CONVERSION DISORDER

Formerly known as "hysteria", the disorder has arguably been known for millennia, though it came to greatest prominence at the end of the 19th century, when the neurologist Jean-Martin Charcot, and psychiatrists Pierre Janet and Sigmund Freud made it the focus of their study.

The term "conversion" has its origins in Freud's doctrine that anxiety is "converted" into physical symptoms.

Definition

DSM-IV defines conversion disorder as follows:

One or more symptoms or deficits are present that affect voluntary motor or sensory function suggestive of a neurological

or other general medical condition. Psychological factors are judged, in the clinician's belief, to be

associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit. A diagnosis where the stressor precedes the onset of symptoms by up to 15 years is not unusual.

The symptom or deficit is not intentionally produced or feigned The symptom or deficit, after appropriate investigation, cannot be

explained fully by a general medical condition, the direct effects of a

substance, or as a culturally sanctioned behavior or experience. The symptom or deficit causes clinically significant distress or

impairment in social, occupational, or other important areas of

functioning or warrants medical evaluation.

The nature of the association between the psychological factors and the neurological symptoms remains unclear. Earlier versions of the DSM-IV employed psychodynamic concepts, but these have been incrementally removed from successive versions. The ICD-10 classifies conversion disorder as dissociative (conversion) disorder, which suggests the symptoms arise through the process of dissociation

History

The term "Conversion disorder" originated with Freud. He viewed these apparently neurological symptoms as a result of the conversion of intrapsychic distress in to physical symptoms.

The affected body part was seen as a symbolic infantile sex organ.

Presentation Conversion disorder can present with any motor or sensory symptom

including any of the following: Weakness/paralysis of a limb or the entire body (hysterical paralysis or

motor conversion disorders)

Impaired hearing or vision Loss/disturbance of sensation

Impairment or loss of speech (hysterical aphonia) Psychogenic non-epileptic seizures

Fixed dystonia unlike normal dystonia Tremor, or other movement disorders Gait problems Syncope (fainting)

Diagnosis

The diagnosis of conversion disorder involves three elements:

the exclusion of neurological disease, the exclusion of feigning, and the determination of a psychological

mechanism

Epidemiology

Prevalence Large scale psychiatric registers in the US and Iceland found rates

of 22 and 11 per 100000 per year, respectively,[34] but it is unclear what proportion of unexplained symptoms these represent.

Culture A community survey of urban Turkey found a rate of 5.6%.

Many authors have found rates to be higher in rural and lower socio-economic groups where technological investigation of patients is limited

Gender 'Hysteria' was originally understood to be a condition

exclusively affecting women, though it has increasingly been recognized in men.

In recent, larger studies women continue to predominate, with between 2 and 6 female patients for every male.

Age Conversion disorder may present at any age but is rare

in children younger than 10 years or in the elderly. Studies suggest a peak onset in the mid-to-late 30s.

Symptom Groupings:

Sensory Symptoms: These include anesthesia, excessive sensitivity to strong  simulation

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

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.

Treatment Explanation. This must be clear and coherent as attributing physical

symptoms to a psychological cause is not accepted by many educated people in western cultures. It must emphasize the genuineness of the condition, that it is common, potentially reversible and does not mean that the sufferer is a "psycho".

Physiotherapy where appropriate; Treatment of comorbid depression or anxiety if present. There is little evidence-based treatment of conversion disorder.

Other treatments such as cognitive behavioral therapy, hypnosis,

and psychodynamic psychotherapy need further trials.