Conversion disorder
Conversion disorder, also referred to as functional neurological symptom disorder, is a condition where psychological stress manifests as physical symptoms without any identifiable physical cause. Typically triggered by severe emotional crises, individuals may experience symptoms such as paralysis, blindness, or uncontrollable movements that mimic physical ailments. The onset of these symptoms is often sudden and can relate to traumatic experiences or even memories of past events. Diagnosing conversion disorder involves ruling out other medical conditions through comprehensive testing.
Despite the lack of physical causes, the symptoms are very real to the individual, and they have no conscious control over them. Treatment options can include counseling, physical therapy, and sometimes innovative approaches like transcranial magnetic stimulation. Most individuals with conversion disorder have a favorable prognosis, with many experiencing spontaneous recovery or gradual improvement, although some may face prolonged symptoms due to delays in treatment or preexisting mental health issues. In certain situations, the disorder can affect multiple individuals in a group under similar stressors, leading to what is known as conversion reaction.
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Conversion disorder
Conversion disorder is also known as functional neurological symptom disorder, and it was once known as hysterical neurosis. It is a medical condition in which mental stress is displayed in physical ways that are outside a person's control. It is often triggered by a severe emotional or mental crisis that "converts" to a physical problem. For example, a person who witnesses a traumatic accident may suddenly become blind. The condition has no physical cause—for instance, there is no actual damage to the eyes—but the psychological stress of what happened is so great that it causes the nerves to react as if there is some physical problem, resulting in symptoms similar to those present with physical damage. The condition usually affects one person at a time but groups of people can suffer from conversion disorder too. This condition is known as conversion reaction, sometimes called mass hysteria. Conversion disorder can be treated and cured. The prognosis depends on the person and the physical and mental state that was present before the disorder emerged.
Background
The symptoms of conversion disorder vary depending on the area of the body that is affected. In general, the person will have a physical health problem that affects one of the senses (sight, hearing, taste, smell, or touch) or the movement of one or more body parts. Such problems can include paralysis, blindness, or another symptom such as uncontrolled movements, diarrhea, numbness in a hand or foot, an inability to speak, or any other physical malfunction that has no discernible physical cause.
Most of the time, the onset of these symptoms is sudden and can eventually be traced to some traumatic or upsetting experience. This experience need not be recent, as conversion disorder can be triggered by remembering a past event. For instance, a woman who was molested as a child may hear a news story about another child's molestation and develop a facial tic or numbness when she recalls her own helplessness.
In some instances, a person will be affected with a more intermittent form of conversion disorder. For example, a person who is afraid of public speaking may experience severe stomach cramps and diarrhea whenever a speech must be made but appear fine afterwards. The stomach problems are not brought on by any physical problem, such as a virus or food poisoning, but rather by stress that the body has converted to a physical symptom.
The clearest sign that a physical problem is the result of conversion disorder is its sudden onset. For instance, it is likely to be conversion disorder if someone who is going skydiving suddenly develops numbness in both legs after witnessing another skydiver have a rough landing. In this case, the mind is attempting to protect the person from experiencing the rough landing that is now feared. Other signs of conversion disorder include a history of a psychological problem that resolves once the physical symptom appears to prevent the person from facing the source of the fear or stress and a lack of concern or even a feeling of relief that the symptom has occurred (as in the would-be skydiver seeming unconcerned about the numbness).
Conversion disorder is diagnosed when a physician rules out all physical causes for the symptoms. A person who becomes blind after seeing a traumatic accident will have a full range of tests and imaging done on the brain and eyes, for instance. Once these tests have ruled out any physiological cause for the condition, the doctor will diagnose the condition as conversion disorder.
Overview
Despite the fact that patients with conversion disorder experience no physical cause for their symptoms, it is not appropriate to say the problem is "all in the head" or that the condition is not real. The stress or shock that the person has experienced triggers the nerves to react as if there is a real trauma and send signals to the affected body part that cause it to malfunction. The person does not have conscious control over this and cannot will it to stop.
Some cases of conversion disorder resolve as spontaneously as they began. This can happen when the person realizes or is helped to realize that the source of stress or fear is not as intimidating as it once seemed. For example, a person who is very intimidated by meeting an expert in his or her field may suddenly become unable to speak. If the person subsequently hears the expert make a mistake, however, the person may realize that the expert is not as formidable as once thought and recover the ability to speak. Other patients may find that their symptoms resolve after they perform the activity that they were afraid of several times. For example, the person afraid of public speaking may not experience stomach upset anymore after he or she has given several speeches. In some instances, merely assuring the person that the health condition is not serious will be enough to resolve the problem.
In other cases, patients may need more help to recover from conversion disorder. This might involve counseling and/or behavioral training to help in dealing with the disorder trigger, physical therapy to help retrain the body part to respond to normal nerve impulses, and treatment for stress. Physicians may also attempt transcranial magnetic stimulation (TMS), a procedure that uses a magnetic coil to send small electrical impulses into the brain to "reset" the affected nerves.
The outcome for most patients with conversion disorder is good. As noted, some cases will resolve spontaneously, while others will gradually improve and disappear in the course of a few days or weeks. In either event, the condition is not usually life-threatening, but it does affect a person's quality of life.
Some factors that can prolong a bout of conversion disorder include delays in treatment that allow the symptoms to become more established as habits or preexisting mental conditions. In some cases where a person already has a mental health disorder, converted symptoms will come on more slowly over time. These are generally harder to resolve.
When groups of people are under similar stresses and one begins to experience some conversion disorder symptoms, others in the group may subconsciously notice the condition and develop similar symptoms. For instance, if a group of students and their teacher are involved in a standardized testing procedure that requires good scores from all, the shared pressure may result in a version of conversion disorder known as conversion reaction. Symptoms, treatment, and prognosis for conversion reaction are similar to those of conversion disorder.
Bibliography
"Conversion Disorder." Genetic and Rare Diseases Information Center, 25 June 2016, rarediseases.info.nih.gov/diseases/6191/conversion-disorder. Accessed 31 Mar. 2017.
"Conversion Disorder." Harvard Health Publications, Harvard Medical School, Mar. 2013, www.health.harvard.edu/mind-and-mood/conversion-disorder. Accessed 31 Mar. 2017.
"Conversion Disorder." Mayo Clinic, www.mayoclinic.org/diseases-conditions/conversion-disorder/basics/definition/con-20029533. Accessed 31 Mar. 2017.
"Conversion Disorder." MedlinePlus, 31 Oct. 2014, medlineplus.gov/ency/article/000954.htm. Accessed 31 Mar. 2017.
Dicou, Natalie, and Julie Kiefer. "Conversion Disorder: Mind over Matter." University of Utah Healthcare, 27 Oct. 2016, healthcare.utah.edu/healthfeed/postings/2016/10/conversion‗disorder.php. Accessed 31 Mar. 2017.
Dimsdale, Joel E. "Conversion Disorder." Merck Manual, www.merckmanuals.com/home/mental-health-disorders/somatic-symptom-and-related-disorders/conversion-disorder. Accessed 31 Mar. 2017.
Gupta, Sanjay, and Elizabeth Cohen. "Taking the Mystery Out of Conversion Disorder." CNN, 4 Feb. 2012, thechart.blogs.cnn.com/2012/02/04/taking-the-mystery-out-of-conversion-disorder/. Accessed 31 Mar. 2017.
Stonnington, Cynthia M., et al. "Conversion Disorder." American Journal of Psychiatry, Aug. 2006, ajp.psychiatryonline.org/doi/full/10.1176/ajp.2006.163.9.1510. Accessed 31 Mar. 2017.