CONVERSION DISORDER

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CONVERSION DISORDER

• By
• Dr. Hena Jawaid

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Definition

• Term refers to a condition in which there are
  isolated neurological symptoms that can not be
  explained in terms of known mechanism of
  pathology and in which there has been a
  significant pathological stressor.

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Derivation

• Hysterikos (Greek)- suffering in the uterus ?
  hystericus (Latin) ? Hysteric (Latin) ? hysteria

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Background

• Upto 17th CE Hysteria is due to abnormal
  position/function of Uterus
• Charcot (1825-93) identified it as functional
  disorder of brain that enhances hypnotic ability,
  existing symptoms can be modified and symptoms
  can be induced
• Pierre Janet (1859-1947) tendency to
  dissociation loss normal integration
• Frued in 1893-95 wrote a paper Studies on
  Hysteria adopted word Conversion.
• (Unexpressed emotions to physical symptoms)

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DSM IV Criteria

• deficits suggest a neurological or other general
  medical condition
• deficit is preceded by conflicts or other
  stressors
• deficit is not intentionally produced or feigned
• deficit can not be fully explained
• deficit causes significant distress
• deficit is not limited to pain or sexual
  dysfunction, somatization dis.

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DSM IV Criteria (cont.)

• With Motor Deficit
• With Sensory Deficit
• With Seizures or Convulsions
• With Mixed Presentation

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ICD - 10

• Clinical features as specified for the individual
  disorders
• No evidence of a physical disorder that might
  explain the symptoms
• Evidence for psychological causation, in the form
  of clear association in time with stressful
  events and problems or disturbed relationships

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ICD 10

• D. Amnesia
• D. Fugue
• Multiple Personality disorder
• D./Conversion NOS
• D. Stupor
• Trance and Possession disorder
• Gansers Syndrome

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Classification

• DSM IV
• D. Amnesia
• D. Fugue
• D. Identity disorder
• Depersonalization dis.
• D. Disorder NOS

• ICD -10
• D. Amnesia
• D. Fugue
• Multiple Personality disorder
• D./Conversion NOS
• D. Stupor
• Trance and Possession disorder
• Gansers Syndrome

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Epidemiology

• Incidence 5-12/ 100,000
• Prevalence 50/100,000
• Reference-
• Shorter Oxford textbook of Psychiatry 5th edn.

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Epidemiology (Cont.)

• In India, 31 among IP, 6-11 in OP setting
• In Turkey among OP 27.2
• In Pakistan -12.4 in OP and 4.8 of the
  admissions in IP psychiatric units 
• Females as compared to males (60 vs. 4.20),
  middle income group, less education  
• References
• Malik P, Singh P. Characteristics and outcome of
  children and adolescent with conversion disorder.
  Indian J Pediatr 200239747-52.
• Wig NN. A follow up study of hysteria. Indian J
  Psychiatry 1982350-5.
• Pehlivanturk B, Unal F. Conversion disorder in
  children and adolescents clinical features and
  co morbidity with depressive and anxiety
  disorders. Turk J Pediatr 200042132-7.
• Malik SB, Bokhari IZ. Psychiatric admissions in
  a teaching hospital a profile of 177 patients. J
  Coll Physicians Surg Pak 19959159-61

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Epidemiology (Cont.)

• The commonest symptoms among the patient
  population in Pakistan may be extremely rare in
  West, unresponsiveness and jerky body movements
  (pseudo-seizures) 53
• Refrences
• Conversion Disorder Difficulties in Diagnosis
  using DSM-IV/ ICD-10 by Syed EU et al

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Etiology

• Psychodynamic theories
• Social factors
• Neuro-physiological mechanisms
• Cognitive explanations
• Cultural explanations

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Neuro-physiological mechanisms

• SPECT using (99m)Tc-ECD- decrease RCBF in
  thalamus basal ganglia opposite to the deficit.
• Lower activation in contralateral caudate during
  hysterical conversion symptoms predicted poor
  recovery at follow-up. hysterical conversion
  deficits may involve a functional disorder in
  striatothalamocortical circuits controlling
  sensorimotor function and voluntary motor
  behavior
• References -
• Functional neuroanatomical correlates of
  hysterical sensorimotor loss Brain. 2001 Jun by
  Vuilleumier P

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Treatment

• Reassurance
• Immediate efforts to resolve any stressful
  conflict or event
• Should provide healthy alternatives for return to
  normal functioning
• Attention should be directed away from symptoms
  to resolution of problems
• Offer continuing help

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Treatment (Cont.)

• Medication has no direct play in the treatment
• If conversion is secondary Depression
• If conversion is secondary Anxiety

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Prognosis

• Good
• Short history
• Young age

• Bad
• Long history
• Personality disorder
• Receipt of disability benefit

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