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Conversion Disorder

Aynur Khosravi Bachemir

Department of Psychology/Clinical Psychology, Khazar University

CPSY 400: Mind Brain and Behaviour

Ulkar Isayeva

December 15, 2021

Conversion disorder

Background.

Conversion disorder (Functional Neurological Symptom Disorder) is categorized under

the new  Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-

5) category of Somatic Symptom and Related Disorders. (American Psychological Association,

2017). Conversion disorder is a disorder in which a person experiences one or more than one

motor or sensory changes which affects the nervous system which cannot be explained by

medical illness or injury. (Aybek S, 2008). Those symptoms begin suddenly after a period of

emotional or physical distress or sometimes after psychological conflict. (Berger FK,2016).

Etiology

Conversion disorder is caused by the body’s reaction to a stressful physical or

emotional event. (Marshall SA, 2015). It can be mixed with other neurological disorders. The

main reason behind it is still not clear. It has to be differentiated properly to get the correct

treatment. Mostly it’s the bodies response to something that the brain perceives as a threat.

This can be psychological or physical trauma, depression or extreme stress. For example, a

military man who has trauma from shooting and even killing people can experience paralysis

in his hands. (Thimoty J, 2017)

Symptoms.

Symptoms of the disorder are sudden blindness, paralysis, loss of the voice, trouble

coordinating movements (ataxia), loss of the sense of smell (anosmia), loss of sense of touch,

or tingling in the extremities. (National Organization for Rare Disorders. 2003;). Individuals
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with conversion disorder may experience seizures or hallucinations. (Marshall SA, 2015). The

symptoms of conversion disorder—such as paralysis of an arm or leg or loss of sensation in

a part of the body—suggest nervous system dysfunction. Other symptoms may resemble a

seizure or involve problems with thinking, difficulty swallowing, or loss of one of the

special senses, such as vision or hearing. (Tsuruga K, 2008).

It’s riskier for people who also have a mental illness, dissociative disorder,

or personality disorder. Most affected individuals first develop symptoms of conversion

disorder during adolescence or adulthood. (National Organization for Rare Disorders. 2003).

Some researchers believe that conversion disorder is most common after instances of physical

or psychological stressors. In other instances, affected individuals do not seem to have a

stressor that is causing the symptoms. In these cases, the cause of conversion disorder is

unknown. (Vermeulen M, 2015). Research into the cause of conversion disorder has found

that the brain imaging of some individuals with the disorder shows increased or reduced blood

flow to certain areas of the brain. (Gurses N,2018).

There are areas of the brain which are responsible for communication. If those areas

reduce blood flow this may be the main cause of neurological symptoms in conversion

disorder. Regardless of the cause of the disorder, it is important to remember that the

symptoms are very real; affected individuals are not faking symptoms of the disorder.

(National Organization for Rare Disorders. 2003;)

Diagnosis

The diagnosis of the conversion disorder is often made by psychiatrist or neurologist.

Other causes of similar symptoms should be ruled out to avoid misdiagnosis. (Allin M, 2009).

There are different diagnostic criteria for conversion disorder. One or more symptoms of

neurological dysfunction. Firstly, there should be no physical findings that may explain the
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symptoms. Then, it shouldn’t be related with other disease that better explains the symptoms.

Lastly, the symptoms cause significant distress or impairment so that medical evaluation is

desired. (Marshall SA,2015).

DSM-5 lists these criteria for conversion disorder (functional neurological symptom

disorder): One or more symptoms that affect body movement or your sense, 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. (American Psychological

Association, 2017)

Treatment.

The specific type of treatment depends on the particular signs and symptoms of the

disorder. Treatment methods mainly are counselling (psychotherapy), hypnosis, physical

therapy ,occupational therapy and treatment of related physical or psychological stressors.

