Conversion Disorder (Hysteria)

         Conversion Disorder (CD) is a neurological symptoms in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation. It is also known as Hysteria or Hysterical Conversion Reaction (HCR) or Somatoform Disorders.

Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-IV) defines conversion disorder as follows :

1. One or more symptoms or deficits are present that affect voluntary motor or sensory function suggestive of a neurologic or other general medical condition.

2. Psychological factors are judged, in the clinician's belief, to be associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit. A diagnosis where the stressor precedes the onset of symptoms by up to 15 years is not unusual.

3. The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering).

4. The symptom or deficit, after appropriate investigation, cannot be explained fully by a general medical condition, the direct effects of a substance, or as a culturally sanctioned behavior or experience.

5. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

6. The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder.

Sign & Symptoms

Symptoms of a conversion disorder include the loss of one or more bodily functions, such as:

- Blindness

- Inability to speak

- Numbness

- Paralysis

Common signs of conversion disorder include:

- A debilitating symptom that begins suddenly

- History of a psychological problem that gets better after the symptom appears

- Lack of concern that usually occurs with a severe symptom.

Diagnosis & Tests

1. Diagnostic testing does not find any physical cause for the symptoms.

2. The doctor will do a physical exam and may order diagnostic tests. These are to make sure there are no physical causes for the symptom.

Treatment

There are a number of different treatments that are available to treat and manage conversion syndrome. While occasionally symptoms do disappear on their own, many people benefit from a variety of treatment options. Treatments for conversion syndrome include hypnosis, psychotherapy, physical therapy, stress management, and transcranial magnetic stimulation. Treatment plans will consider duration and presentation of symptoms and may include one or multiple of the above treatments.

This may include the following :

1. Explanation. This must be clear and coherent as attributing physical symptoms to a psychological cause is not accepted by many educated people in western cultures. It must emphasize the genuineness of the condition, that it is common, potentially reversible and does not mean that the sufferer is psychotic. Taking an etiologically neutral stance by describing the symptoms as functional may be helpful but further studies are required. Ideally, the patient should be followed up neurologically for a while to ensure that the diagnosis has been understood.

2. Physiotherapy where appropriate;

3. Occupational Therapy to maintain autonomy in activities of daily living;

4. Treatment of comorbid depression or anxiety if present.

There is little evidence-based treatment of conversion disorder. Other treatments such as cognitive behavioral therapy, hypnosis, EMDR, and psychodynamic psychotherapy, EEG brain biofeedback need further trials.