Section 7. Mental Health Disorders

Chapter 99. Somatoform Disorders

Topics: Introduction | Somatization Disorder | Conversion Disorder | Hypochondriasis | Body Dysmorphic Disorder

Conversion Disorder

In conversion disorder, physical symptoms that are caused by psychologic conflict are unconsciously converted to resemble those of a neurologic disorder.

Conversion disorder, once referred to as hysteria, is caused by psychologic stress and conflict, which people with this disorder unconsciously convert into physical symptoms. Although conversion disorder tends to occur during adolescence or early adulthood, it may first appear at any age. The disorder is generally believed to be somewhat more common in women than in men.

Symptoms and Diagnosis

The symptoms of conversion disorder are limited to those that suggest a nervous system dysfunction--usually paralysis of an arm or leg or loss of sensation in a part of the body. Other symptoms may include simulated seizures and the loss of one of the special senses, such as vision or hearing.

Generally, the onset of symptoms is linked to some distressing social or psychologic event. A person may have only a single episode in his lifetime or sporadic episodes, but usually the episodes are brief. If people with conversion symptoms are hospitalized, they generally improve within 2 weeks. However, 20 to 25% of those people who are hospitalized have recurrences within a year, and for some people, symptoms become chronic.

The diagnosis tends to be initially difficult for a doctor to make because the person believes that the symptoms stem from a physical problem and does not want to be seen by a therapist. Also, doctors take great care to be certain no physical disorder is responsible for the symptoms. Thus, the diagnosis is usually considered only after extensive physical examinations and tests fail to reveal a physical disorder that can fully account for the symptoms.

Treatment

A trusting doctor-patient relationship is essential. As the doctor evaluates a possible physical disorder and reassures the person that the symptoms do not indicate a serious underlying disease, the person usually begins to feel better and the symptoms fade. When a psychologically distressing situation has preceded the onset of symptoms, psychotherapy can be particularly effective.

Various treatment methods have been tried. Although some may be helpful, none of them have been uniformly effective. In one method, hypnotherapy, the person is hypnotized, and psychologic issues that may be responsible for the symptoms are identified and discussed. Discussion continues after the hypnosis, when the person is fully alert. Another (rarely used) method is narcoanalysis, a procedure similar to hypnosis except that the person is given a sedative to induce a state of semisleep. Behavior therapy, including relaxation training, has also been effective for some people.