Conversion Disorder Essay

Conversion Disorder Formerly known as “Hysteria,” and also called Pseudoneurologic Syndrome, Hyterical Neurosis, or Psychogenic Disorder, Conversion Disorder is a type of Somatoform disorder. Symptoms occur that commonly resemble those of neurological disorders such as stroke, multiple sclerosis or epilepsy, but seemingly happen without corresponding bodily damage, and there are no existing physical disorders. Medical tests on people that have this disorder are either normal or they are unable to explain the cause of the problems.

Diagnoses of this disorder includes the disqualification of conscious malingering (fabrication or exaggeration of symptoms) or factitious disorders. The symptoms that occur are narrowed to problems in structures that are governed by the Somatic nervous system. These symptoms include the following: Hysterical paralysis– weakness/paralysis of a limb or the entire body, impaired vision or hearing, loss or disturbance of sensation, hysterical aphonia– impairment or loss of speech, psychogenic non-epileptic seizures, fixed distonia, tremors, gait problems, or fainting.

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These symptoms happen unexpectedly and dramatically, sometimes after a stressful event in one’s life. Symptoms are thought to disappear when the patient is asleep, hypnotized, under anesthesia, or unconscious (Parobek, 1997; Silver, 1996), and are often more severe on the non-dominant (often left) side of the body. Some believe that because of unconscious knowledge that the symptoms are unreal, patients show “a relative lack of concern about the nature or implications of the symptoms. (DSM-IV) This is called “La Belle Indifference. ” A later study showed that no evidence was found suggesting that petients with “functional” symptoms were any more likely to show this than patients with real neurological conditions. (Stone J, Smyth R, Carson A, Warlow C, Sharpe M: 2006) “Hysteria” was once originally thought to effect only women, but recent studies show that men also suffer from this disorder, although there are about 2-6 female patients for every male patient.

The diagnosis of Conversion Disorder is a complex process, so these studies should not always be relied upon to tell us whether women or men are more effected. This disorder may happen at any age, but is rare in the elderly and children under ten years old. The cause of Conversion Disorder is often considered an effect of repression of stressful events, and often happens after conflicts, stressors, or diffulculties in a patient’s life. (DSM-IV) The name “conversion” came from Sigmund Freud’s theory that anxiety or intrapsychic distress is “converted” into physical symptoms.

Early Freudian model proposed the idea that the emotional charge of painful experiences would be consciously repressed as a defense mechanism to lessen the anxiety, but this emotional charge would somehow be “converted” into the neurological symptoms. (Breuer & Freud 1895) Freud also believed that the repressed experiences were “of a sexual nature. ” Support for this claim includes the findings of high rates of childhood sexual abuse in conversion patients. (Roelofs K, Keijers GP, Hoogduin KA, Naring GW, Moene FC, 2002)

The ICD-10 classifies Conversion Disorder as Dissociative (Conversion) Disorder, suggesting that the symptoms emerge through the process of dissociation– which may be a response to trauma, because it allows the mind to distance itself in a way from experiences that are too much for the psyche to handle at that time. Dissociations are often upsetting because they are unexpected and obscure to the people who experience them. Pierre Janet, another influential theoretician of hysteria, didn’t see dissociation as a psychological defense, but believed that it acts on a personality already vulnerable to dissociation. Janet, P. 1920) Support for the dissociation model includes studies showing heightened suggestibility in patients diagnosed with Conversion Disorder, and in abnormalities in motor imagery. (Roelofs K, Hoogduin KA, Keijers GP, Naring GW, Moene FC, Sandijck P. , 2002) The following are treatments for Conversion Disorder, however much of it is still under trial. Physiotherapy, or physical therapy, evaluates and supplies treatment to develop, maintain, and restore ideal function and movement. This is applied where appropriate.

Cognitive Behavioral Therapy (CBT), aims to solve problems that have to do with dysfunctional emotions, thoughts, and behaviors through a systematic and goal-oriented procedure. Eye Movement Desensitization and Reprocessing (EMDR), was developed to help deal with symptoms that are the cause of disruptive and/or unresolved experiences through an approach that discusses past, present, and future aspects. Psychodynamic Psychotherapy is found in Depth Psychology, and attempts to uncover unconscious thought to lessen psychic tension.

This therapy often relies on the relationship between the client and therapist, and instead of using a single system of influence, it uses many sources, and is considered much more diverse and less concentrated than Psychoanalysis. Other treatments include stress management training, hypnosis, and treatment of depression or anxiety if it is present. Sources/References: Roelofs K, van Galen GP, Keijers GP, Hoogduin CA “Motor Initiation & Execution in Patients with Conversion Paralysis” Acta Psychol. (Amst. ) 2002 May; 110 (1): 21-34 Roelofs K, Hoogduin KA, Keijers GP, Naring GW, Moene FC, Sandijck P. Hynotic Susceptibility in Patients with Conversion Disorder. ” J Abnorm. Psychol. 2002 May; 111 (2): 390-395 Roelofs K, Keijers GP, Hoogduin KA, Naring GW, Moene FC “Childhood Abuse in Patients with Conversion Disorder” Am J Psychiatry, 2002 Nov: 159(11): 1908-13 Janet, Pierre “The Major Symptoms of Hysteria,” 1920 2nd ed. Breuer & Freud “Studies in Hysteria,” 1895 Stone J, Smyth R, Carson A, Warlow C, Sharpe M “La Belle Indifference in Conversion Symptoms & Hysteria: Systematic Review” Br J Psychiatry, 2006 Mar: 188 pgs. 204-9

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