Conversion Disorder Causes And Symptoms

Introduction

Conversion disorder, also known as a functional neurological disorder (FND) and historically known as ‘hysteria’, is a neurological disorder affecting the brain’s sensory and motor function.⁴ This disorder causes physical and neurological symptoms that cannot be explained by existing diseases of the nervous system. The reason they are called “functional symptoms” is because they affect the body’s function without damage to the structure.¹

Sigmund Freud introduced the term “conversion disorder” because patients are thought to “convert” their stress into physical symptoms. He hypothesised that an unconscious conflict is represented by some of the symptoms that a disease cannot justify. Relative to other psychiatric and neurological diseases, there has not been substantial progress in understanding conversion disorder. It is critical to understand that conversion disorder is a serious neurological condition and is not simply the patient’s imagination. The patient cannot control the symptoms. They may have to stop working because of this disorder and spend a large amount of money on healthcare.² This article aims to offer an overview of conversion disorder with a focus on both the biological and non-biological causes, symptoms, diagnosis, treatment, and prevention.

Causes of conversion disorder

Depending on the type of conversion disorder, the cause can be based on both non-biological and biological factors.²

Psychological factors

Symptoms of conversion disorder may suddenly appear after experiencing physical or emotional trauma or after a major stressor or event. Other psychological factors that may increase the risk of developing conversion disorder include a history of neglect, physical or sexual abuse during childhood, or having other mental health conditions such as anxiety, dissociative disorder, mood disorder (depression), or personality disorders.^1,3

Physical factors

Physical factors that can increase the risk of conversion disorder are disruptions or modifications of the brain’s metabolism, structure, and function. This includes impairment in the communication between parts of the brain.² Several neurological diseases are risk factors for conversion disorder, including migraines, movement disorders, and epilepsy.^1,2,3 Moreover, having a family history of neurological conditions can increase your risk of conversion disorder.²

Symptoms of conversion disorder

Signs and symptoms of conversion disorder may differ between individuals but are critical enough to warrant medical evaluation. Conversion disorder can affect both the body’s senses as well as the body’s function and movement. Therefore, symptoms are classified as motor or sensory.

Motor symptoms

Motor symptoms are symptoms that affect the body’s function and movement and include:

• Weakness
• Abnormal movement
• Paralysis
• Jerking/tremor
• Difficulty walking
• Muscle stiffness 
• Tics 
• Reduced balance
• Difficulty swallowing
• Unresponsiveness episodes
• Shaking episodes
• Seizures
• Loss of consciousness 

Sensory symptoms

Sensory symptoms refer to symptoms that affect the body’s senses, such as:

• Reduced touch sensation
• Inability to speak
• Slurred speech
• Hearing problems
• Vision problems

Other symptoms

Besides motor and sensory symptoms, an individual may experience other symptoms, such as:

• Memory problems
• Concentration problems
• Discomfort 
• Unexplainable pain 
• Chronic fatigue
• Extreme slowness 
• Faintness
• Nausea 

Diagnosis of conversion disorder

Since the symptoms of conversion disorder do not result from a physical condition, the diagnosis may take time. Conversion disorder shares symptoms with other conditions, so both a neurologist and a psychiatrist will be needed to rule out other neurological and psychological conditions, respectively, and make a diagnosis. Tests will include neurological, physical, and psychiatric exams. 

Physical and neurological exams

During a physical examination, your healthcare specialist will take your medical history and ask you questions about your symptoms, any life changes, stress, or trauma. Depending on your symptoms, the doctor will carry out certain tests to check your balance, reflexes, and physical movement to rule out any other neurological conditions. Such tests may include magnetic resonance imaging (MRI) scans and X-rays to check if the symptoms are associated with neurological abnormalities. Electroencephalograms (EEGs) may also be used to examine any problems related to the brain’s electrical activity (e.g. epilepsy).

Psychological evaluation

Your neurologist may refer you to a mental health professional for a psychological evaluation. The mental health professional may ask about your feelings and thoughts and further discuss your symptoms. If consent is given, they may also contact your family to learn more information about your condition and behaviour.

Diagnostic tests

For a complete diagnosis, your healthcare specialist will need to compare your symptoms to the criteria for diagnosis found in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). In order to be diagnosed with conversion disorder, you have to meet the following criteria:²

• Your symptoms should not be attributed to drug use or another condition (physical or neurological)
• You should have at least one symptom that affects your senses or movement and that you are not able to consciously control these symptoms 
• Your symptoms should cause you fundamental distress or difficulties with socializing, work, and other activities or should be important enough to require medical evaluation 

Treatment of conversion disorder

Sometimes, people with conversion disorder may not need any treatment once they learn that their symptoms are not related to any other, more severe, health condition. However, treatment may be beneficial to people with recurrent, serious symptoms or with co-occurring mental health issues.²

Psychotherapy

The way you think and feel can have an impact on your symptoms. Therefore, when the conversion disorder is caused by trauma or stress, the person may require working with a psychologist or psychotherapist. Psychotherapy options include cognitive behavioural therapy (CBT), which is a type of psychotherapy that helps with recognizing negative thinking and leads to having a clearer view of situations and learning to effectively respond to them. Using CBT, you may learn to manage your symptoms and any stressful situations that cause or worsen them. Moreover, mindfulness and relaxation exercises may aid in the reduction of stress. Some individuals may also benefit from hypnosis to manage their symptoms.^1,2,3

Medications

There are no effective medications to treat conversion disorder, but certain medications may be prescribed by your doctor to treat co-occurring conditions such as depression, anxiety, insomnia, pain, or headache.²

Alternative treatments

Alternative therapies include occupational, physical, and speech therapy. 

• Occupational therapy is used to improve your performance and ability to complete everyday activities
• Physical therapy is designed for muscle weakness treatment and movement impairment
• Speech therapy may be needed if your symptoms affect your ability to swallow or speak

Furthermore, in conversion disorder, your symptoms may be increased when you pay attention to unwanted movements. A type of treatment that might be beneficial in this case is learning to redirect your attention. For instance, doing anything else when these unwanted movements occur. Other treatments include transcutaneous electrical nerve stimulation (TENS) for pain relief and transcranial magnetic stimulation (TMS) for anxiety and depression treatment.^2,3

Prevention of conversion disorder

There is no clear way to prevent conversion disorder, but there are several things one can do to reduce the risk. Stress management may be a way to help manage the risk of developing conversion disorder. Stress can be managed by relaxation techniques, regular exercise, yoga, meditation, sleep, and social activities. If you have any of the risk factors, such as a family history of neurological disorders or trauma, you should consult your doctor. It is also important to get an early diagnosis so that your healthcare team can provide you with an appropriate treatment plan.

Summary

Conversion disorder is a psychiatric condition that can be caused by both psychological and physical factors but cannot be explained by any medical condition. The disorder can present motor, sensory, and other symptoms, including weakness, tremors, speech difficulties, loss of sensations, cognition problems, unexplainable pain, and others. Diagnosis normally involves psychological evaluation, neurological and physical exams, and various diagnostic tests. Once a diagnosis is made, the treatment a patient will receive may vary depending on their symptoms. Typically, treatment will include psychotherapy, medications for co-occurring conditions, and stress management techniques, which may also be useful in the prevention of the disorder. It is important to detect this disorder early so you can get the most appropriate treatment and prevent the symptoms from becoming more serious.