What is conversion disorder?
According to the National Library of Medicine, conversion disorder is a psychiatric disorder characterized by signs and symptoms affecting sensory or motor function inconsistent with patterns of known neurologic diseases or other medical conditions and significantly impact the patient’s ability to function. The Cleveland Clinic states that functional neurological symptom disorder – better known as “conversion disorder” – is a mental health condition that causes physical symptoms. The symptoms happen because your brain “converts” the effects of a mental health issue into disruptions of your brain or nervous system.
Signs and symptoms vary, depending on the type of functional neurologic disorder, and may include specific patterns. Typically, this disorder affects your movement or your senses, such as the ability to walk, swallow, see or hear. Symptoms can vary in severity and may come and go or be persistent. However, you can’t intentionally produce or control your symptoms.
The symptoms are real but don’t match up with recognized brain-related conditions. It’s important to know that conversion disorder is a real mental health condition. It’s not faking or attention-seeking. It isn’t just something in a person’s head or that they’ve imagined. While it’s a mental health condition, the physical symptoms are still real. A person with conversion disorder can’t control the symptoms just by trying or thinking about it.
The cause of functional neurologic disorder is unknown. The condition may be triggered by a neurological disorder or by a reaction to stress or psychological or physical trauma, but that’s not always the case. Functional neurologic disorder is related to how the brain functions, rather than damage to the brain’s structure (such as from a stroke, multiple sclerosis, infection, or injury). Early diagnosis and treatment, especially education about the condition, can help with recovery.
Symptoms
Signs and symptoms of functional neurologic disorder may vary, depending on the type of functional neurological symptoms, and they’re significant enough to cause impairment and warrant medical evaluation. Symptoms can affect body movement and function and the senses. Signs and symptoms that affect body movement and function may include:
- Weakness or paralysis
- Abnormal movement, such as tremors or difficulty walking
- Loss of balance
- Difficulty swallowing or feeling “a lump in the throat”
- Seizures or episodes of shaking and apparent loss of consciousness (nonepileptic seizures)
- Episodes of unresponsiveness
Signs and symptoms that affect the senses may include:
- Numbness or loss of the touch sensation
- Speech problems, such as the inability to speak or slurred speech
- Vision problems, such as double vision or blindness
- Hearing problems or deafness
- Cognitive difficulties involving memory and concentration
When to see a doctor
Seek medical attention for signs and symptoms that concern you or interfere with your ability to function. If the underlying cause is a neurological disease or another medical condition, quick diagnosis and treatment may be important. If the diagnosis is functional neurologic disorder, treatment may improve the symptoms and help prevent future problems.
Causes
The exact cause of functional neurologic disorder is unknown. Theories regarding what happens in the brain to result in symptoms are complex and involve multiple mechanisms that may differ, depending on the type of functional neurological symptoms. Basically, parts of the brain that control the functioning of your muscles and senses may be involved, even though no disease or abnormality exists. Symptoms of functional neurologic disorder may appear suddenly after a stressful event, or with emotional or physical trauma. Other triggers may include changes or disruptions in how the brain functions at the structural, cellular, or metabolic level. But the trigger for symptoms can’t always be identified.
Risk Factors
Factors that may increase your risk of functional neurologic disorder include:
- Having a neurological disease or disorder, such as epilepsy, migraines, or a movement disorder
- Recent significant stress or emotional or physical trauma+
- Having a mental health condition, such as a mood or anxiety disorder, dissociative identity disorder, or certain personality disorders
- Having a family member with a neurological condition or symptoms
- Having a history of physical or sexual abuse or neglect in childhood
Females may be more likely than males to develop functional neurologic disorder.
Complications
Some symptoms of functional neurologic disorder, particularly if not treated, can result in substantial disability and poor quality of life, similar to problems caused by medical conditions or diseases. Functional neurologic disorder may be associated with:
- Pain
- Anxiety disorders, including panic disorder
- Depression
- Insomnia
- Fatigue
Diagnosis
There are no standard tests for functional neurologic disorder. Diagnosis usually involves assessment of existing symptoms and ruling out any neurological or other medical condition that could cause the symptoms.
