What Is Conversion Disorder (Functional Neurological Symptom Disorder)?

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What Is Conversion Disorder?

Conversion disorder (also known as functional neurological symptom disorder) is a psychological condition that causes symptoms that appear to be neurological, such as paralysis, speech impairment, or tremors, but with no organic or biochemical causes. In the past, these events were often referred to as "hysterical blindness" or "hysterical paralysis."

Conversion disorder is a relatively rare mental illness, with fewer than 25 cases reported in a population of 100,000, according to the National Organization for Rare Diseases. It is categorized as a type of somatoform disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the leading diagnostic guide for the mental health profession.

Understanding the medical definition of conversion disorder is the first step toward getting help for yourself or someone you love.

Symptoms

There's typically a sudden onset of symptoms that affect voluntary motor or sensory function—and these symptoms can disappear just as suddenly, without any physiological reason. 

The physical symptoms of conversion disorder are often described as your body's way of dealing with unresolved stress or unexpressed emotions that triggered the disorder. In other words, the physical symptoms distract the person from the emotional duress. Conversion disorder typically affects movement function as well as the senses.

Symptoms of conversion disorder can be about any neurological deficit imaginable, including:

  • Abnormal walking or tremors
  • Blindness or double vision
  • Deafness or problems hearing
  • Disturbances in coordination
  • Episode of unresponsiveness
  • Loss of balance
  • Loss of the sense of smell (anosmia)
  • Loss of touch (anesthesia)
  • Loss of voice (aphonia)
  • Numbness or loss of the sensation of touch 
  • Seizures or convulsions
  • Slurred speech or inability to speak
  • Temporary blindness or double vision
  • Trouble swallowing or feelings of "a lump" in your throat
  • Weakness or paralysis

Diagnosis

The DSM-5 offers several specific criteria for diagnosing conversion disorder, including: 

  • There must be at least one symptom of sensory or motor impairment.
  • Symptoms are not caused by neurological condition, physical disease, or substance use.
  • Symptoms are preceded by conflict or psychological stress.
  • Symptoms are not better explained by somatization disorder or another psychological condition.

Differential Diagnosis

Your healthcare provider will also need to rule out conditions that may cause similar symptoms, including:

  • Lupus
  • Multiple sclerosis (blindness resulting from optic neuritis)
  • Myasthenia gravis (muscle weakness disorder)
  • Periodic paralysis (muscle weakness)
  • Polymyositis (muscle weakness)
  • Spinal cord injury
  • Stroke

Causes and Risk Factors

Conversion disorder is usually caused by a psychological reaction to a highly stressful event or emotional trauma. For example, a soldier who subconsciously wishes to avoid firing a gun may develop paralysis in their hand. 

The disorder does not necessarily develop immediately following the trigger, so it's important to disclose recent and past stress when speaking to your therapist.

Other risk factors of conversion disorder include:

  • Being female (Women have a higher risk of developing the disorder.)
  • Being highly conscientious, hard-working, compulsive and a perfectionist
  • Having a family member with conversion disorder (People with a first-degree female relative—sister, mother, or daughter—with conversion disorder are more likely to develop symptoms than females in the general population.)
  • Having a mental health condition, including mood or anxiety disorders, dissociative identity disorder (formerly known as multiple personality disorder) or other personality disorders
  • Having a neurological disease, such as epilepsy
  • History of physical or sexual abuse and neglect as a child

Treatment

Conversation disorder is not a lifelong disorder. If you or someone you love is experiencing severe or lingering symptoms of conversion disorder, treatment may be required and will depend on your individual symptoms.

Psychotherapy

Psychotherapy, including individual or group therapy, cognitive behavioral therapy (CBT), hypnosis, biofeedback, and relaxation therapy, have been found to help people with conversation disorder recognize triggers and symptoms and learn new ways to cope with them.

Medication

Your healthcare provider may prescribe an anti-anxiety medication or antidepressant to treat the underlying stress or anxiety that is causing the symptoms of conversion disorder.

Physical Therapy

Physical therapy is often used for people with conversation disorder who have movement disturbances, including problems with coordination, balance, or walking or weak limbs. It's also important to prevent any secondary complications, including muscle weakness and stiffness, that result from inactivity.

Non-Invasive Brain Stimulation (NIBS) Methods

Non-invasive brain stimulation (NIBS) methods, such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS), are possible alternative treatments to reduce conversion disorder symptoms, including limb weakness and paralysis.

Coping

In addition to treatment, adopting some healthy lifestyle changes can help ensure that you better manage any stress and anxiety causing your symptoms. This could include:

Seeking Support

In addition to emotional support, online support communities and Facebook groups can help ensure that you're educated on the latest findings and approaches to managing conversion disorder. A few social networking websites to consider include:

If you or a loved one are struggling with conversion disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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Article Sources
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