Conversion Disorder: Key Characteristics and Treatment
Primary gain is a typical component of conversion disorder. This is the most accurate statement among the options presented, as conversion disorder involves unconscious psychological processes that provide a primary gain through symptom formation 1.
Understanding Conversion Disorder
Conversion disorder (also called functional neurological symptom disorder in DSM-5) is characterized by:
- Neurological symptoms (such as weakness, abnormal movements, or sensory changes) that cannot be explained by medical conditions
- Symptoms that are not intentionally produced or feigned
- Symptoms that cause significant distress or impairment in functioning
- Symptoms that are not better explained by another medical or mental disorder 1, 2
Key Distinctions
Conversion disorder differs from other conditions in important ways:
Not an organic mental illness: Conversion disorder is classified as a functional disorder, not an organic mental illness. It involves altered brain functioning rather than structural abnormalities 1, 2
Primary gain is central: Primary gain refers to the psychological benefit of converting emotional distress into physical symptoms, which helps the individual avoid conscious awareness of distressing psychological conflicts 3, 4
Different from malingering and factitious disorder: Unlike these conditions, symptoms in conversion disorder are not intentionally produced. There is no conscious intent to deceive 5
Treatment Approaches
The treatment options mentioned in the question can be evaluated as follows:
Systematic desensitization: Not typically used as a primary treatment for conversion disorder
Clozapine: Not indicated for conversion disorder treatment
Aversion therapy: Not recommended for conversion disorder
Instead, evidence-based treatment typically includes:
- Cognitive-behavioral therapy (CBT) - showing promising results 2
- Psychotherapy addressing underlying psychological conflicts 6
- Physical therapy for motor symptoms 5
- Antidepressants when comorbid anxiety or depression is present 5
Diagnostic Considerations
When evaluating for conversion disorder, clinicians should:
- Look for "positive" clinical signs based on symptom incongruence with known neurological conditions 5
- Consider recent stressors, though these are no longer required for diagnosis in DSM-5 2
- Rule out medical conditions that could explain symptoms
- Assess for comorbid psychiatric conditions, which are common
Prognosis
The prognosis for conversion disorder varies:
- Early intervention improves outcomes
- Symptom duration affects prognosis - longer duration often means poorer outcomes 2
- Misdiagnosis rates have decreased significantly, now around 4% 2
Functional neuroimaging has revealed patterns of hypoactivation in brain regions related to specific conversion symptoms, with accompanying activations in limbic, paralimbic, and basal ganglia structures, supporting a neurobiological basis for these symptoms 2.