Conversion disorder
Functional neurological symptom disorder; Hysterical neurosis
Conversion disorder is a mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.
Causes
Conversion disorder symptoms may occur because of a psychological conflict.
Symptoms usually begin suddenly after a stressful experience. People are at risk of conversion disorder if they also have:
- A medical illness
- A dissociative disorder (escape from reality that is not on purpose)
- A personality disorder (inability to manage feelings and behaviors that are expected in certain social situations)
People who have conversion disorder are not making up their symptoms in order to obtain shelter, for example (malingering). They are also not intentionally injuring themselves or lying about their symptoms just to become a patient (factitious disorder). Some health care providers falsely believe that conversion disorder is not a real condition and may tell people that the problem is all in their head. But this condition is real. It causes distress and cannot be turned on and off at will.
The physical symptoms are thought to be an attempt to resolve the conflict the person feels inside. For example, a woman who believes it is not acceptable to have violent feelings may suddenly feel numbness in her arms after becoming so angry that she wanted to hit someone. Instead of allowing herself to have violent thoughts about hitting someone, she experiences the physical symptom of numbness in her arms.
Symptoms
Symptoms of a conversion disorder include the loss of one or more bodily functions, such as:
- Blindness
- Inability to speak
- Numbness
- Paralysis
Common signs of conversion disorder include:
- A debilitating symptom that begins suddenly
- History of a psychological problem that gets better after the symptom appears
- Lack of concern that usually occurs with a severe symptom
Exams and Tests
The provider will do a physical exam and may order diagnostic tests. These are to make sure there are no physical causes for the symptom.
Treatment
Talk therapy and stress management training may help reduce symptoms.
The affected body part or physical function may need physical or occupational therapy until the symptoms go away. For example, a paralyzed arm must be exercised to keep the muscles strong.
Outlook (Prognosis)
Symptoms usually last for days to weeks and may suddenly go away. Usually the symptom itself is not life threatening, but complications can be debilitating.
When to Contact a Medical Professional
See your provider or mental health professional if you or someone you know has symptoms of a conversion disorder.
References
American Psychiatric Association. Conversion disorder (functional neurological symptom disorder). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013:318-321.
Cottencin O. Conversion disorders: psychiatric and psychotherapeutic aspects. Neurophysiol Clin. 2014;44(4):405-410. PMID: 25306080
Gerstenblith TA, Kontos N. Somatic symptom disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 24.
Version Info
Last reviewed on: 11/7/2020
Reviewed by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
