From the Guidelines
Conversion disorder, now known as functional neurological symptom disorder, is a condition where patients experience neurological symptoms like paralysis, blindness, or seizures that cannot be explained by medical conditions, and the most effective treatment approach involves a multidisciplinary strategy combining psychotherapy, physical therapy, and addressing underlying psychological factors, as recommended by the most recent consensus guidelines 1. The condition typically develops in response to psychological stress or trauma, with the brain essentially converting emotional distress into physical symptoms.
- Treatment involves a combination of:
- Psychotherapy, particularly cognitive behavioral therapy (CBT), which can aid in treating functional movement disorders and dissociative seizures, and help patients notice and challenge unhelpful thoughts 1.
- Physical therapy to address physical symptoms and improve functioning.
- Addressing underlying psychological factors, such as anxiety, depression, or trauma, which can contribute to the development and maintenance of symptoms.
- Antidepressants or anti-anxiety medications may help manage associated symptoms but are not the primary treatment.
- Early diagnosis and explanation to patients that their symptoms are real but not caused by structural damage is crucial for recovery, as it helps to reduce anxiety and improve treatment outcomes.
- The condition is not "all in the head" but represents a genuine disruption in how the brain processes sensory information and controls bodily functions, and most patients improve with appropriate treatment, though some may experience chronic or recurring symptoms, especially without proper psychological support.
- A recent study published in the Journal of Neurology, Neurosurgery and Psychiatry provides consensus recommendations for speech and language therapy in the management of functional communication, swallowing, cough, and related disorders, which can be applied to the treatment of conversion disorder 1.
From the Research
Definition and Diagnosis of Conversion Disorder
- Conversion disorder is characterized by the development of symptoms of neurological disease with no organic basis, making it a challenge for mental health professionals to diagnose and treat effectively 2.
- The diagnosis of conversion disorder requires a thorough understanding of the patient's symptoms and medical history, as well as the exclusion of other potential causes of the symptoms 3, 4.
Treatment of Conversion Disorder
- Psychotherapy is considered the primary effective treatment for patients with conversion disorder, particularly those with adequate capacity to engage in the process 2, 3.
- A combination of antidepressants, psychotherapy, and a multidisciplinary approach to rehabilitation may be beneficial in treating conversion disorder 3.
- Cognitive behavioral therapy (CBT) has also been shown to be effective in treating conversion disorder, particularly in cases where the patient has a history of traumatic events 5.
- Coordination between specialists and general practitioners is an important part of the treatment, which frequently requires long-term intervention 4.
Etiology and Prevalence of Conversion Disorder
- Conversion disorder has a history that may reach back into antiquity, and it continues to present a clinical challenge to both psychiatrists and neurologists 3.
- The etiology of conversion disorder is not fully understood, but it is thought to be related to a combination of psychological, social, and biological factors 6.
- The prevalence of conversion disorder is not well established, but it is thought to be relatively rare 3, 6.
Neurobiological Understanding of Conversion Disorder
- Recent advancements in neuropsychology and brain imaging have led to a greater understanding of the neuroscientific psychopathology of conversion disorder 6.
- The available evidence suggests that conversion disorder is associated with abnormalities in neural circuits, particularly those involved in emotion regulation and motor control 6.