What Is It?

Conversion disorder is one of the somatoform disorders, in which symptoms suggest a medical illness, yet no medical condition can be found to explain the symptoms. They do cause significant distress and can impair functioning. The patient is not “faking,” and the symptoms are not under the person’s conscious control.

In conversion disorder, the symptom that cannot be explained medically involves a person’s sensations or voluntary muscle (motor) control. For example, the person may have a paralyzed limb or numbness over a portion of the body. There can be blindness, deafness, seizures or even unconsciousness. A good neurological examination often will demonstrate that the problem is unusual and that it does not match the anatomy of the nervous system, and cannot be explained by any known medical illness.

The symptoms of conversion disorder often follow conflict or stress in the person’s life. The person is not aware of producing the symptoms and is convinced that the problem is physical. The name of the disorder comes from the idea that psychological distress is being converted into a physical symptom. Experts believe that in conversion disorder, a conflict or painful thought is so unacceptable that it never reaches the person’s awareness. In some cases, the person shows little concern about the physical symptom, a phenomenon sometimes called la belle indifference.

Conversion disorder is rare. It is more common in women than men. It also appears more often in places where people know less about medicine and psychology, for example, in developing countries rather than in industrialized ones. When this disorder occurs in a more sophisticated person, the symptoms tend to be subtler, while the symptoms are likely to be more far-fetched in a person who doesn’t know as much abut medicine. The disorder occurs most frequently between adolescence and middle age.

Conversion disorder is characterized by one or more symptoms that suggest a neurological condition. Examples include:

• Poor coordination or balance
• Paralysis or weakness
• Difficulty speaking or swallowing
• Retention of urine
• Loss of touch or pain sense
• Blindness or other visual symptoms
• Deafness
• Seizures or convulsions

Psychological factors, such as stress or conflict, are associated with the physical symptoms.

Conversion disorder usually is diagnosed by a primary-care physician or mental-health professional based on the person’s history and a careful neurological examination. In the least plausible cases, the diagnosis of conversion may be obvious to a neurologist because the physical symptom is not part of any known disorder of the nervous system. Sometimes additional tests may be done to clarify the diagnosis. These tests may include an electroencephalogram (EEG), which measures electrical activity in the brain, or an electromyogram (EMG), which measures how well nerve impulses are being conducted through muscle tissue.

The doctor also will try to determine if any stress or conflict is at the root of the symptoms.

Even if tests don’t explain the symptom, it is always possible that a medical or neurological illness is causing the symptoms. For example, multiple sclerosis can cause unusual symptoms even when diagnostic tests are normal. The person also may have another psychiatric problem, such as a mood disorder or a personality disorder.

Conversion symptoms usually do not last long. Generally, the more quickly the symptoms start, the more rapidly they will go away. The symptoms also are more likely to last only a short time if the stress is clearly defined. More severe symptoms, such as paralysis or blindness, are less likely to last a long time because it is harder to sustain symptoms that interfere significantly with daily activities. A less severe symptom, such as tremor, or one that is repeated and limited, such as seizure, can persist, and come and go, depending on the nature of the stress.

There is no way to prevent this disorder.

Sometimes symptoms will go away on their own after stress has been reduced, conflict has been resolved, or the family or community has responded with a show of concern and support. If there is evidence of anxiety, an alteration of mood, or disordered thinking, antianxiety, antidepressant or antipsychotic medication may help.

If the source of conflict or stress can be determined, it may be possible to provide relief through psychotherapy. For example, the person may be in conflict about taking a developmental step, such as leaving home, starting a new job or having a first child. With the help of psychotherapy, the person may be able to deal with the conflict and proceed with the new experience or retreat from the dilemma. In either case, physical symptoms may stop.

The person should be evaluated as soon as physical symptoms emerge. If the person is indifferent to the symptoms, it may take a supportive family member or friend to help him or her seek treatment.

The outlook for conversion disorder varies. The outcome depends on the nature of the stress and of the symptoms.

Most conversion symptoms last a relatively short time. The more severe the symptoms, the more quickly they are likely to disappear. However, the disorder may indicate that the person has trouble coping with stress and conflict, so other symptoms can occur later. The same or other physical symptoms might appear or the person might develop anxiety or depression.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.