By: Catherine Joachin
What is conversion disorder?
Conversion disorder, otherwise known as functional neurological disorder, is a psychiatric condition that impairs sensory and motor functioning (Cleveland Clinic, 2024). It features abnormal physical symptoms that are caused by psychological stress and which cannot be explained by a medical condition (Mayo Clinic, 2022).
Symptoms and causes
The degree of functional neurological impairment experienced by people with conversion disorder differs from one individual to another (Mayo Clinic, 2022).
The most commonly reported symptoms include:
- Nonepileptic seizures
- Muscle weakness or paralysis
- Difficulty swallowing
- Loss of balance
- Muscle spasms, tremors and twitches caused by disruption in muscle control
- Episodes of unresponsiveness (fainting)
- Dizziness
- Chronic fatigue
(Cleveland Clinic, 2024; Mayo Clinic, 2022)
Numbness, cognitive difficulties, speech, hearing and vision problems—the latter, which can worsen to the point of deafness or blindness—are among common sensory symptoms (Mayo Clinic, 2022). Moreover, people with conversion disorder generally display indifference in the face of their symptoms (Cleveland Clinic, 2024; Peeling & Muzio, 2023).
Conversion disorder is believed to be the result of complex but poorly understood mechanisms; therefore, its origins are not clearly defined (Mayo Clinic, 2022). However, there are risk factors associated with an increased likelihood of developing this condition, namely:
- An history of childhood abuse
- A recent stressful event
- An emotional or physical trauma
- Mental health problems
- Neurological disease or family history of neurological conditions
(Mayo Clinic, 2022)
Psychogenic non-epileptic seizures
Psychogenic non-epileptic seizures (PNES) are a defining sign of conversion disorder. They refer to seizures originating from psychological factors rather than abnormal electrical brain activity (Cleveland Clinic, 2024). These seizures typically feature generalized limb shaking and hip thrusting but lack the state of altered consciousness that usually follows an epileptic attack (Peeling & Muzio, 2023). On the surface, psychogenic non-epileptic seizures closely resemble epileptic seizures and can therefore be misdiagnosed as such (Cleveland Clinic, 2024). While the two conditions are distinct from one another, comorbid epilepsy, which occurs in approximately 10 to 15% of PNES cases, is still possible (Cleveland Clinic, 2024).
An electroencephalogram recording showing an absence of convulsive brain activity can help rule out an epilepsy diagnosis (Cleveland Clinic, 2024). Additionally, resistance to eye closure during a seizure, a trait not commonly observed in epilepsy, is an indicator of PNES that can be revealed through a physical exam (Peeling & Muzio, 2023). Addressing any source of psychological distress through psychotherapy, such as cognitive behavioral therapy (CBT), or the treatment of underlying psychiatric conditions is the main approach used to tackle PNES symptoms, as the condition is resistant to anti-seizure medication (Cleveland Clinic, 2024).
Diagnosis and Treatment
There are no standardized exams that can detect conversion disorder; therefore, a diagnosis is usually established by performing any test that could rule out a physical affliction. These include:
- EEG (electroencephalogram)
- CT (computerized tomography) scan
- MRI (magnetic resonance imaging)
- Blood tests
- Evoked potentials test
(Cleveland Clinic, 2024)
Conversion disorder shares similarities with other psychotic disorders, namely factitious disorder and somatic symptom disorder. However, unlike people with factitious disorder, patients with conversion disorder experience real neurological symptoms and are not trying to deceive others by faking or exaggerating their symptoms (Peeling & Muzio, 2023). Furthermore, their symptoms, while distressing and disruptive, are inconsistent with an identifiable diagnosis, which is not the case in somatic symptom disorder (Cleveland Clinic, 2024).
Treatment for conversion disorder is symptom dependent and can range from learning about the condition to physical, psychiatric or occupational therapy, all depending on the issues meant to be treated (Mayo Clinic, 2022).
Conclusion
Conversion disorder is a mental illness marked by neurological symptoms that cannot be explained by a medical diagnosis. These symptoms are real somatic experiences that can cause psychological distress, yet they cannot be explained by medical screening results, nor can they be treated by conventional medication. An hallmark of this disorder is psychogenic non-epileptic seizures, which are epilepsy-like attacks unrelated to unusual brain activity. Education and psychological treatment options are the most promising avenues in terms of addressing functional neurological disorder.
References
Cleveland Clinic. (2024). Conversion Disorder. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17975-conversion-disorder#symptoms-and-causes
Cleveland Clinic. (2024). Psychogenic Nonepileptic Seizure (PNES). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/24517-psychogenic-nonepileptic-seizure-pnes#diagnosis-and-tests
Mayo Clinic. (2022). Functional neurologic disorder/conversion disorder – Diagnosis & treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/conversion-disorder/diagnosis-treatment/drc-20355202
Mayo Clinic. (2022). Functional neurologic disorder/conversion disorder – Symptoms & causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/conversion-disorder/symptoms-causes/syc-20355197
Peeling, J. L., & Muzio, M. R. (2023). Functional Neurologic Disorder. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK551567/#:~:text=Introduction,diseases%20or%20other%20medical%20conditions.