Conversion disorder

Conversion disorders, categorised under the heading of Somatoform Disorders in both DSM IV and ICD 10 have an historical heritage in the classical descriptions of hysteria as presented by, for example, Sigmund Freud. As a group of syndromes they are representative of the combined understanding of brain disorders, once again after decades of a dichotomous approach to the brain in medicine, being treated by the subspecialty of Neuropsychiatry. more...

A Conversion disorder manifests itself in many different ways. Conversion disorders can be triggered by acute psychosocial stress that the individual cannot process psychologically. This overwhelming distress causes the brain to unconsciously disable or impair a bodily function which will relieve or prevent the patient from experiencing this stressor again. Therefore, the psychosocial stress could be seen to be "converted' into a physical symptom. The patient, by definition, is always unaware of this process, and is often not concerned with his deficit - a characteristic feature called 'la belle indifference'.

The possible presentations are endless, often approximating to similar neurological disorders which may include any one or more of the following:

• Paralysis of a limb or the entire body hysterical paralysis or motor conversion disorders
• Impaired hearing or vision
• Loss of sensation
• Impairment or loss of speech - hysterical aphonia
• Psychogenic non-epileptic seizures
• Psychogenic dystonias

It is often very difficult to diagnose these disorders, and it takes careful history taking and observation to rule out the possibility that the patient has a factitious disorder or is malingering or even an unrecognised biological cause. With this illness careful physical and particularly, neurological examination will reveal that there is no or not sufficient organic cause for the disability experienced. When organic disorders have been appropriately investigated and ruled out, the patient is often referred to a therapist for cognitive behavioural therapy to try and break the psychological barriers and cycles of behaviour that the stressors have produced. A multidisciplinary, goal oriented approach to treatment utilising the skills of Neurologists, Psychiatrists, Cognitive Therapists, Physiotherpaists, Occupational Therapists and Nursing staff is the most appropriate (but often unavailable) method of management. Such treatment programmes are exemplified in the UK by the teams at The National Hospital for Neurology & Neurosurgery and The Lishman Unit at The Maudsley Hospital, London.

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