Conversion Disorder: Symptoms, Causes, Treatment

Conversion disorder (also known as functional neurological symptom disorder) is a psychological condition that causes symptoms that appear to be neurological, such as paralysis, speech impairment, or tremors, but with no obvious or known organic causes. In the past, these events were often referred to as "hysterical blindness" or "hysterical paralysis."

Conversion disorder is a relatively rare mental illness, with 2 to 5 out of 100,000 people reporting symptoms per year. It is categorized as a type of somatic symptom disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the leading diagnostic guide for the mental health profession.

Understanding the medical definition of conversion disorder is the first step toward getting help for yourself or someone you love.

Symptoms

There's typically a sudden onset of symptoms that affect voluntary motor or sensory function—and these symptoms can disappear just as suddenly, without any physiological reason. 

The physical symptoms of conversion disorder are often described as your body's way of dealing with unresolved stress or unexpressed emotions that triggered the disorder. In other words, the physical symptoms distract the person from the emotional duress. Conversion disorder typically affects movement function as well as the senses.

Symptoms of conversion disorder can be about any neurological deficit imaginable, including:

• Abnormal walking or tremors
• Blindness or double vision
• Deafness or problems hearing
• Disturbances in coordination
• Episode of unresponsiveness
• Loss of balance
• Loss of the sense of smell (anosmia)
• Loss of touch (anesthesia)
• Loss of voice (aphonia)
• Numbness or loss of the sensation of touch 
• Seizures or convulsions
• Slurred speech or inability to speak
• Temporary blindness or double vision
• Trouble swallowing or feelings of "a lump" in your throat
• Weakness or paralysis

Diagnosis

The DSM-5 offers several specific criteria for diagnosing conversion disorder, including: 

• There must be at least one symptom of sensory or motor impairment.
• Symptoms are not caused by a neurological condition, physical disease, or substance use.
• Symptoms are associated with significant distress.
• Symptoms are not better explained by another physical or psychological condition.

Differential Diagnosis

Your healthcare provider will also need to rule out conditions that may cause similar symptoms, including:

• Lupus
• Multiple sclerosis (blindness resulting from optic neuritis)
• Myasthenia gravis (muscle weakness disorder)
• Periodic paralysis (muscle weakness)
• Polymyositis (muscle weakness)
• Spinal cord injury
• Stroke

Causes and Risk Factors

While exact causes are not well understood, research suggests that it could be caused by abnormal flow to certain areas of the brain.

Conversion disorder may also be a psychological reaction to a highly stressful event or emotional trauma. For example, a soldier who subconsciously wishes to avoid firing a gun may develop paralysis in their hand. 

Other risk factors of conversion disorder include:

• Being female (Women have a higher risk of developing the disorder.)
• Being highly conscientious, hard-working, compulsive and a perfectionist
• Having a family member with conversion disorder (People with a first-degree female relative—sister, mother, or daughter—with conversion disorder are more likely to develop symptoms than females in the general population.)
• Having a mental health condition, including mood or anxiety disorders, dissociative identity disorder (formerly known as multiple personality disorder) or other personality disorders
• Having maladaptive personality traits
• Having a neurological disease that causes similar symptoms (such as non-epileptic seizures in people that have epilepsy)
• History of physical or sexual abuse and neglect as a child

Research also suggests that people with conversion disorder also tend to have abnormal emotional regulation.

Treatment

Conversation disorder is not a lifelong disorder. If you or someone you love is experiencing severe or lingering symptoms of conversion disorder, treatment may be required and will depend on your individual symptoms.

However, symptoms may improve on their own with time even without treatment, and most people do get better with time and reassurance.

Psychotherapy

Psychotherapy, including individual or group therapy, cognitive-behavioral therapy (CBT), hypnosis, biofeedback, and relaxation therapy, have been found to help people with conversation disorder recognize triggers and symptoms and learn new ways to cope with them.

Medication

Your healthcare provider may prescribe an anti-anxiety medication or antidepressant to treat the underlying stress or anxiety that is causing the symptoms of conversion disorder.

Physical Therapy

Physical therapy is often used for people with conversation disorders who have movement disturbances, including problems with coordination, balance, or walking or weak limbs. It's also important to prevent any secondary complications, including muscle weakness and stiffness, that result from inactivity.

Non-Invasive Brain Stimulation (NIBS) Methods

Non-invasive brain stimulation (NIBS) methods, such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS), are possible alternative treatments to reduce conversion disorder symptoms, including limb weakness and paralysis.

However, it is important to be aware that these treatments are considered experimental and there is a lack of rigorous randomized controlled trials. Because of this, these treatments should be viewed with caution.

Coping

In addition to treatment, adopting some healthy lifestyle changes can help ensure that you better manage any stress and anxiety causing your symptoms. This could include:

• Eating a balanced diet.
• Fostering positive relationships.
• Getting ample sleep.
• Practicing relaxation techniques like yoga, meditation, or progressive muscle relaxation.

Seeking Support

In addition to emotional support, online support communities and Facebook groups can help ensure that you're educated on the latest findings and approaches to managing conversion disorder. A few social networking websites to consider include:

• Conversion Disorder (aka Functional Neurological Disorder) Facebook Group
• Conversion Disorder Awareness Facebook Group
• Conversion Disorder Support Group