(Dimsdale JE, 2017). Another one is physical or occupational therapy. Working with a

physical or occupational therapist may improve movement symptoms and prevent

complications. For example, regular movement of arms or legs may ward off muscle tightness

and weakness if you have paralysis or loss of mobility. Gradual increases in exercise may

improve your ability to function. (Smith HE,2007).

Prognosis.

Symptoms of conversion disorder are different for each individual. In some people, it

can last for several weeks and then fade away however for other people it can get worse. For

most people, symptoms of conversion disorder get better with reassurance and time. However,

up to one in four people may show a recurrence or new symptoms later. (Marshall SE, 2015).
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Long-lasting disorders or even developing new symptoms occur in those people who delay

their treatment, have serious psychiatric disorders or have tremors or seizures not caused by

epilepsy. 25% are diagnosed with neurological disease in a 10-year follow-up that could

account for presenting symptoms approximately. (Gellauf J, 2016).

Current researches.

Conversion disorders are common and cause considerable morbidity but, despite

attracting ongoing controversy and theoretical interest, there has been relatively little

empirical research in this field. Early neuropsychiatric studies of conversion symptoms

focusing on the apparent importance of laterality and patients with brain lesions failed to

produce consistent findings. (Zeman A, 2001). Neurophysiological studies have suggested

that conversion disorder results from changes in higher-order cortical processing. The

development of functional neuroimaging has provided a new paradigm with which to study

the neural basis of conversion. (Broome 2004). Difficulties with classification and

terminology continue to hamper research in this area. This has led some authors to question

the usefulness of a distinction between conversion and factitious disorders (Austen and Lynch

2004; Shapiro and Teasell 2004).

Reflection.

I chose conversion disorder as my project topic, because it is not very known among

people and the symptoms are mixed with physical or medical disorders. Conversion disorder

is our response to mental or emotional crisis in our life. The stress that we experience turns

into a physical problem. As those symptoms are real, we have to be careful while working

with patients with conversion disorder. The biggest mistake is calling them liars or
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manipulative people. To establish effective therapy, you have to understand your patient in

the first step. Also, you have to obtain a broad information about patient’s psychological and

physical history. There are limited knowledge regarding this condition but psychiatrist are

improving their ability to identify cases of conversion disorder. So, my general idea is that we

need more systematic research and case studies in this area.

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders.5th

ed. Washington DC:American Psychiatric Association; 1994.

Allin M, Streeruwitz A, Curtis V. 2005 Sep Progress in understanding conversion disorder.

Neuropsychiatr Dis Treat. 1(3):205-9

Aybek S, Kanaan RA, David AS. 2008 May. The neuropsychiatry of conversion disorder.

 Curr Opin Psychiatry.21(3):275-80.

Austen S, Lynch C. 2004; Non-organic hearing loss redefined: understanding, categorizing

and managing non-organic behaviour. Int J Audiol. 43:449–57.

Berger FK, Zieve D, and Conaway B. November18,2016. Conversion disorder.

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Conversion disorder.National Organization for Rare Disorders.2003

https://rarediseases.org/rare-diseases/conversion-disorder/.

Dimsdale JE. Conversion Disorder (Functional Neurological Symptom Disorder,2017)

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and-related-disorders/conversion-disorder.

Gurses N, Temucin CM, Lay Ergun E, et al. [Evoked potentials and regional cerebral blood

flow changes in conversion disorder: a case report and review,2008] Turk

Psikiyatri Derg. 19(1):101-7. 

Marshall SA, Landau ME, Carroll CG, Schwieters B, and Llewellyn A, 2015 .Conversion

disorders. 

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Owens C and Dein S, 2006. Conversion disorder: the modern hysteria. Advances in

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Smith HE, Rynning RE, Okafor C, et al, 2007. Evaluation of neurologic deficit without

apparent cause: the importance of a multidisciplinary approach. J Spinal Cord Med,

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Tsuruga K, Kobayashi T, Hirai N, et al.2008 [Foreign accent syndrome in a case of

dissociative

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Zeman A,2001. Consciousness. Brain. 124:1263–89.