Compiled by Paul John P. Lanic
University of Santo Tomas
The conversion disorder is a somatoform disorder characterized by the ‘conversion’ of a person’s psychic conflict into somatic form (Reber, Allen & Reber, 2009). The symptoms of the conversion disorder can vary widely: blindness, deafness, paralysis, seizures, mutism, loss of balance, anaesthesia and other somatoform dysfunctions.
The functional disorder may appear superficially to have physical or physiological cause but frequently follows no known organic system. However, the symptoms of the conversion are not feigned and are not under conscious control. Before, the conversion disorder is known as conversion reaction, conversion hysteria, and hysterical neurosis – conversion type.
The conversion disorder is subjected to change in the DSM-5. The focus of the principal diagnostic criteria for conversion disorder in the DSM-5 will be the ruling out of the medical causes of the symptoms which are crucial in making diagnosis of conversion.
Essential Features of the Conversion Disorder
Conversion disorder is characterized by the occurrence of certain signs or symptoms that are clearly inconsistent with what is known about anatomy and pathophysiology. For example, the patient may complain of blindness, yet cortical visual evoked potentials are normal. Most patients that complain about a disorder are found to have symptoms of conversion. This conversion is basically the transformation of stress and other negative energies into physical form. Another essential feature of the conversion disorder is the la belle indifference.
La belle indifference is the French term for ‘sublime indifference’. It is a psychiatric condition wherein the patient showing conversion symptoms seems to be inappropriately unconcerned with his disabilities. A person with organic disorder shows anxiety and concern with his disabilities but a person with conversion does not.
Symptoms of Conversion Disorder
a. Motor Symptoms
i. Paralysis – Any partial or complete loss of some bodily function; figuratively, it means loss of sensory and motor function and even a crippling, loss of effectiveness or cognitive processes.
- Spastic Paralysis – involves organic damage to the upper motor neurons thus the loss of control over musculature with tremors or spasms.
- Flaccid Paralysis – involves lesions in the lower motor neurons thus there is a loss of voluntary control and no movement.
- Hemiplegia – paralysis to one side of the body; usually the result of damage to the Primary Motor Cortex accompanied by lesions in the basal ganglia (Reber et al., 2009)
ii. Astasia-Abasia – inability to sit upright or to stand (astasia) and inability to walk (abasia); both owing to impairment in motor coordination.
iii. Convulsions (pseudoconvulsions) and seizures (pseudoseizures) – conversion seizures are relatively common form of conversion symptom which resembles epileptic seizures but modern medical technology can differentiate one from the other. In patients with epilepsy, they may show confusion, loss of memory, and the EEG will show abnormalities. At one hand, patients with conversion disorder will show no EEG abnormalities and they may show excessive thrashing about and writhing unseen in true seizures.
iv. Aphonia – inability to produce the voiced speech sounds
v. Globus Hystericus – a feeling of a lump in the throat or illusory lump that actually interferes with swallowing.
vi. Urinary retention
b. Sensory Symptoms
i. Paraesthesia – abnormal skin sensation such as tickling, itching, tingling or burning sensation.
- Ex. Formication – a kind of hallucination wherein one feels that ants or snakes are crawling on or under the skin.
ii. Anaesthesia – any partial or loss of sensitivity.
- Glove anaesthesia – loss of sensitivity in the hand and wrist area.
- Foot, shoe or stocking anaesthesia – syndromes affecting the lower extremities.
iii. Anosmia – deficiency in the sense of smell
iv. Blindness (conversion/functional) – loss of vision in the absence of any known organic dysfunction.
v. Tunnel vision – a condition in which peripheral vision is severely reduced or lacking altogether and a person can only see objects projected onto the central area of the retina.
vi. Deafness (conversion/functional) – loss of hearing in the absence of any known organic dysfunction
vii. Double blindness
c. Other symptoms
B. Prognosis and Development of Conversion Disorder
Conversion disorders occur two to ten times more often in women than in men. It can develop at any age but most commonly occurs between early adolescence and early adulthood (Maldonado & Spiegel, 1998). It generally has a rapid onset after a significant stressor but due to the precipitating factors, its prognosis is good and can be resolved within 2 weeks depending on gravity. Conversion disorder oftentimes occurs along with other major psychological disorders like major depression, anxiety, and somatization and dissociative disorders.
