What is conversion disorder and how is it treated?

Conversion Disorder: Diagnosis and Treatment

Conversion disorder is a psychiatric condition characterized by neurological symptoms that cannot be explained by medical pathology, is not intentionally produced for material gain, and causes significant distress or impairment. 1 It is not an organic mental disorder, and neither aversion therapy nor sensitization are appropriate treatments.

Diagnostic Characteristics

• Conversion disorder (now called Functional Neurological Symptom Disorder in DSM-5) presents with:

  • Neurological symptoms without identifiable medical cause
  • Involuntary symptoms that are not consciously fabricated
  • Symptoms causing genuine distress and dysfunction
  • No association with material gain (unlike malingering)
  • Often vague, poorly described complaints that fluctuate with activity or stress 1

• Epidemiology:

  • More common in females
  • Often affects young adults, though can occur in children
  • May have history of physical or sexual abuse
  • Often comorbid with other psychiatric conditions
  • May occur after injury, illness, or psychological stress 1

Treatment Approach

• Cognitive behavioral therapy (CBT) is the first-line treatment for conversion disorder, not aversion therapy or sensitization 1

• Effective therapeutic communication strategies include:

  • Clear but sympathetic explanation of the diagnosis
  • Acknowledging the involuntary nature of symptoms
  • Creating an expectation of recovery
  • Avoiding confrontation or suggesting symptoms are "made up" 1, 2

• Psychotherapy approaches:

  • CBT helps patients understand connections between psychological factors and physical symptoms
  • Addresses underlying psychological conflicts
  • Provides coping strategies for symptom management 1, 3
  • Behavior therapy reinforcement may be helpful for chronic or resistant symptoms 2

• Pharmacotherapy:

  • Has not shown significant benefit in treating conversion disorder
  • Medication may be used to treat comorbid conditions like depression or anxiety 1

Important Clinical Considerations

• Differential diagnosis is crucial:

  • A thorough neurological evaluation is essential to rule out organic causes
  • Important conditions to exclude: neurological disorders, stroke/TIA, seizure disorders, Guillain-Barré syndrome 1

• Prognosis factors:

  • 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 1

• Common pitfalls:

  • Misdiagnosing organic disease as conversion disorder (though uncommon)
  • Confrontational approaches that suggest the patient is "faking" symptoms
  • Failing to address underlying psychological stressors
  • Reinforcing symptoms through excessive medical attention 2, 4

The biopsychosocial model is the prevailing framework for understanding and treating conversion disorder, with psychotherapy as the cornerstone of treatment 3. While the exact psychological mechanisms remain under investigation, the diagnosis is made based on positive clinical signs and the exclusion of organic pathology 4.