Chapter 288

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. 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 conflict.

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 becomes blind.

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 ...

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