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Conversion Disorder (a type of somatoform disorder)

Conversion disorder is a type of somatoform disorder that occurs in 2 out of 5 individuals all over the world. This disorder occurs when mental or emotional stress triggers neurological symptoms. Neurological symptoms include paralysis, tremors, blindness that cannot be diagnosed or explained visually by any medical staff or doctors. These symptoms, however, exist and are experienced by individuals but cannot be perceived by a third eye. A classic example stated by WebMD was to imagine falling off a bike and experiencing the physical trauma of not able to move your arm or any other body part. Additionally, all the medical tests say clear and no injury to your arm or any body part. But you still feel the pain of it like it would when the actual body part is injured. These symptoms are often a result of the brain converting psychological stress to physical and neurological symptoms.

The DSM classifies these types of disorders under the category of somatoform disorders. These disorders are often psychological with some of the other form of neurological symptoms which cannot be explained by any medical practitioners. These symptoms are most of the time caused by severe psychological trauma that gets converted into physical symptoms. Earlier, this disorder was considered hysteria. In greek terms, hysteria meant wandering uterus. In the past, this was associated with females as gender or the position of the baby in the womb. As generations progressed, APA in 1980 classified it as conversion hysteria that included individuals experiencing systems like dissociation. However, the term hysteria no more in use as it limits its understanding to a particular gender it’s believed to be co-morbid with other disorders like dissociative amnesia.

Sigmund Freud, a prominent figure in the field of Psychology, is known to study in-depth hysteria and conversion disorder. He also studied and found that these can occur in both women and men. Freud believed that individuals consciously suppress painful experiences that somehow got converted into neurological disorders. However, freudian’s emotional model is studied vastly there, have been many arguments and research on reasons or causes for such neurological symptoms. Recent studies have shown conversion disorder to occur more commonly in women.

Conversion disorder is more common in countries with poor to low-income areas. Adolescents and young adults are commonly diagnosed with it. India currently battles inpatients with about 31% of individuals with other co-morbid disorders like depression, anxiety which majorly reported come from the rural area. The USA reported around 14% of the general population with symptoms every year. In the below figure:1 we can observe that the brain scan shows (Amygdala, part of the brain responsible for controlling emotions) results of the emotional state of mind of individuals with conversion disorder. The attached has a link to the full study conducted on different groups of individuals as well. 

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Cause

However, the causes of this disorder are not clear. However, after an individual experiences psychological stress or trauma, it then gets converted into neurological symptoms. People with a prior diagnosis of dissociative disorder (dissociate oneself from reality without conscious effort), Personality disorders are at a higher risk of experiencing such symptoms. Even though it is not definite, it is one of the possibilities. It’s important to note that these symptoms exist, are real and this occurs without any conscious effort of the individual whatsoever.  

Symptoms

These usually occur suddenly and have to do mostly with the nervous systems like the brain, spinal cord, and other nerves. The following symptoms do not always come all the time. They differ in degree while, in some cases, individuals can experience only one or two of the below list.

-Numbness or paralysis
-Blindness or tunnel vision
-Loss of smell or touch
-In some cases, tremors, loss of balance
-Episodes of unresponsiveness
-Hearing problems or some deafness 

The diagnosis of this disorder includes physical examination where questions about the symptoms will be noted. Different tests might be conducted, depending on the signs, ruling out any other underlying medical diseases. A psychiatric evaluation will also be done to understand one’s thoughts, behaviors, feelings, and understand any minor or major triggers that lead to one experiencing these symptoms with consent from family and individuals. 

Treatments

The treatment would differ from the neurological symptoms that the individual experiences. There are no particular medications that are there to cure this disorder. However, antidepressants may help with any mood disorders or depressive episodes.

Treatment for neurological symptoms include:

-Occupational therapy (Therapy that can help in movements of hands, leg, and wave off any muscle stiffness.)
-Speech therapy
-Stress reduction ( therapy that involves activities for distraction and handling stress by breathing exercises, talking to people, listening to music)

Additionally, treatment for psychological symptoms include: 

-Cognitive Behavioural Therapy (CBT)
-Hypnosis
-Other therapies depending on the signs that show up.