What is the treatment for conversion disorder?

Treatment of Conversion Disorder

Psychotherapy, specifically Cognitive Behavioral Therapy (CBT), is the first-line treatment for conversion disorder, as there is no evidence supporting significant benefit from pharmacotherapy specifically for functional symptoms. 1, 2

Diagnosis and Initial Approach

• Conversion disorder presents with neurological symptoms (motor, sensory, or autonomic dysfunction) that cannot be explained by medical conditions and typically worsen with attention while improving with distraction 2
• A clear, empathetic explanation of the diagnosis that acknowledges the involuntary nature of symptoms is crucial for treatment success 2, 3
• Avoid both reinforcing illness behavior through excessive focus on symptoms and taking a dismissive approach that fails to acknowledge the genuine nature of symptoms 2

Psychotherapeutic Interventions

Cognitive Behavioral Therapy (CBT)

• CBT has shown the most benefit for patients with functional neurological symptoms 2
• A typical course of CBT comprises 12-22 sessions, occurring weekly 4
• Key components include:
  • Psychoeducation and formulation (typically sessions 1-3) 4
  • Exposure with response prevention and/or behavioral experiments (typically from session 4 onwards) 4
  • Relapse prevention (final sessions) 4

Behavioral Approaches

• Operant behavioral treatment has shown effectiveness in resolving conversion symptoms, with a strong correlation between symptom duration and treatment time required 5
• Behavioral management includes providing a benign explanatory model of symptoms and creating an expectation of recovery 6
• For functional tremor specifically, rhythm modification techniques and entrainment can be effective 3

Other Psychotherapeutic Approaches

• Motivational interviewing techniques are often helpful, especially at the start of therapy to increase engagement 4
• Psychodynamic therapy may be beneficial for patients with adequate capacity to engage in the process, particularly when addressing underlying psychological factors 7

Multidisciplinary Management

• Physical therapy is a key component of treatment, especially for motor symptoms 8
• Collaboration between healthcare professionals should be coordinated, preferably by the patient's primary care physician 8
• Minimize the use of adaptive equipment, as aids are generally unhelpful in the rehabilitation process for functional disorders 1, 3

Role of Medication

• Unlike other conditions, there is no evidence supporting significant benefit from pharmacotherapy specifically for conversion symptoms 1, 2
• Medication should be limited to treating comorbid conditions (such as depression or anxiety) rather than targeting conversion symptoms directly 1, 7

Treatment Pitfalls to Avoid

• Reinforcing illness behavior by excessive focus on symptoms or providing unnecessary aids 2, 3
• Taking a dismissive approach that fails to acknowledge the involuntary nature of symptoms 2
• Overreliance on pharmacotherapy, which has limited evidence for treating conversion symptoms directly 2
• Prolonged diagnostic workups that may reinforce the sick role and delay appropriate treatment 6

Prognosis Factors

• Early diagnosis and intervention are essential to lessen the financial burden on families and speed up the recovery process 9
• Longer duration of symptoms correlates with longer treatment time required for symptom resolution 5