Conversion disorder — also known as “functional neurological symptom disorder” — is a mental health condition where affected individuals experience neurological (brain and nervous system) symptoms that cannot be explained by any organic pathology (disease or injury). People with conversion disorder are not faking their symptoms. Their symptoms are real, cause distress and disability, and are not controllable.
Conversion disorder is one of a group of mental health disorders known as somatoform disorders, which are characterized by physical illness symptoms for which there is no organic explanation. Somatoform disorders are not due to another medical, mental health or substance use disorder, and are most likely due to psychological factors.
Conversion disorder is often poorly understood, resulting in unwarranted accusations and stigma directed at the affected individuals. The key to understanding this nebulous mental health disorder is to separate the myths from the facts.
Myth #1: It’s all in your head.
Fact: Conversion disorder is not imagined or made-up; it has physical and mental causes.
Conversion disorder got its name from the concept that, at some point, psychological stressors convert from having solely mental effects to manifesting physical effects. Even though no physical disease or injury is responsible for the physical symptoms, research has discovered that there are physical and physiological changes in the brain and body that cause conversion disorder.
Brain imaging studies using functional MRI (highly detailed pictures of brain function) show promising evidence of the biological nature of conversion disorder. Specifically, there are physical disruptions in the brain areas that are involved in planning movement and controlling sensory perception. Further, it appears that emotional stress activates brain areas that suppress the regions that control movement and sensation.
Additionally, the increased stress caused by the psychological distress that lies behind conversion disorder results in the body releasing above-normal levels of the stress hormone cortisol. People with conversion disorder get above-average psychological reactions to stress and conflict and produce higher levels of cortisol. Cortisol has powerful adverse effects on the immune system and the brain, as well as far-reaching negative effects on physical and mental health.
However, there remains much work to be done to understand conversion disorder fully, and until more research develops, there are no diagnostic tests to confirm or refute the diagnosis. As such, conversion disorder is a “diagnosis of exclusion,” meaning that it can only be diagnosed when all other possible explanations for the affected person’s neurological symptoms have been excluded.
Myth #2: People with conversion disorder are faking it.
Fact: The physical symptoms of conversion disorder are real and unintentional.
The idea that individuals with conversion disorder are faking their symptoms is the most common and the most harmful myth about this mental health disorder.
Ruling out all possible organic explanations for the neurological symptoms of conversion disorder, especially symptoms such as numbness in a limb or blindness, is a very time-consuming and expensive process. People with psychological problems or mental health disorders who convert their symptoms spend nine times as much on health care compared to those who do not.
Unfortunately, differentiating between conversion disorder (where the affected individual truly feels the symptoms) and malingering or factitious disorder (where the individual is faking the symptoms) can be very difficult or even impossible. This is especially the case because so many people with conversion disorder (82% of them) stop working due to their symptoms, so they may be accused of malingering or purposely faking their symptoms to avoid work or to support an insurance claim.
Conversion disorder occurs when individuals experience enough conflict or stress that they reach a tipping point where the resulting psychological distress converts into physical symptoms. This occurrence is usually due to past traumatic experiences (especially physical or sexual abuse) that have lowered the individuals’ resilience to stress. By being accused of faking their symptoms, the conflict and stress from the accusation can worsen their symptoms.
Myth #3: Conversion disorder only affects women.
Fact: Conversion disorder is more common in women, but occurs in both genders.
Statistics on the incidence of conversion disorder are sparse, presumably because it is difficult to diagnose and because many affected individuals are mistakenly believed to be malingering. However, one older, Canadian, study showed an incidence of 22 cases per 100,000 persons per year.
Although conversion disorder only appears to be responsible for 1-3% of illnesses in a hospital setting, because the symptoms are neurological, conversion disorder is much more commonly seen in neurological wards and clinics. About 30% of people in neurological specialty care have medically unexplained symptoms, and continue to be unexplained during the course of their symptoms. Presumably, many of these are due to conversion disorder.
Myth #4: Conversion disorder is a new phenomenon.
Fact: There are records of conversion disorder dating back more than 2,000 years.
Conversion disorder is certainly not an invention of the modern era. Historically, conversion disorder was known as hysteria. Some of the earliest surviving medical records, from the time of Hippocrates in the fifth century BCE, show the origins of the word hysteria to describe this mental health disorder. Egyptian hieroglyphic inscriptions from even earlier have been interpreted to be referring to cases of conversion disorder.
Hysteria, by various names, has been also described in various medical writings during the Middle Ages, and at one point was attributed to witchcraft or demonic possession.
Eventually, by the 17th century, hysteria became generally recognized as a psychological issue beyond the control of the affected individuals. In the 20th century, the famed Austrian neurologist Sigmund Freud formally established the direct link between psychological distress related to earlier life traumas and the unexplained neurological symptoms and coined the term conversion.
Despite its relative prevalence among patients in neurology clinics, little research is currently being done on conversion disorder. Progress has been made in identifying the brain processes involved in the disorder but has not yet led to any diagnostic tests or new therapies.
