What Is Conversion Disorder?

Conversion disorder, also called functional neurological symptom disorder, is a psychiatric condition in which a person has neurological symptoms, like paralysis or blindness, with no physiological cause.

People with conversion disorder are not faking their illness. While there may be no identifiable cause to conversion disorder, it is a very real psychiatric condition that is often preceded by a stressful or traumatic event.

This article will discuss the symptoms, causes, diagnosis, and treatment of conversion disorder.

Conversion Disorder Symptoms

The word "conversion" in the term "conversion disorder" is used to explain the body's converting psychological stress to physical symptoms in order to cope with the stress.

The nerves of a person with conversion disorder do not send and receive signals properly. It's as though the brain and the body are miscommunicating with one another. For example, the brain sends a signal to move the arm, but this message is never received. This miscommunication explains the neurological symptoms central to conversion disorder.

Everyone with conversion disorder presents slightly differently, but common symptoms include:

• Blindness
• Paralysis
• Loss of speech
• Difficulty swallowing
• Body weakness
• Sudden onset of illness

These symptoms may be constantly present, or they may come and go.

Importantly, the symptoms cannot be created at will. The person is not faking their illness. Conversion disorder is a very real condition that can be extremely distressing to the person experiencing it.

Causes

Researchers do not yet know the exact cause for conversion disorder. It is likely that a range of factors come together to cause conversion disorder in certain predisposed people.

However, this theory has been criticized due to lack of supporting evidence and because patients do not agree with psychological explanations being given for severe physical symptoms.

Although no longer a requirement for diagnosis, it is common for an emotionally stressful event to precede the development of conversion disorder. In one study, 56% of participants with conversion disorder identified a "severe event" in the month before symptom onset.

Research in the neurological field is focusing on possible physical causes or contributors to conversion theory. Hypotheses include the interaction of trauma and sex hormones, or trauma and the biological stress response. However, more research is needed to make any conclusions.

Risk Factors for Conversion Disorder

Certain factors put a person at higher risk of developing conversion disorder. These include:

• Experiencing a stressful or traumatic event
• Being female or having a first-degree female relative with the condition
• Having a mood disorder
  

Diagnosis

Diagnosing conversion disorder can be challenging, because symptoms are not due to an identifiable neurological cause or abnormalities in the brain. There is no one specific test that can identify conversion disorder, and it often involves ruling out other possible conditions, such as stroke or another neurological injury. As such, delayed diagnosis and misdiagnosis are common.

The first step clinicians take to diagnose conversion disorder is to gather a detailed medical history and to review symptoms. They will look specifically for neurological symptoms, such as blindness or paralysis, that are inconsistent with the individual's known diseases or medical conditions.

Medical tests may also be needed to identify or exclude medical conditions, such as brain tumors or stroke. These tests typically include:

• Computed tomography scan (CT scan)
• Magnetic resonance imaging (MRI)
• Electroencephalogram (EEG)

The patient may then undergo various psychological assessments to identify any possible psychiatric conditions, such as mood or anxiety disorders, which often coincide with conversion disorder.

A healthcare provider will also gather information on recent or past life events, particularly trauma or stressors preceding the onset of symptoms. This is not required for a diagnosis of conversion disorder, but it is a common risk factor that may aid in diagnosis.

How Is Conversion Disorder Classified?

The "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSM-5) is a handbook that provides diagnostic criteria for all mental health conditions. It helps guide mental health professionals in making accurate diagnoses.

In the DSM-5, functional neurological disorder (conversion disorder) is classified as one of the somatic symptom and related disorders. This is a change from the DSM-IV, the previous edition of the handbook, which used the term "somatoform disorders."

Between the DSM-IV and the DSM-5, criteria for conversion disorder changed to focus on symptoms that are present, rather than ruling out all other possible medical explanations. Another important change is that the requirement for a person to have a preceding stressor or to have experienced a traumatic event—although common in conversion disorder—has been removed.

Neurological Signs

In the early 2000s, prior to the DSM-5, diagnosis of conversion disorder focused on ruling out all other possible medical explanations for a person's symptoms. While this is still an important part of the diagnostic process, recently it is not as heavily emphasized.

Recent research has identified some possible positive neurological signs for conversion disorder. These signs are found in somatic symptom and related disorders, and not in organic conditions. They include:

• Hoover's sign, a test for leg weakness
• Tremor entrainment test, to test for shaking or tremors
• Dissociative (non-epileptic) seizure identification

Treatment

There is limited research on treatments specifically for conversion disorder. However, in clinical practice there are a variety of treatments that psychiatrists and neurologists recommend to reduce symptoms over time.

One of the most important aspects of treatment is getting patients to understand their diagnosis. Due to their severe physical symptoms, many people have a negative reaction to a diagnosis of conversion disorder. They may feel disbelieved by their healthcare provider or feel like they are being told that it's "all in their head."

The provider should approach this discussion therapeutically, reassure the patient that their symptoms are very real and not made up, and explain the conflict between the mind and body. Establishing trust between the patient and provider is essential for treatment of conversion disorder.

Other forms of treatment include:

• Psychotherapy (talk therapy): This is the mainstay of treatment and is focused on helping the patient arrive at an understanding of the issues underlying their symptoms. There are several types of talk therapy available, including psychodynamic psychotherapy and cognitive-behavioral therapy (CBT), which has been proven to be effective for treating certain types of conversion disorder.
• Physical therapy: Muscle weakness or dysfunction may result from conversion disorder. Physical therapy can help a person regain strength and retrain functional movement patterns.
• Occupational therapy: Due to weakness, paralysis, or sensory changes, a person with conversion disorder may struggle to engage in their daily life, work, school, or relationships the way they did before. Occupational therapy can help them get back to regular functioning through the use of assistive devices, environmental changes, strengthening exercises, sensory conditioning, and more.
• Medication: There is no medication available for treating conversion disorder itself, but if conversion disorder occurs along with another psychiatric condition such as an anxiety or mood disorder, treating the underlying condition with antidepressants or anti-anxiety medications may help.

Prognosis

The prognosis for conversion disorder is better the earlier a person is diagnosed and treated. Unfortunately, though, it can take an average of seven years for someone to be properly diagnosed.

Longer symptom duration, delayed diagnosis, and effects from unnecessary medications due to misdiagnosis can all negatively impact prognosis. Healthcare provider and patient misunderstandings of the condition is also common and can negatively affect prognosis.

Summary

Conversion disorder is a psychiatric disorder in which a person has neurological symptoms with no medical cause. People with conversion disorder are not faking their illness, but are experiencing a psychiatric condition. It is often caused by a traumatic event.

A Word From Verywell

Being diagnosed with conversion disorder can be confusing. You may be experiencing very real—often very severe—physical symptoms, but medical tests don't show any signs of neurological illness. Know that just because these tests are negative, your condition isn't any less valid.

As you come to terms with your diagnosis, you may find it helpful to focus on the fact that conversion disorder is treatable, unlike many progressive neurological disorders. There is hope that one day your symptoms will be managed or completely resolved.