Psychosomatic Illnesses: Conversion Disorder

In 1985, a 21-year-old woman by the name of Anna O. began developing strange symptoms five months after her father became ill. During the day she began experiencing blurry vision and every once in her while she had trouble moving her right arm and her legs. Other symptoms began to develop. Suddenly, it was difficult for her to speak and she developed psychological symptoms and behavioral problems.

Anna's personality was altered, she became extremely malnourished because of her refusal to eat and drink at times, despite her hunger and thirst, and she was easily confused and at times delirious. Prior to the onset of Anna's symptoms, she was an intelligent, perfectly healthy woman.

Anna finally consulted Dr. Josef Breuer, who confronted one symptom at a time by hypnosis. Each symptom had been traced back to the death of Anna's father. Thus, the hypothesis that the stress surrounding the death of her father was the cause of her bizarre symptoms.

Sigmund Freud took Dr. Breuer's observations and used his psychoanalytic model to analyze Anna's condition. The term "conversion" simply referred to the psychological stress and anxiety that had been converted into physical symptoms.

Conversion disorder is a psychosomatic illness classified as a somatoform disorder.

The term psychosomatic illness refers to any physical symptoms that originate from the mind and from emotions. Somataform (from the root word soma, body) clasifies these disorders that appear to be purely physical.

People with conversion disorder have physical malfunctioning without any physical or organic causes. Meaning, people with conversion disorder have physical symptoms but not physical causes. Psychological symptoms manifest in physical symptoms.

1. Conversion disorder with motor symptom or deficit
2. Conversion disorder with sensory symptom or deficit
3. Conversion disorder with seizures or convulsions
4. Conversion disorder with mixed presentation.

The subtype of Conversion Disorder is diagnosed based on the symptoms exhibited. For example, conversion disorder with motor symptoms or deficit will have symptoms that mimic physical conditions such as tremors or Parkinson's Disease.

Pseudoparalysis

• Loss of the ability to move half of the body or a single limb
• Weakness that doesn't make sense anatomically
• Inconsistency with examination (never the same symptom)

Pseudosensory Syndromes

• Numbness or lack of feeling in various parts of the body
• Anatomical pattern doesn't make sense (is based on the patient's knowledge of their body)

Pseudoseizures (non-epileptic/psychogenic)

• Seizures that have no physical or organic cause
• This is the most difficult to diagnose especially because 5% and 35% of patients with pseudoseizures also have epilepsy

Pseudocoma

• A coma not caused by physical or organic causes

Psychogenic Movement Disorders

• Can mimic myoclonus (muscle spasams), Parkinson's, Dystonia (abnormal muscle tone), Dyskinesia (uncontrolled bodily movement) and tremor

Pseudoblindness

• The affected patient believes they are blind however if a mirror is placed in front of him/her and tilted from side to side, their eyes follow the reflection. Yet, they truly believe that they cannot see.

Pseudodiplopia

• Double vision without physical or organic causes

Pseudoptosis

• Droopy eyelids without physical cause.
• In real ptosis (droopy eyelids), the eyebrows are lifted. In pseudoptosis, the eyebrows are lowered

Hysterical Aphonia

• Aphonia is the loss of the ability to produce sounds (to speak)
• In true apnonia there is usually abnormality in the movement of the vocal cords and trouble producing any sounds. In hysterical aphonia, the patient will be able to cough and whisper normally. Their movement of the vocal cords is also normal.

In patients, this is attitude of relative unconcern about their symptoms is another feature of Conversion Disorder. This is more often seen in adults because children are more likely to react to their strange symptoms with fear. Younger children are also more hopeless about their symptoms. In a way, adults with this mind-blowing psychiatric disorder deny their symptoms.

The exact cause of Conversion Disorder is unknown, however there are theories that suggest the primary cause is a stressful event or situation in the patient's life. Most often, the stressful event is physical, emotional or sexual abuse. The disorder tends to be the result of an extremely delayed reaction to childhood abuse.

Risk Factors

• A recent significant stress
• Emotional trauma
• Being female (statistically)
• Being a teen or young adult (most common)
• Having another psychological condition (e.g. dissociative disorder, personality disorders and anxiety disorders)
• A family history (at least one member with the disorder)
• Physical or sexual abuse in the past 
• Financial problems

• Hospitalization (patients often go to the hospital thinking they have a physical problem)
• Anti-anxiety and anti-depressants
• Psychotherapy and psychodynamic therapy
• Family and group therapy
• Hypnosis
• Relaxation techniques and visualization
• Biofeedback therapy

Today, Conversion Disorder is still mind-boggling to medical and psychiatric professionals. I mean, think about it... blindness, paralysis, comas caused by psychological issues. Like most psychosomatic and somatoform disorders, Conversion Disorder is especially difficult to diagnose. This is because the symptoms mimic medical conditions such as:

• Mutiple sclerosis
• Myasthenia gravis
• Periodic Paralysis
• Myopathies
• Polymyositis
• and even Guillian-Barré Syndrome

To diagnose Conversion Disorder, several tests and examinations must be done to rule out every similar medical condition. Therefore, the psychiatric disorder is often diagnosed as one of the seemingly medical conditions mentioned above.

By now, you must be wondering "exactly how common is this disorder?" To answer that question: Conversion Disorder is a lot more common than people believe. In the West between 30 and 60% of seemingly neurological disorders are unexplained, which implies that percentage can represent cases of Conversion Disorder or other psychosomatic/somatoform disorders.

With more research about psychological problems, Conversion Disorder and other such psychosomatic/somatoform disorders can be prevented.

What do you think of Conversion Disorder? Share your opinion below.