Conversion or Somatic Disorder

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Conversion or Somatic Disorder

What is conversion disorder?

Conversion disorder is a somatic disorder in which neurological symptoms arise with no physiological or medical explanation. It is believed that it may be a response to mental stress or traumatic life events. As of recently, conversion disorder is now referred to as functional neurological symptom disorder. To the person enduring this disorder, the symptoms are very real and can cause significant distress in their lives.

How common is conversion disorder?

About 7 percent of the American population suffers from conversion disorder.

Who suffers from this type of disorder?

Conversion disorder can manifest as early as late childhood but may develop at any stage of life. Early adulthood seems to be the most common age when this disorder occurs-usually around 30 years old. It also appears to affect women more than men. Many believe this may be related to women being exposed to sexual trauma more often than men,  placing them at higher risk of developing this disorder.

Causes

What causes conversion disorder?

The cause of conversion disorder is not well understood at this time. Many times there may be an incident that precipitates the disorder, such as:

  • Stressful event
  • Physical
  1. Sexual abuse
  2. Physical abuse 
  • Psychological
  • Child neglect  
  • Neurological disease
  1. Epilepsy
  2. Migraines 
  • Changes in brain function

What other risk factors may increase the chances of developing conversion disorder? 

  • Genetic factors-  having family members with conversion disorder places the person more at risk of developing the same mental illness. 
  • Traumatic events- traumatic life events may precipitate the development of conversion disorders. Significant stress, emotional or physical trauma, and chaotic lifestyles are all possibilities of causing this mental disorder.
  • Mental illnesses-  a variety of mental disorders such as depression, anxiety disorder, dissociative disorder, or certain personality disorders may make someone more vulnerable to developing a conversion disorder.
  • Pain tolerance- people with a lower threshold for pain may have a higher risk for conversion disorder. 

What complications may arise from conversion disorder?

Due to the person's out-of-proportion perception of pain from their symptoms, the person will often visit multiple healthcare professionals looking for explanations of their symptoms. Many unnecessary surgeries or procedures may be performed to address the person's pain.

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Symptoms

What are the signs and symptoms of conversion disorder?

Usually, after the occurrence of a traumatic event occurs, symptoms from conversion disorder may develop. The presentation of symptoms varies as there may be a single incident or multiple episodes at random times that may range from severe to mild pain. Most symptoms involve impairment of body movement, function, and/or senses. Some signs and symptoms may include:

  • Deficits in voluntary motor or sensory function 
  • Tremors
  • Seizures
  • Impaired balance
  • Paralysis of arms or legs
  • Loss of sensation
  • Blindness
  • Double vision
  • Deafness
  • Difficulty swallowing
  • Urinary retention
  • Unresponsiveness
  • Numbness
  • Slurred speech
  • Inability to speak

Diagnosis

How is conversion disorder diagnosed?

An accurate diagnosis of conversion disorder can only be made by an experienced healthcare professional such as our medical providers at TeleMed2U. This is because appropriate medical and neurological diagnostic testing must be performed to ensure there is no other cause for the symptoms.

What tests are there to confirm conversion disorder? 

Currently, there are no diagnostic tests available to confirm conversion disorders. The diagnosis is based solely on the expertise of a healthcare provider. They will perform a thorough medical exam to rule out other neurological causes for the symptoms.

What are the DSM-5 criteria used to diagnose conversion disorder?

In order to diagnose conversion disorder, the Diagnostic and Statistical Manual of Mental Disorders, 5th ed, (DSM-5) diagnostic criteria is that the symptoms must be so severe that it negatively impacts the person’s quality of life. At least one symptom must be present that affects body movement. Lastly, the symptoms cannot be caused by other neurological or medical conditions.

Treatment

What are the treatment options for conversion disorder? 

It is important that an accurate diagnosis is made for conversion disorder as the type of symptoms presenting dictates the type of treatment used. Treatment usually involves a multidisciplinary approach to address all symptoms experienced by the patient. It is usually recommended that the person’s internist and psychiatrist work together to develop the best treatment plan for optimal mental and physical health.

  • Physical treatment focuses on the improvement of neurological symptoms. Some options include:
  1. Stress reduction- there are various options available for this, including regular exercise, breathing exercise, and muscular stretching.
  2. Physical or occupational therapy- addresses abnormalities with the movement of limbs, balance disturbances, or weakness. The goal of this treatment is to prevent future complications.
  3. Speech therapy- is geared at correcting any speech limitations and returning to normal function.
  4. Distraction techniques-  some successful options for distraction include listening to music, talking to friends and family, or attempting to purposely alter the function of some body movements.
  • Mental health treatment
  1. Psychotherapy can help manage feelings about the illness that may trigger symptoms.
  • Cognitive-behavioral therapy (CBT) is the most common type of psychotherapy and can be used to manage stress- a believed cause of the disorder. Coping skills are also designed to manage the pain and neurological symptoms.
  1. Hypnosis is another option used by trained professionals to help improve motor functions such as speech abnormalities.

Any other underlying mental health disorder must also be addressed and properly treated to ensure effective treatment for conversion disorder.

How does education play a role in the treatment of conversion disorder?  

Sometimes education can effectively treat this disorder. If a patient is reassured that their symptoms are not due to a serious medical condition, this may give them the confidence needed to heal. This usually happens with the support of family and loved ones.

What medications are used for conversion disorder?

Currently, there are no medications approved for the treatment of conversion disorder. Sometimes medications like antidepressants or anti-anxiety medications may be helpful but only if treating underlying medical conditions such as depression or anxiety.

Can conversion disorder be prevented?

Unfortunately, there are currently no preventable measures in place for conversion disorder.

When should medical attention be sought out?

Are you suffering from unexplainable neurological pain and symptoms that negatively impact your life and prevent you from functioning as you had previously?   Then you may be experiencing conversion disorder and need to speak to a healthcare provider.

Fortunately, this is a very treatable mental illness. Our licensed mental healthcare providers at TeleMed2U may be able to help you and your internist come up with an effective treatment plan.

Information

Medically reviewed by:

Dr Roy Kedem, MD

Dr Zenon Andreou studied medicine at University College London, graduating in 2006. His postgraduate training was in hospitals in and around London and he trained for four years in Otolaryngology before completing his training in General practice

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