Conversion Disorder: Characteristics and Treatment Approaches
Conversion disorder (functional neurological symptom disorder) is a psychiatric condition characterized by neurological symptoms that cannot be explained by medical pathology, is not intentionally produced for material gain, and is best treated with cognitive behavioral therapy rather than medications like clonidine or aversion therapy.
Definition and Diagnostic Features
Conversion disorder is classified in the DSM-5 as a functional neurological symptom disorder characterized by:
- Neurological symptoms affecting voluntary motor or sensory function
- Clinical findings that are incompatible with recognized neurological conditions
- Symptoms not better explained by another medical or mental disorder
- Symptoms causing clinically significant distress or impairment
- Symptoms not intentionally produced (unlike factitious disorder or malingering) 1
Key distinguishing features:
- Not for material gain: Unlike malingering, conversion disorder symptoms are not associated with material gain 1
- Not intentionally produced: Symptoms are not consciously fabricated 1
- Significant functional impairment: Symptoms cause real distress and dysfunction 1
Clinical Presentation
Common manifestations include:
- Neurological symptoms (paralysis, weakness, abnormal movements)
- Sensory disturbances (numbness, blindness, deafness)
- Psychogenic non-epileptic seizures
- Gait disturbances (astasia-abasia)
- Speech difficulties 2
Patients often present with:
- Vague, poorly described complaints
- Recent or current stressful events
- Symptoms that fluctuate with activity or stress
- Lack of physical findings or laboratory abnormalities 1
Epidemiology and Risk Factors
- More common in females
- Often young adults, though can occur in children
- History of physical or sexual abuse may be present
- May have comorbid psychiatric conditions
- Often occurs after injury, illness, or psychological stress 1, 3
Treatment Approaches
First-line Treatment: Psychotherapy
Cognitive behavioral therapy (CBT) is the recommended first-line treatment for conversion disorder, showing benefit in multiple studies 1:
- Helps patients understand the connection between psychological factors and physical symptoms
- Addresses underlying psychological conflicts
- Provides coping strategies for symptom management
- May produce a non-statistically significant trend toward improvement at 3 months 1
Communication Approach
A therapeutic communication strategy is important:
- Clear but sympathetic explanation of the diagnosis
- Acknowledgment of the involuntary nature of symptoms
- Creating an expectation of recovery
- Avoiding confrontation or suggesting symptoms are "made up" 1, 4
Multidisciplinary Management
An effective treatment plan often includes:
- Psychiatric evaluation and therapy
- Physical therapy when motor symptoms are present
- Patient education using a non-stigmatizing explanatory model
- Addressing comorbid psychiatric conditions 2
What Doesn't Work
Pharmacotherapy has not shown significant benefit in treating conversion disorder 1:
- Clonidine is NOT the treatment of choice for conversion disorder
- Aversion therapy is NOT a recommended treatment modality as it can worsen symptoms and damage therapeutic alliance
- Medications may be used for comorbid conditions (anxiety, depression) but not for the conversion symptoms themselves
Prognosis
Prognosis varies based on:
- Duration of symptoms before treatment
- Presence of comorbid psychiatric conditions
- Quality of therapeutic relationship
- Patient's insight into psychological factors
- Early intervention generally leads to better outcomes 5
Differential Diagnosis
Important conditions to rule out include:
- Neurological disorders (multiple sclerosis, myasthenia gravis)
- Stroke or TIA
- Seizure disorders
- Guillain-Barré syndrome
- Functional disorders with organic basis 1
Thorough neurological evaluation is essential to rule out organic causes before confirming a diagnosis of conversion disorder.