Functional neurologic disorder is diagnosed based on what is present, such as specific patterns of signs and symptoms, and not just by what is absent, such as a lack of structural changes on an MRI or abnormalities on an EEG.
Testing and diagnosis usually involve a neurologist but may include a psychiatrist or other mental health professional. Your health care provider may use any of these terms: functional neurologic disorder (FND), functional neurological symptom disorder or an older term called conversion disorder.
Sometimes your disorder may be called by a term that specifies the type of functional neurological symptoms you have. For example, if your symptoms include problems walking, your health care provider may call it functional gait disorder or functional weakness.
Evaluation may include:
- Physical exam. Your health care provider examines you and asks in-depth questions about your health and your signs and symptoms. Certain tests may eliminate neurological disease or other medical disorders as the cause of your symptoms. Which tests you’ll have depends on your signs and symptoms.
- Psychiatric exam. If appropriate, your neurologist may refer you to a mental health professional. He or she asks questions about your thoughts, feelings and behavior and discusses your symptoms. With your permission, information from family members or others may be helpful.
- Diagnostic criteria in the DSM-5. Your health care provider may compare your symptoms to the criteria for diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists these criteria for conversion disorder (functional neurological symptom disorder):
- One or more symptoms that affect body movement or your senses.
- Symptoms can’t be explained by a neurological or other medical condition or another mental health disorder.
- Symptoms cause significant distress or problems in social, work, or other areas, or they’re significant enough that medical evaluation is recommended.
Treatment
Treatment for functional neurologic disorder will depend on your particular signs and symptoms. For some people, a multispecialty team approach that includes a neurologist; psychiatrist, or other mental health professional; speech, physical, and occupational therapists; or others may be appropriate.
Understanding what functional neurologic disorder is, that the symptoms are real, and that improvement is possible can help you with treatment choices and recovery. Symptoms may get better after an explanation of the condition and reassurance from your healthcare provider that symptoms are not caused by a serious underlying neurological or other medical disorder.
For some people, education, and reassurance that they don’t have a serious medical problem is the most effective treatment. For others, additional treatments may be beneficial. Involving loved ones can be helpful so that they can understand and support you. Your medical team provides treatment of any underlying neurological or other medical disease you may have that might be a trigger for your symptoms.
Depending on your needs, therapies may include:
- Physical or occupational therapy. Working with a physical or occupational therapist may improve movement symptoms and prevent complications. For example, regular movement of arms or legs may ward off muscle tightness and weakness if you have paralysis or loss of mobility. Gradual increases in exercise may improve your ability to function.
- Speech therapy. If your symptoms include problems with speech or swallowing, working with a speech therapist (speech-language pathologist) may help.
- Stress reduction or distraction techniques. Stress reduction techniques can include methods such as progressive muscle relaxation, breathing exercises, physical activity, and exercise. Distraction techniques can include music, talking to another person, or deliberately changing the way you walk or move.
Even though functional neurological symptoms are not “all in your head,” emotions and the way you think about things can have an impact on your symptoms and your recovery. Psychiatric treatment options may include:
- Cognitive behavioral therapy (CBT). A type of psychotherapy, cognitive behavioral therapy (CBT) helps you become aware of inaccurate or negative thinking so that you can view situations more clearly and respond to them in a more effective way. CBT can also help you learn how to better manage stressful life situations and symptoms. This may be particularly beneficial if your symptoms include nonepileptic seizures. Other types of psychotherapy may be helpful if you have interpersonal problems or a history of trauma or abuse.
- Treating other mental health conditions. Anxiety, depression, or other mental health disorders can worsen symptoms of functional neurologic disorder. Treating mental health conditions along with functional neurologic disorder can help recovery.
Medications are not effective for functional neurologic disorder, and no drugs are approved by the Food and Drug Administration specifically as a treatment. However, medications such as antidepressants may be helpful if you also have depression or other mood disorders, or you’re having pain or insomnia.
Regular follow-up with your medical team is important to monitor your recovery and make changes to your treatment plan as needed.
This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.
