Conversion disorder is a mental illness characterized by the loss or alteration of physical functioning without any physiological reason. These physical symptoms are the result of emotional conflicts or needs. The symptoms usually appear suddenly and at times of extreme psychological stress. A lack of concern over the debilitating symptoms (la belle indifference), which commonly accompanies this illness, may be a clue to distinguishing it from the physiological disorder it may mimic.
Patients with conversion disorder usually exhibit one symptom only. However, if episodes reoccur, the symptom may reappear but in a different location or intensity.
The most common symptoms of conversion disorder are similar to those associated with neurological disease. These include paralysis, loss of voice (aphonia), disturbances in coordination, impaired or jerky movements, temporary blindness, tunnel vision, loss of the sense of smell (anosmia) or touch (anesthesia), or a tingling sensation to the skin (paranesthesia).
Conversion disorder is suspected if the onset of the debilitating symptom is sudden, if a recent psychological conflict is resolved as a consequence of the onset of the symptom, and if the patient demonstrates a lack of appropriate concern in facing a serious symptom.
Some psychiatrists and/or psychotherapists believe that the symptoms of conversion disorder may be symbolic resolutions of psychological conflicts. For example, in some cases vomiting may represent revulsion and disgust, or blindness may represent the inability to accept the witnessing of a traumatic event. It is important that physiological diseases be ruled out before a diagnosis of conversion disorder is made.
Conversion disorder is thought to be caused by an “internal” conflict that creates extreme psychological stress. Conversion symptoms represent a partial solution to a conflict. A soldier who subconsciously wishes to avoid firing a gun or who may be frightened but ashamed or afraid of showing it, may develop a paralyzed hand. A person who wishes to prevent desertion by a spouse may suddenly exhibit paralysis. In each case the cause is psychological rather than physical.
The onset of symptoms of a conversion disorder is usually sudden and they disappear just as suddenly. Other disorders must be ruled out since the symptoms of many neurological diseases may wax and wane without apparent reason, and in this way mimic those of conversion disorder.
True conversion disorder is thought to be rare, with reports of an incidence rate of 14-22 cases per 100,000 population. It may be more common in rural settings, and/or among poorer people and/or among military personnel. The comparative incidence among men and women is not known. Some scientists believe it occurs significantly more often among females than among males, but this is not generally concurred upon at this time. Conversion disorder sometimes occurs among children but is more common among adolescents and young adults.
Treatment of conversion disorder varies with the individual. Psychotherapy, individual, for couples or family may be helpful. In some instances specific life changes, such as a job change or homemaking assistance, may be all that is needed. Hypnosis may remove specific symptoms, but a substitute symptom often arises. Certain symptoms may disappear with the use of antidepressant and antipsychotic drugs.
Conversion disorder manifest as temporary paralysis may be treated by electromyographic (EMG) biofeedback.
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