Conversion Disorder

1 What is Conversion Disorder?

Conversion disorder, also called functional neurological symptom disorder, is a condition in which mental is or emotional distress manifests as physical symptoms. For instance, if you have conversion disorder, you may not be able to move your legs after falling from a horse, even though you had no physical injuries. Signs and symptoms can't be associated to a physical cause and are not under your control. Loss of movement or sensory control is common in conversion disorder. The symptoms can be continuous or intermittent. Younger children with conversion disorder have better outcomes compared to teenagers and adults. Treatments improve symptoms. It is common to have signs of conversion disorder after physical or psychological stress or trauma.

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2 Symptoms

Following are signs and symptoms of conversion disorder:

  • Decreased muscle strength or inability to move muscle (Weakness or paralysis)
  • Movement disorders, such as shaking or difficulty walking 
  • Inability to maintain balance 
  • Problem with swallowing 
  • Episode of seizures
  • Episode of detachment 
  • Lack of sensation of touch 
  • Inability to speak or slow speech that is difficult to understand 
  • Vision problems, such as double vision or blindness 
  • Hearing impairment or deafness 

When to see a doctor? 

Visit your doctor as soon as you experience signs and symptoms of conversion disorder. 

3 Causes

The exact cause of conversion disorder is still a mystery. 

In almost all cases, the symptoms appear after exposure to triggers such as emotional disturbances or another mental health disorder like depression. Problems with the area of the brain that regulates your muscles and senses may cause the symptoms. It may be the brain's way of signaling a threat.

4 Making a Diagnosis

The diagnosis of conversion disorder is confirmed if you meet all the symptom criteria mentioned in Diagnostic and Statistical Manual of Mental Disorders (DSM). It is published by the American Psychiatric Association. This is important because insurance companies use this to reimburse for the treatment.

You doctor may refer you to a neurologist or psychiatrist. It is necessary to confirm whether the symptoms are caused by any other medical condition or conversion disorder. 

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms.

Write down your key medical information. 

Write down the names of all your medications, vitamins or supplements. 

Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your doctor. Some typical questions can be: 

  • What could be causing my symptoms? 
  • What are the types of tests that I need? 
  • What are possible treatment approaches and which one do you recommend? 
  • Do I need to take some medications? If so, what are the main side effects? 
  • What will be the duration of my treatment? 
  • How can I prevent symptoms from appearing again? 
  • Should I see a specialist? 

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like: 

  • What are the symptoms you are experiencing and how severe are they? 
  • When did the symptoms start appearing? 
  • How have your symptoms been continuous or intermittent?
  • What do you think may be causing your symptoms? 
  • Have you recently undergone any stressful or traumatic event? 
  • Do you have history of any other medical conditions or mental health problems? 
  • Do you have a family history of mental health problems? 
  • How often do you use alcohol or recreational drugs, if any? 
  • How do you think you will manage this situation?

You can be diagnosed to have conversion disorder if: 

  • You have at least one or more symptoms affecting your movement or senses which can't be associated to neurological or other medical condition. 
  • Your symptoms are seen due to stress or trauma, be it physical or psychological, however this may not hold true every time.
  • Symptoms are spontaneous (You do not produce symptoms intentionally to get some benefits).
  • Your symptoms can't be associated with a general medical condition, drug use or a culturally accepted behavior, such as an experience at a religious ritual. 
  • Your symptoms interfere with your work, social or daily life activities. 
  • Your symptoms can't be explained by another mental health problem. In this scenario, psychological tests are ordered by mental health provider.

No standard tests are available for conversion disorder. The tests are performed to determine if the signs and symptoms you have are caused by any other medical condition or neurological disorder. Following tests may be performed: 

  • Simple tests: These tests are simple as the name suggests, non-invasive, quick and requires no special instrument. For example, your doctor examines normal reflexes to detect whether your signs and symptoms can be related to a physical cause. 
  • X-rays or other imaging tests: These tests are performed to rule out an injury or neurological or other physical conditions that are likely to cause symptoms you have been experiencing. 
  • An electroencephalogram (EEG) scan: An EEG helps to determine the cause of your seizure. This test records electrical activity in your brain and is used to diagnose epilepsy and other brain disorders. 

Diagnosis of conversion can be difficult since the signs and symptoms are likely to be caused by other medical conditions. Conversion disorder can cause symptoms similar to those caused by other health problems, such as:

Myasthenia gravis, weakness of muscle 

 Guillain-Barre syndrome, autoimmune disorder affecting nerves 

 Neurological disorders for example, Parkinson's disease and epilepsy, 

 Stroke

 Lupus 

Spinal cord injury 

 HIV/AIDS

5 Treatment

For most patients, the symptoms of conversion disorder improve on their own and do not need any treatment. If your doctor convinces you that your symptoms are not due to serious medical condition, you may feel relieved without any treatment while some patients feel better after they are referred to mental health professional. You need treatment if you have recurrent, severe signs and symptoms recur or you are suffering from other medical conditions. Treatment option is guided by your signs and symptoms. Some treatment options are:

  • Counselling (psychotherapy): You are likely to be benefitted from counseling if you have mental health problems such as anxiety, depression. Psychologist or professional counselor can help treat symptoms and prevent recurrence. 
  • Physical therapy: Teaming up with physical therapist helps to prevent physical disability associated with conversion disorder. For instance, regular movement of arms or legs might be useful if you have paralysis or loss of mobility. 
  • Treatments for stress and other underlying conditions: Treatments to relieve stress, anxiety or any other problems can improve symptoms of conversion disorder. Your doctor may prescribe medications to reduce anxiety or depressive symptoms depending on your mental health status.
  • Transcranial magnetic stimulation: In this treatment, weak electrical currents are used to excite brain. Only a few studies have been able to show benefits of this treatment. More studies are required to establish the benefits of this treatment. 

6 Prevention

There are several methods to prevent conversion disorder, which include:

  • Avoid stress or trauma. Meditation and yoga might be useful to relieve stress and reduce reactions to the events that are likely to trigger symptoms of conversion disorder. 
  • Try to maintain a good quality of life, secured family environment and balance between work and life.
  • If you are suffering from other mental health conditions, ensure you are being treated. 

7 Risks and Complications

There are several risks and complications associated with conversion disorder.

Risks

  • Any stress or emotional trauma that has been experienced lately
  • Sex: Women are at increased risk of conversion disorder 
  • Other mental health conditions, such as mood or anxiety disorders, dissociative disorder or certain personality disorders, increase your risk. 
  • Neurological disease with similar symptoms, such as epilepsy 
  • Family history of conversion disorder 
  • Victim of physical, sexually abuse or neglect in your childhood

Complications

If conversion disorder is not treated in time, it can cause major impairment of mental and physical functioning. 

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