Behavioral management of conversion disorder archives of. What families should know about conversion disorder. Randomized controlled clinical trials found that conversion disorder can be successfully treated with cbt which included the modification of catastrophic. Pdf treatment of a severe conversion disorder in a 10yearold. Studies have found that 2550 percent of patients diagnosed with conversion disorder are eventually discovered to have a medical condition that could have caused the symptoms. Conversion disorder functional neurological symptom disorder is characterized by neurologic symptoms eg, weakness, abnormal movements, or nonepileptic seizures that are inconsistent with a neurologic disease, but cause distress andor impairment 1. Functional neurologic disorders a newer and broader term that includes what some people call conversion disorder feature nervous system neurological symptoms that cant be explained by a neurological disease or other medical condition. An example of this is a person who loses his voice following a situation in which he was afraid to speak. Testing and diagnosis usually involves a neurologist, but may include a psychiatrist or other mental health professional. An examination of the revised dsm5 criteria for conversion disorder. In simple tracking studies, roughly 50% of patients had recovered at four and ten year followups. Conversion disorder symptoms tend to reflect an intolerable conflict in a way that is unique to the particular stressor or trauma. Conversion disorder one or more symptoms of altered voluntary motor or sensory function.
However, its important to get treatment as soon as symptoms develop. Keep in the program office or library for use by students, faculty, or staff. The disorder is common in clinical settings and often has a poor prognosis. The existence of conversion disorder has been known and documented for millennia. This can occur after they receive a diagnosis of the disorder, reassurance that the symptoms arent caused by an underlying problem, and validation that the symptoms are real. Conversion disorder, also called functional neurological disorder, is a condition in which abnormal movements or sensations spells, weakness, tremors are not due to injury or disease, but rather a result of a miscommunication of the nervous system and the body. The terminology, diagnosis, epidemiology, prognosis, clinical features, and assessment are discussed separately, as are specific subtypes of conversion disorder psychogenic nonepileptic seizures and functional movement disorders. In both these cases, in contrast to conversion disorder, the patient premeditates the symptoms and intentionally feigns them with a clearly conceived purpose in mind. Conversion disorder cd is an uncommon but highly disabling condition in the paediatric. A clinical and holistic approach by tocchio august 2009, vol. Occupational therapy should be part of conversion disorder. A clinical approach to paediatric conversion disorder continued nonepileptic seizures.
In both dsmiv and icd10 classifications, nonorganic neurological symptoms must occur in isolation for a diagnosis of conversion disorder to be made. Treatment is based on the described and physical symptoms. Functional neurologic disorders or conversion disorder include nervous system symptoms affecting movement or the senses that are not caused by medical disease. Conversion disorder genetic and rare diseases information. Pdf treatment of a severe conversion disorder in a 10year. Case history and treatment of a conversion disorder tahira. If something is not visible or told, it is difficult to plan treatment. The cornerstone of treatment for conversion disorder is psychotherapy aimed at.
For this reason, the dissociative disorders were historically grouped with the conversion disorders under the broad rubric of. The category of somatoform disorders was not officially recognized until the publication of dsmiii. Its imperative that there be communication between treatment providers when treating conversion disorder. Full text electroconvulsive therapy treatment in patients. The disorder is common in clinical settings and often has a poor prognosis 25. There was treatment going on, clearly, but not in the same fashion as in europe. Functional neurological disorder conversion disorder is defined in the american psychiatric association. Treatment may include psychotherapy, hypnosis, and stress management training to help reduce symptoms.
An important characteristic differentiates conversion disorders from other stressrelated health problems. Throughout its history, the etiology, diagnosis, and treatment of this disorder have been a subject of controversy. Conversion disorder dsmtreatment for conversion disorder. Conversion disorders medication medscape reference. It describes what dissociation is and what types of dissociative disorders there are. Rather, it means that the dissociative disorders are not instigated by some palpable insult, injury, or disease affecting the brain. Conversion disorder functional neurological symptom disorder is characterized by neurologic symptoms eg, weakness, abnormal.
