Conversion Disorder

Overview

• Full name: Conversion Disorder (Functional Neurological Symptom Disorder)
• Key feature: Altered motor or sensory function that is inconsistent with neural/medical conditions and not better explained by another disorder
  • Often suggestive of neurological problem, but no such problem is detected
• Must cause significant distress/impairment
• May display indifferent attitude toward symptoms (“la belle indifference”)
• Functioning may be mostly normal
• Not deliberately faking symptoms for the purpose of concrete gains (malingering)
• Rare condition, with a chronic intermittent course
• Often comorbid with anxiety and mood disorders
• Seen primarily in females
• Onset usually in adolescence
• Common in some cultural and/or religious groups

DSM-5 Criteria

• One or more symptoms of altered motor or sensory function
• Incompatibility between symptom and medically recognized conditions
• Not better explained otherwise
• Causes significant distress

Causes

• Not well understood
• Freudian psychodynamic view is still common, though unsubstantiated
  • Past trauma or unconscious conflict is “converted” to a more acceptable manifestation, i.e., physical symptoms
• Primary/secondary gains
  • Freud thought primary gain was the escape from dealing with a conflict
  • Secondary gains: Attention, sympathy, etc.
• Sociocultural factors
  • More common in lower education, lower SES
  • Patients likely to adopt symptoms with which they are already familiar

Treatment

• If onset after a trauma, may need to process trauma or treat posttraumatic symptoms
• Remove sources of secondary gain
• Reduce supportive consequences of talk about physical symptoms