What is the treatment for conversion disorder in adults?

Treatment of Conversion Disorder in Adults

The primary treatment for conversion disorder in adults is cognitive behavioral therapy (CBT), delivered alongside a candid but empathetic discussion of the diagnosis that acknowledges the involuntary nature of symptoms. 1

Initial Management: Delivering the Diagnosis

The first critical step is making a positive diagnosis and explaining it appropriately to the patient:

• Provide a clear but sympathetic explanation that acknowledges the involuntary nature of the attacks, avoiding any implication of malingering or fabrication 1, 2, 3
• Explain that physical symptoms have a psychological cause using a benign explanatory model that the patient can accept 2
• Avoid confrontation with the patient about the psychological nature of symptoms 2
• Review all test results and examinations with the patient, creating an explicit expectation of recovery 2
• Consider combined consultation (medicine and psychiatry) to help patients accept the diagnosis and transition to psychological treatment 3

Critical pitfall: Never trivialize or reinforce the symptoms, and avoid suggesting the patient is "faking" or that symptoms are "all in their head" 2, 3

Primary Treatment: Psychotherapy

Cognitive Behavioral Therapy (First-Line)

CBT is the psychological treatment of choice for conversion disorder, though the evidence base is limited 1, 4:

• CBT should include cognitive restructuring to address dysfunctional beliefs about symptoms 4
• For trauma-related conversion disorder, imaginal exposure to trauma memories combined with cognitive restructuring can be highly effective 4
• Treatment requires patience and open-mindedness to motivate patients to recognize the value of psychotherapy 3

Psychodynamic Psychotherapy (Alternative Approach)

For patients with adequate capacity to engage in the therapeutic process:

• Psychodynamic psychotherapy addresses the subjective suffering symbolized by symptoms rather than consciously recognized 5
• This approach is particularly relevant for patients with childhood trauma, alexithymia, or difficulty recognizing emotional states 5
• Identify patients who might benefit by assessing their capacity for psychological insight and engagement 5

Behavioral Therapy Strategies

For chronic or resistant symptoms, especially with significant secondary gain:

• Use behavior therapy reinforcement techniques to reward symptom-free periods 2
• Employ double-bind psychotherapy strategies for more resistant cases 2
• Avoid reinforcing illness behavior while maintaining therapeutic alliance 2

Role of Pharmacotherapy

There are no data supporting significant benefit from pharmacotherapy for conversion disorder itself 1:

• Medications should only target comorbid conditions such as depression or anxiety 5
• Psychotherapy remains the primary effective treatment even when medications are used for comorbidities 5

Long-Term Management and Coordination

Successful treatment requires sustained coordination:

• Long-term intervention is frequently necessary, requiring coordination between specialists and general practitioners 3
• Evaluate the patient's emotional adjustment and refer for ongoing psychotherapy when possible 2
• Maintain therapeutic relationship while avoiding excessive medical investigations that reinforce symptom focus 2, 3

Evidence Quality Considerations

The evidence base for conversion disorder treatment is notably weak. A Cochrane review identified only three small randomized trials (total n=119) of poor methodological quality, making it impossible to draw firm conclusions about benefits or harms of specific psychosocial interventions 6. Despite this limitation, there is clinical consensus favoring a positive role for psychotherapy, particularly CBT, based on case studies and clinical experience 1, 3, 4.