Conversion Disorder

[David Baxter PhD]

Conversion disorder
By Mayo Clinic Staff
Feb. 6, 2009

Conversion disorder is a condition in which you show psychological stress in physical ways. Conversion disorder usually appears suddenly after a stressful event. For example, your leg may become paralyzed after falling from a horse even though you weren't hurt. Conversion disorder signs and symptoms appear with no underlying physical cause, and you can't control them.

Signs and symptoms of conversion disorder typically affect your movement or your senses, such as the ability to walk, swallow, see or hear. Conversion disorder symptoms can be severe, but for most people, they get better within a few weeks.

Symptoms
Conversion disorder symptoms usually appear suddenly after a stressful event. Common symptoms can include:

• Poor coordination or balance
• Paralysis in an arm or leg
• Difficulty swallowing or "a lump in the throat"
• Inability to speak
• Impaired vision, including double vision and blindness
• Deafness
• Seizures or convulsions

Other conversion disorder symptoms include:

• Loss of balance
• Numbness or loss of the touch sensation
• Inability to feel pain
• Hallucinations
• Difficulty with walking
• Urinary retention

When to see a doctor
It's best to seek medical attention as soon as you notice symptoms that might be caused by conversion disorder. If the underlying cause of your signs and symptoms is actually caused by something physical, quick diagnosis and treatment may be important. If the diagnosis is conversion disorder, then psychological help may improve the symptoms and prevent future episodes.

Causes
Episodes of conversion disorder are nearly always triggered by a stressful event, an emotional conflict or another mental health disorder, such as depression.

The exact cause of conversion disorder is unknown, although researchers think the part of the brain that controls your muscles and senses may be involved. It may be the brain's way of coping with something that seems like a threat.

Risk factors
Conversion disorder risk factors include:

• Recent significant stress or emotional trauma
• Being female ? women are much more likely to get conversion disorder than are men
• Being an adolescent or young adult ? conversion disorder can occur at any age, but it's most common during adolescence or early adulthood
• Having a mental health condition such as mood and anxiety disorders, dissociative disorder and certain personality disorders
• Having a family member with conversion disorder
• A history of physical or sexual abuse
• Economic hardship

Complications
For most people, symptoms of conversion disorder get better with nothing more than reassurance that they don't have a serious health problem. However, up to one in four people may show new conversion symptoms later on. You may be more likely to have long-lasting symptoms or develop new conversion disorder symptoms if:

• You delay seeking treatment
• Your symptoms aren't clearly linked to stress
• Your symptoms come on slowly, or don't improve quickly
• You have more-serious psychiatric conditions along with conversion disorder
• You have tremors or seizures not caused by epilepsy

Rarely, a person with a neurological condition will also develop symptoms of conversion disorder.

Preparing for your appointment
You're likely to start by first seeing your family doctor or a general practitioner. Generally, if a clear diagnosis can't be made by your family doctor, you'll be referred to a neurologist or psychiatrist. In some cases both a neurologist and a psychiatrist are needed to rule out an underlying neurological condition and to verify that it is indeed conversion disorder ? and not another psychological condition.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. Some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Are there other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Do you use drugs or drink alcohol?

Tests and diagnosis
To be diagnosed with conversion disorder, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment. For you to be diagnosed with conversion disorder:

• You must have one or more symptoms you can't control that affect movement of part of your body or your senses. These symptoms must seem like they could be caused by a neurological or other medical condition.
• Your symptoms must have occurred after a stressful event.
• You don't produce symptoms intentionally.
• Your symptoms aren't fully explained by a general medical condition, drug use or a culturally accepted behavior, such as experiencing visions at a religious ritual.
• Your symptoms must cause significant distress or impairment in social, work or other settings.
• Your symptoms aren't limited to pain or sexual problems, and aren't better accounted for by another mental disorder.

