Conversion Disorder: Diagnosis and Management
Conversion disorder presents with neurological symptoms that cannot be explained by medical conditions, typically worsening with attention and improving with distraction, often developing in the context of injury, illness, or psychological distress. 1
Clinical Features and Presentation
- Conversion disorder manifests with a range of neurological symptoms including motor dysfunction (weakness, abnormal movements), sensory disturbances (numbness), speech difficulties, seizure-like episodes, or autonomic dysfunction 1
- Symptoms typically worsen with attention and improve with distraction, a key diagnostic feature 1, 2
- Symptoms result in significant impairment in psychosocial functioning, affecting relationships, academic performance, or occupational abilities 1
- While often developing in the context of psychological distress, the absence of obvious psychological factors does not rule out the diagnosis 2
Diagnostic Criteria
- Somatic symptoms that are distressing or significantly disrupt daily life 1
- Excessive thoughts, feelings, or behaviors related to the symptoms, including disproportionate concerns about symptom seriousness, persistent anxiety about health, or excessive time devoted to symptoms 1
- Symptoms may not be continuously present but typically persist for more than six months 1
- Comprehensive neurological evaluation is essential to rule out conditions like Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, stroke, metabolic disorders, and inflammatory/infectious conditions 1
Clinical Presentations
- Motor symptoms: weakness, paralysis, abnormal movements, tremor, difficulty walking (astasia-abasia) 1, 3
- Sensory symptoms: numbness, tingling, blindness, deafness 1
- Speech symptoms: aphonia, dysphonia, slurred speech 4
- Seizure-like episodes: non-epileptic seizures with preserved consciousness 1
- Cognitive symptoms: memory difficulties, attention problems, executive dysfunction 5
Treatment Approach
- Psychotherapy, not medication, is the first-line treatment for conversion disorder, as there is no evidence supporting significant benefit from pharmacotherapy specifically for functional symptoms 1, 2
- Cognitive Behavioral Therapy (CBT) has demonstrated benefit for patients with functional neurological symptoms 1, 4
- Clear, empathetic explanation of the diagnosis that acknowledges the involuntary nature of symptoms is crucial for treatment success 1, 2
- For specific symptoms like functional tremor, specialized techniques such as rhythm modification, entrainment, and music incorporation can be effective 6
- Early diagnosis and intervention are essential for better outcomes and to reduce the financial burden on families 7
Treatment Pitfalls to Avoid
- Reinforcing illness behavior through excessive focus on symptoms or providing unnecessary aids 1, 6
- Taking a dismissive approach that fails to acknowledge the involuntary nature of symptoms 1, 6
- Overreliance on pharmacotherapy, which has limited evidence for treating conversion symptoms directly 1, 2
- Excessive use of adaptive equipment, which can hinder rehabilitation progress 6, 2
Prognosis
- Typical course is short, lasting about two weeks, with only 20-25% of patients relapsing in the following year 8
- However, some cases can become chronic, with symptoms persisting for years 8
- Early diagnosis and personalized therapy plans are key to successful outcomes 7
- Patients with conversion disorder may show deficits in learning, memory, executive functions, visuospatial abilities, and attention compared to healthy controls 5