in some cases, primarily to target co-occuring mental health conditions like depression or anxiety. Studies have shown that selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, analgesics and beta blockers all lead to improvements in patient symptoms.5

Alternative therapies

Hypnotherapy is a possible option to treat conversion disorder and is generally used when your ability to speak is impacted. In studies, it led to an improvement in symptoms after 3 months, however, it had no benefit over the other treatment options. It is thought to work because conversion disorder and hypnosis share the same neurological pathways.5

Physiotherapy is essential in supporting people with conversion disorder through their recovery. It helps them to overcome their physical symptoms, which may prevent secondary problems such as muscle loss as a result of limited movement, for example. Starting with simple exercises and gradually increasing has shown to be the most effective method for treatment.3

Coping strategies for conversion disorder and trauma

Self-care techniques

Self-care techniques are things you can do yourself to optimise your overall wellbeing, thus reducing stress, low mood and anxiety. 

When people talk about self-care, they’re referring to making positive changes in your life, such as incorporating relaxation into your daily routine. This is a fantastic way to make time for yourself, reflect on your mental state and focus on the present moment, rather than stressing about future or past events. This can also include yoga and meditation. 

Support groups

Support groups can include an organised group of people with similar experiences. Some people with conversion disorder have a negative view of themselves, often feeling that they are a burden to those around them, resulting in worsening self-esteem. Having someone who understands the illness helps to address this issue. 

Talking to people with similar experiences can also help you build hope of recovery. You may learn about someone’s journey and what was helpful to them. You may also be in a position to help someone else who is not as far into their recovery, thus increasing your own self-esteem and confidence. 

Lifestyle changes

It is important to look after yourself in order to enhance your recovery. Diet and exercise both play a huge part in affecting how we feel on a day-to-day basis. Poor diet and little to no exercise may result in you feeling lethargic, low in mood and with lower self-esteem. 

Ensuring you have a healthy sleep pattern is also essential. Poor sleep results in lethargy, increased irritability and makes us more susceptible to stress. Having good sleep can increase your tolerance to certain life stressors.

Building resilience

The strategies described above all contribute to building your resilience to stress and emotional distress. Optimising your wellbeing and building a reliable support network go a long way to making you more resilient against life stressors. If you increase your resilience, you are able to tolerate more life stressors and improve your ability to challenge negative emotions when they occur. 

Summary

Trauma and conversion disorder are interconnected in several ways. Conversion disorder is a condition characterised by physical symptoms that cannot be explained by any known medical or neurological condition. These symptoms often mimic neurological disorders, such as paralysis, blindness, or seizures, but they are not due to any underlying physical cause. 

Understanding this relationship is crucial for clinicians and researchers to provide appropriate assessment, diagnosis, and treatment for people with conversion disorder who have a history of trauma. This way, people with the condition can get the best care, which will aid their recovery.

References

  1. van der Hart O, Brown P, van der Kolk BA. Pierre Janet’s treatment of post-traumatic stress. J Trauma Stress [Internet]. 1989 Oct 1 [cited 2023 Jun 1];2(4):379–95. Available from: https://link.springer.com/chapter/10.1007/978-1-4899-1034-9_12  
  2. Nicholson TRJ, Stone J, Kanaan RAA. Conversion disorder: a problematic diagnosis. J Neurol Neurosurg Psychiatry [Internet]. 2011 Nov 1 [cited 2023 Jun 1];82(11):1267–73. Available from: https://jnnp.bmj.com/content/82/11/1267
  3. Ali S, Jabeen S, Pate RJ, Shahid M, Chinala S, Nathani M, et al. Conversion disorder— mind versus body: a review. Innov Clin Neurosci [Internet]. 2015 [cited 2023 Jun 1];12(5–6):27–33. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479361/
  4. Heseltine-Carp W, Dale V, Van Eck Van Der Sluijs J, Van Der Feltz-Cornelis C. Are serum hsCRP and IL-6 prognostic markers in somatic symptom disorder and related disorders? An exploratory analysis in a prospective cohort study. Journal of Psychiatric Research [Internet]. 2023 Jan [cited 2023 Jun 1];157:88–95. Available from: https://pubmed.ncbi.nlm.nih.gov/36455378/ 
  5. Stonnington CM, Barry JJ, Fisher RS. Conversion disorder. AJP [Internet]. 2006 Sep [cited 2023 Jun 1];163(9):1510–7. Available from: http://psychiatryonline.org/doi/abs/10.1176/ajp.2006.163.9.1510
  6. Kozlowska K. Functional somatic symptoms in childhood and adolescence. Current Opinion in Psychiatry [Internet]. 2013 Sep [cited 2023 Jun 1];26(5):485. Available from: https://journals.lww.com/co-psychiatry/Abstract/2013/09000/Functional_somatic_symptoms_in_childhood_and.11.aspx 
  7. Morgante F, Edwards MJ, Espay AJ. Psychogenic movement disorders. Continuum (Minneap Minn) [Internet]. 2013 Oct [cited 2023 Jun 1];19(5 Movement Disorders):1383–96. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4234133/ 

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Karl Jones

BA Hons in Learning Disability Nursing, Diploma in Mental Health Nursing (Oxford Brookes
University)

Karl has 12 years of experience in learning disability and mental health nursing in a variety of
settings. He has worked predominantly in general hospitals specialising in suicide prevention and the
psychological impact on long term health conditions. Most recently he has worked as a clinical
educator in the field of mental health. He is currently focusing on writing as a career with the aim of
imparting his knowledge to a wider audience.

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