There are no standard tests to check for conversion disorder. The tests your doctor uses will depend on what kind of signs and symptoms you have. They may include:

• Simple bedside tests. Your doctor checks for normal reflexes to help rule out a physical cause for your signs and symptoms. These tests don't require any specialized equipment and are quick and painless. The exact tests your doctor does depends on your signs and symptoms.
• X-rays or other imaging tests. These tests may help your doctor confirm that your symptoms aren't caused by an injury or neurological or other physical conditions that might cause similar symptoms.
• An electroencephalogram (EEG) scan. Your doctor uses EEG because it can help rule out a neurological cause of seizure symptoms. This test is a painless procedure to detect electrical activity in your brain. It's used to test for epilepsy and other brain disorders.

Diagnosis can be tricky because a doctor must rule out medical conditions with a physical cause. Conversion disorder can mimic a number of other health problems, including:

• Myasthenia gravis ? a muscle weakness disorder
• Neurological disorders such as multiple sclerosis, Parkinson's disease and epilepsy
• Stroke
• Lupus
• Spinal cord injury
• HIV/AIDS

Treatments and drugs
For many people, symptoms of conversion disorder get better without treatment, especially after reassurance from the doctor that their symptoms aren't caused by a serious underlying problem.

You may benefit from treatment if you have conversion disorder signs and symptoms that linger or keep coming back, you have severe symptoms, or you have other mental or physical health conditions. Treatment will depend on your particular signs and symptoms and may include:

• Counseling (psychotherapy). Seeing a psychologist or professional counselor can help treat symptoms of conversion disorder and prevent it from coming back. This can be especially helpful if you have anxiety, a mood disorder such as depression or other mental health issues.
• Physical therapy. Working with a physical therapist may prevent complications of certain symptoms of conversion disorder. For example, regular movement of arms or legs may ward off muscle tightness and weakness if you have paralysis or loss of mobility.
• Treating related stress and other conditions. Conversion disorder may improve when you get treatment for stress, anxiety or another underlying problem. Your doctor may prescribe a sedative or anti-anxiety medication, such as a benzodiazepine (Valium, Xanax, Ativan), or a beta blocker, such as nadolol (Corgard) or atenolol (Tenormin). If you have depression, your doctor may prescribe a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine (Prozac), or another type of antidepressant medication.
• Hypnosis. Undergoing hypnosis with a trained expert may help a person identify and resolve psychological issues. Hypnosis is usually done along with another form of psychotherapy in treating conversion disorder.
• Transcranial magnetic stimulation. Some reports have shown that people with conversion disorder may benefit from this type of treatment, which involves exciting brain activity by using weak electrical currents. This stimulation is believed to alter the brain's biochemistry and can improve symptoms of various mental disorders.

Prevention
Conversion disorder is triggered by a reaction to some kind of stress. Stress-relieving activities such as meditation and yoga may help reduce reactions to the events that prompt symptoms of conversion disorder.

If you have other mental health conditions, make sure you're getting the right treatment. Treatment may include counseling and medications.

 

[Jazzey]

I had a very stressful week this week. Funnily enough (or not), I've again lost all feeling or function in my left hand and arm, my neck is frozen and, my sense of balance just plain stinks...I'm now a little granny hanging on to walls and/ or rails to get around.

It made me think of this article that you posted Dr. Baxter. My psychologist this week also alluded to my physical condition being more symptomatic of conversion (I've already been checked out several times by doctors and specialists).

I've found that going and doing something physically active, something that gets the heart rate up, really helps me to set aside these episodes.

 

[ladylore]

The more stress I am under the worse my physicality gets. There was a point about 5 years ago that my neck would go into severe spasms - they hurt like hell and I couldn't move my neck at all. All because of added stress.

 

[Jazzey]

There was a point about 5 years ago that my neck would go into severe spasms - they hurt like hell and I couldn't move my neck at all

Bingo! That's exactly where I am LL If it weren't so painful, I'd actually find it comical - it's frozen to the left - makes driving a real interesting little *thing* for me.

 

[forgetmenot]

I can relate sometimes my back feels like it is breaking or has been hit by a transport truck. All test show nothing. Pain medication doesn't help only with decrease stress does the pain decrease. My doctor also feels perhaps stress is the cause.