Myth #5: Medication is the primary treatment option for conversion disorder.
Fact: Medication has little, if any, role in treating conversion disorder.
Treatment of conversion disorder begins with discussing the suspected diagnosis with the affected individuals, which can be problematic. The symptoms are very real to these individuals, and the diagnosis may come off as an accusation of malingering or faking the illness.
Given that conversion, disorder is a “diagnosis of exclusion” that doesn’t have any “smoking gun” diagnostic tests to support it, presenting this diagnosis may draw ire and resistance to participating in therapy. Affected individuals must be introduced to the diagnosis and presented with the evidence that shows the absence of any disease or injury, a process referred to as psychoeducation.
The best treatment for conversion disorder is a holistic biopsychosocial approach that addresses three main factors that lie behind the conversion:
- Triggering events: The conversion is usually in response to a history of overwhelming stress, from prior abuse or other traumatic events, or from accumulated life stressors. Identifying and addressing these past events through skilled counseling enables individuals to adopt a more functional ability to handle life’s stressors in the present without converting.
- Perpetuating factors: The symptoms are brought on when affected individuals are confronted by intolerable or fearful circumstances that produce great psychological distress and conversion. Cognitive behavioral therapy (CBT) is the mainstay of identifying and correcting these perpetuating factors. Hypnosis may also prove useful, but only as an adjunct to CBT.
- Risk factors: Identifying and treating co-occurring (comorbid) mental health disorders may be pivotal in returning individuals with conversion disorder to good function. Although statistics are widely varied, it appears that more than 90% of people with conversion disorder have a comorbid mental health disorder that is likely contributing to their conversion disorder. Other risk factors are more difficult to address, but should be acknowledged include:
- Female gender
- Living in a rural area
- Lack of education
- Low socioeconomic status
- Young age
- History of sexual or physical abuse
There is some spotty anecdotal evidence that the use of antidepressant medications may have some effect on conversion disorder. However, given the high incidence of significant comorbid mental health disorders, medications may be useful in treating these related conditions.
If you or someone you love has developed a drug or alcohol addiction to cope with the effects of conversion disorder, The Recovery Village can help. Please feel welcome to contact us for a confidential discussion with a representative.
Ali, Shahid; et al. “Conversion disorder- mind versus body: A Review.” Innovations in Clinical Neuroscience, May-June 2015. Accessed June 9, 2019. Allin, Matthew; Streeruwitz, Anna; Curtis, Vivienne. “Progress in understanding conversion disorder.” Neuropsychiatric Disease and Treatment, September 2005. Accessed June 9, 2019. Black, Deborah; Seritan, Andreea; Taber, Katherine; Hurley, Robin. “Conversion hysteria: Lessons from functional imaging.” Journal of Neuropsychiatry and Clinical Neurosciences, August 1, 2004. Accessed June 9, 2019. Feinstein, Anthony. “Conversion disorder: Advances in our understanding.” Canadian Medical Association Journal, May 17, 2011. Accessed June 9, 2019. Harvard University Health Publishing. “Conversion disorder (functional neurological symptom disorder).” March 2019. Accessed June 9, 2019. Rowe, James. “Conversion disorder: Understanding the pathogenic links between emotion and motor systems in the brain.” Brain, May 2010. Accessed June 9, 2019. Smith, Jonathan; Józefowicz, Ralph. “Diagnosis and treatment of somatoform disorders.” Neurology Clinical Practice, June 2012. Accessed June 9, 2019. Stonnington, Cynthia; Barry, John; Fisher, Robert. “Conversion disorder.” American Journal of Psychiatry, September 1, 2006. Accessed June 9, 2019.
Ali, Shahid; et al. “Conversion disorder- mind versus body: A Review.” Innovations in Clinical Neuroscience, May-June 2015. Accessed June 9, 2019.
Allin, Matthew; Streeruwitz, Anna; Curtis, Vivienne. “Progress in understanding conversion disorder.” Neuropsychiatric Disease and Treatment, September 2005. Accessed June 9, 2019.
Black, Deborah; Seritan, Andreea; Taber, Katherine; Hurley, Robin. “Conversion hysteria: Lessons from functional imaging.” Journal of Neuropsychiatry and Clinical Neurosciences, August 1, 2004. Accessed June 9, 2019.
Feinstein, Anthony. “Conversion disorder: Advances in our understanding.” Canadian Medical Association Journal, May 17, 2011. Accessed June 9, 2019.
Harvard University Health Publishing. “Conversion disorder (functional neurological symptom disorder).” March 2019. Accessed June 9, 2019.
Rowe, James. “Conversion disorder: Understanding the pathogenic links between emotion and motor systems in the brain.” Brain, May 2010. Accessed June 9, 2019.
Smith, Jonathan; Józefowicz, Ralph. “Diagnosis and treatment of somatoform disorders.” Neurology Clinical Practice, June 2012. Accessed June 9, 2019.
Stonnington, Cynthia; Barry, John; Fisher, Robert. “Conversion disorder.” American Journal of Psychiatry, September 1, 2006. Accessed June 9, 2019.
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