Conversion disorder is a mental disorder characterized by symptoms that
suggest a neurologic or general medical condition but that cannot
be fully explained by a neurologic or mental disorder. Other synonyms
include psychogenic disorder, pseudoneurologic syndrome, or hysterical neurosis.
Conversion disorder is one of several types of somatoform disorder
(conversion disorder, hypochondriasis, somatization disorder, somatoform
pain disorder) that is characterized by persistent physical symptoms
for which no cause can be found. For a diagnosis of conversion disorder
to be made, the following five criteria must be met1:
1. A symptom is expressed in which there is a change
or loss of physical function suggesting a physical disorder.
2. The patient has experienced a recent psychological stressor or
3. The patient unconsciously produces the symptom.
4. The symptom cannot be explained by a known organic etiology or culturally
sanctioned response pattern.
5. The symptom is not limited to pain or sexual dysfunction.
An illustrative example involves the case of a young wife who
is scheduled to visit her debilitated father in the hospital. His
recent diagnosis of cancer has left her distraught, and the sight
of him depresses her greatly. On the morning of her visit, she suddenly
This example typifies a conversion
disorder in which conflict is caused by the patient’s intense,
but psychically unacceptable, urge to avoid a required action (in
this case, visiting her father). The physical symptom (blindness)
allows expression of the urge (how can she drive there if she is
blind?) without consciously confronting the feelings that led to
the wish. At the same time, the symptom imposes morbidity as a punishment
for the wish. Often, the presenting symptom will have a symbolic relationship
to the conflict, but this is not always the case. In this case,
the sight of her father is distressing; and therefore, loss of sight
is the chief complaint.
Conversion disorders are often thought of as
nonverbal exertions of control on the environment. Two mechanisms
are responsible for the symptoms. The first is primary gain,
in which the symptom allows patients to avoid confronting their
uncomfortable feelings. The second is secondary gain,
in which uncomfortable situations are avoided and support is given that
might not normally be available. In our example, secondary gain would
occur if the patient’s husband then stayed home from work
to tend to his “blind” wife.
Conversion disorders are described as rare, and
most agree that the incidence is declining. Cases predominantly
involve neurologic and orthopedic manifestations and are seen in
the military during times of war, in victims of industrial accidents,
and in victims of violence. Conversion disorders are much more frequent
in women, accounting for most cases in some series, than in men.
The most common ages of presentation are adolescence or early childhood,
although other age groups are affected.2 A recent
large Australian study found the average age of ...