Perspectives in Explaining Conversion Disorder
A. Biological Perspective
Since the functional symptoms of conversion disorder do not show any organic or neurological cause, then it hard to explain the disorder in a biological point of view. However, the biological perspective in analyzing the conversion is helpful in diagnosis. If the conversion symptom of a person has been proven to be of organic origin, then the attending psychologist/psychiatrist may rule-out conversion disorder.
B. Behavioral Perspective
As part of development, conversion symptoms may have arisen as part of learning. In an anxiety-provoking event, patients may have learned to adapt certain behaviors like unconsciousness, paralysis and astasia-abasia to escape anxiety. These maladaptive operant behaviors may have been reinforced by situations wherein they have escaped the anxiety-provoking event, thus they continue using the maladaptive behaviors until it became unconscious and functional.
C. Cognitive Perspective
Different persons interpret anxiety-provoking events differently. So, a highly stressful event to one may not be stressful to others. A person who stresses himself in thinking of his problems may develop certain behaviors unsuitable to solve the problem. However, these persons may not know that their behaviors are unsuitable in solving the problem like being mute or aphonic when being reprimanded.
D. Psychodynamic Perspective
In the psychodynamic perspective, the unconscious mental conflict governs the symptoms. There are two kinds of gains that are gratifying to the patient’s ego, the primary and the secondary gain.
The primary gain of conversion symptoms “buries” the unconscious mental conflict of the patient making him escape or avoid the stressful situations. A painful and unacceptable thought is repressed and is turned inward making the emotional energy converted to a physical symptom. Usually, according to Tomb (2008), conversion symptoms are represented by the conflict symbolically (Ex. A negligent mother of a burned child may develop anaesthesia over corresponding parts of her body.)
A soldier in a battlefield may show conversion symptom like paralysis of the legs. This paralysis enables him to avoid the high-anxiety combat situations without being labeled as a coward or being court-martialed. At one hand, the secondary gain of conversion symptoms is the rewarding feeling of the patient. The symptoms make the patient get things that the he needs or wants.
Individual psychology would explain conversion symptoms as “organ dialects”. These are repressed emotions that are unconsciously and symbolically represented or uttered by different body organs.
E. Sociocultural Perspective
According to Owens & Dein (2006), the sociocultural formulations of conversion disorder observe that in some cultures the direct expression of intense emotions is prohibited. This may predispose people to exhibit conversion symptoms as a more acceptable form of communication. Conversion disorder would thus represent non-verbal communication of a forbidden idea or feelings. Such prohibitions can be reinforced by gender roles, religious beliefs and sociocultural influences (Schwartz et al., 2001). The expression of intense emotions in culturally defined rituals can be part of the healing process.
F. Family-Systems Perspective
The first person to notice changes in a person’s behavior is his family. However, oftentimes, the family members themselves are the ones causing the change in behavior. Some conservative family would restrict expression of emotions and feelings thus may cause an inward movement of emotional energies.
According to the psychodynamic social theory, emotional problems are developed due to weak parent-child relationships. An uncaring parent may predispose a child to behave in ways abnormal. Due to the basic anxiety, children of uncaring parents may harbor deeply-seated resentments and hostility. However, these children would repress the emotion due to fear of losing their thus may resort to the unconscious conversion of repressed emotional energies to physical abnormality.
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DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (2002). American Psychiatric Association.
Maldonado, J. R., Butler, L. D., & Spiegel, D. (1998). Treatments for dissociative disorders. In P. E. Nathan & J. M. Gordon (Eds.). A Guide to Treatments that Work. New York: Oxford University Press.
Owens, C., & Dein, S. (2006). Conversion disorder: The modern hysteria. Advances in Psychiatric Treatment, 12, 152-157.
Reber, A. S., Allen, R., & Reber, E. S. (2009). Penguin dictionary of psychology. (4th ed.). London, England: Penguin Books Ltd.
Schwartz, A., Calhoun, A., Eschbich, C., et al (2001) Treatment of conversion disorder in an African American Christian woman: cultural and social considerations. American Journal of Psychiatry, 158, 1385–1391.