What is the recommended treatment for conversion disorders?

Treatment of Conversion Disorder

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

Diagnostic Considerations

• Conversion disorder presents with neurological symptoms including motor, sensory, or autonomic dysfunction that cannot be explained by medical conditions 1
• Symptoms typically worsen with attention and improve with distraction, often developing in the context of injury, illness, or psychological distress 1
• Common presentations include weakness, numbness, abnormal movements, speech difficulties, seizure-like episodes, or sensory disturbances 1

Evidence-Based Treatment Approach

First-Line Treatment: Psychotherapy

• Cognitive Behavioral Therapy (CBT) has shown the strongest evidence for treating functional neurological symptoms 1, 2
• A typical course of CBT comprises 12-22 weekly sessions 1
• Key components include:
  • Psychoeducation and formulation 1
  • Exposure with response prevention and/or behavioral experiments 1
  • Relapse prevention strategies 1

Treatment Delivery

• Clear, empathetic explanation of the diagnosis that acknowledges the involuntary nature of symptoms is crucial for treatment success 1, 2
• Motivational interviewing techniques are often helpful, especially at the start of therapy to increase engagement 1
• Behavioral approaches have shown effectiveness in inpatient settings, with studies showing successful resolution of symptoms using operant conditioning techniques 3

Specific Techniques for Different Presentations

• For functional tremor:
  • Rhythm modification techniques (superimposing alternative, voluntary rhythms) 4
  • Entrainment techniques using the unaffected limb to dictate a new rhythm 4
  • Music incorporation to override tremor patterns 4

Multidisciplinary Considerations

• A holistic bio-psycho-social model is beneficial for interpretation and treatment guidance 5
• Combined consultation between medical specialists and psychiatrists can help patients accept the diagnosis and engage in treatment 6
• Coordination between specialists and general practitioners is important, as treatment frequently requires long-term intervention 6

Treatment Pitfalls to Avoid

• Reinforcing illness behavior through excessive focus on symptoms or providing unnecessary aids 1, 2
• Taking a dismissive approach that fails to acknowledge the involuntary nature of symptoms 1, 2
• Overreliance on pharmacotherapy, which has limited evidence for treating conversion symptoms directly 1, 2
• Delaying treatment, as symptom longevity can negatively influence outcomes 7

Prognosis

• Studies show that the rate of misdiagnosis has declined significantly since the 1970s and is now around 4% 7
• Early intervention is associated with better outcomes, with a strong positive correlation between duration of conversion symptoms and the time required to resolve them 3
• Behavioral treatment approaches have shown clinically significant long-lasting resolution of symptoms in follow-up studies 3