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Diagnostic Criteria Section_Index.

Refer to conditions of use

Conversion Disorder

Whilst "hysterical" blindness, paralysis, anesthesia, dysphagia, and gait disturbance have been described for millennia, The patient confronts an acute stressor that creates a psychic conflict, and the physical symptom(s) serve as the resolution for the conflict.  The patient may repress the stressor or be unaware of its impact. . Failure to recognize and treat this early in the course may lead to symptoms which eventually become harder or impossible to cure. This disorder may occur at any age, either gender, any personality.  A conversion disorder is characterized by the loss of a bodily function, for example blindness , paralysis, or the inability to speak . The loss of physical function is involuntary, but diagnostic testing does not show a physical cause for the dysfunction. 

At least one symptom or deficit of sensory or voluntary motor function suggests a neurological or general
     medical condition.

It is not limited to pain or sexual dysfunction.

Appropriate investigation does not identify a neurological or general medical condition or the
     direct effects of substance use that can fully explain it.

Conflicts or other stressors that precede the onset or worsening of this symptom suggest
      that psychological factors are related to it.

The patient doesn't consciously feign the symptoms for material gain (Factitious Disorder)
      or to occupy the sick role (Malingering).

It is not a culturally sanctioned behavior or experience.

It is serious enough to produce at least 1 of:

* warrants medical evaluation, or
* causes distress that is clinically important, or
* impairs social, occupational or personal functioning

It does not occur solely during Somatization Disorder, and no other mental disorder better
      explains it.

Symptom Goupings:

* Sensory Symptoms: These include anesthesia, excessive sensitivity to strong simulation
  (hyperanesthesia), loss of sense of pain (analgesia), and unusual symptoms such as tingling or
   crawling sensations.

* Motor Symptoms: In motor symptoms, any of the body's muscle groups may be involved: arms,

  legs, vocal chords. Included are tremors, tics (involuntary twitches), and disorganized mobility or
   paralysis.

* Visceral Symptoms: Examples are trouble swallowing, frequent belching, spells of coughing or

  vomiting, all carried to an uncommon extreme. In both sensory and motor symptoms, the areas
  affected may not correspond at all to the nerve distribution in the area." 1

Specify type of symptom or deficit:

*  With Motor Symptom or Deficit
* With Seizures or Convulsions
* With Sensory Symptom or Deficit
* With Mixed Presentation

Associated Features

Depressed Mood
Somatic or Sexual Dysfunction
Guilt or Obsession
Anxious or Fearful or Dependent Personality

Differential Diagnosis 

Some disorders have similar or even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.

Generalized Anxiety Disorder
Histrionic Personality Disorder
Dependent personality Disorder

Cause:

The symptom onset of this disorder is usually very sudden and follows a stressful experience.  These disorders may be best thought of as disturbances of illness perception or need. They are paradigms of mind-body interactions and of the critical role of mental factors in the production of illness. Though the role of the mind in creating and maintaining illness has been known since antiquity, terms such as hysteria or psychosomatic illness have lost their meaning over time. All illnesses are "psychosomatic:" they occur in an individual at a particular psychological point in his/her life.

Treatment:

A physical examination is performed to rule out physical cause for loss of function. Specific diagnostic testing related to the exhibited symptom may be warranted to rule out a physical cause.

Counseling and Psychotherapy [ See Therapy Section ]:

The loss of function may symbolize the underlying conflict associated with it. Psychodynamic theory interprets the cause of the symptoms as a defense mechanism that absorbs and neutralizes the anxiety generated by an unacceptable impulse or wish. 

Psychiatric treatment is recommended to help the person understand the underlying psychological conflict. The person needs to know there is no organic cause for the symptom. The integrity of the affected body part or function must be maintained until the conflict is resolved and the symptoms usually disappear.

Complications can result from disuse of a body part or system. Seizure-like disorders referred to as pseudoseizures develop in some individuals.

Pharmacotherapy [ See Psychopharmacology Section ] :

Anti Depressants

See our Somatoform Disorders Page for links