Conversion symptoms suggest a physical disorder but are the result of psychological factors. Diagnostic and statistical manual of mental disorders dsmv as a condition in which symptoms and deficits in altered voluntary motor and sensory function. The core feature of conversion disorder is a deficit or distortion in neurological functioning, or symptoms suggesting a general medical condition that is not referable to an organic lesion. It is difficult to identify the cause of the chronic recurrent abdominal pain in the childhood. Conversion disorder is as serious, impairing, and disabling as any medical disorder epilepsy, stroke and should be treated that way 22. Throughout its history, the etiology, diagnosis, and treatment of this disorder have been a. Conversion disorder remains a diagnosis of exclusion. Treatment will also be tailored to fit the specific symptoms experienced by the individual. A brief summarize of conversion disorder treatments iaap.
Patients were in a wheelchair when not in therapy, and a physical therapy program was devised, using a treatment sequence based treatment of the analogous. An examination of the revised dsm5 criteria for conversion disorder including the current neuropsychiatric understanding of the condition is presented. Treatment of a severe conversion disorder in a 10yearold boy. Conversion disorder functional neurologic symptom disorder is characterized by neurologic symptoms eg, weakness, abnormal movements, or nonepileptic seizures that are inconsistent with a neurologic disease, but cause distress, andor impairment. Conversion disorder conversion disorder is a specific form of somatization in which the patient presents with symptoms and signs that are confined to the voluntary central nervous system 5. Jan 11, 2018 while the exact cause of conversion disorder is unknown, researchers believe it occurs in response to stressful situations or trauma. Conversion disorder cd, or functional neurologic symptom disorder, is a diagnostic category used in some psychiatric classification systems. Pdf conversion disorder cd in children remains a major challenge both in pediatric and mental health clinics and is still a prevalent psychiatric. A clinical approach to paediatric conversion disorder.
Symptoms usually begin suddenly after a period of emotional or physical distress or psychological conflict. Conversion disorder, also called functional neurological symptom disorder, 1 is defined as a psychiatric illness in which symptoms and signs affecting voluntary motor or sensory function cannot be explained by a neurological or general medical condition. Functional magnetic resonance imaging has shown cerebral correlates of clinical signs. Conversion disorders are different and much less common. Conversion disorder may slip through the cracks when determining possible presence of disorder. We describe a patient with nonepileptic seizures and psychogenic tremors as a starting point for a discussion about how to. The symptoms of conversion disorder dont typically last for more than a few weeks.
According to the psychodynamic model, the symptoms are a consequence of emotional conflict, with the repression of conflict into the unconscious. Treatment for patients with a functional neurological disorder conversion disorder. Cognitive behaviour therapy to treat a case of conversion. Onset tends to be more gradual than occurs with epileptic seizures. Conversion disorder american journal of psychiatry. Conversion disorder is a neurological disorder in which physical symptoms are unconsciously caused by a stressful or traumatic event. Psychoeducation helps patients accept their symptoms as real, validates the diagnosis, and allows for treatment. The course of a conversion disorder can vary across different individuals. Somatization and conversion disorder sage publications. Reproduce for distribution to other students, faculty, or staff.
So, although we present the treatments classified under the model which created them, never forget that in present psychology, therapies from different approaches are used together. Yet, following a thorough evaluation, which includes a detailed neurol. Somatic symptom and related disorders are those with distressing physical symptoms that are not fully explained by other medical, neurologic, or psychiatric disorders also known as somatization. For example, the patient may complain of blindness, yet cortical visual evoked potentials are normal. Physical therapy management of an adolescent with conversion disorder. Jul 03, 2017 the symptoms of conversion disorder dont typically last for more than a few weeks.
In this article, learn about the common symptoms and treatment. Diagnostic and statistical manual of mental disorders, fifth edition american psychiatric association. Physical therapy management for conversion disorder. In the end i had to make compromises, and see centres specialising in conversion disorder in children, or see individuals rather than centres, or see treatments for dissociative seizures a subtype of conversion disorder that is considered distinct by many. By determining origin of symptoms, a physical therapist can properly administer treatment. Treatment talk therapy and stress management training may help reduce symptoms. Since doctors have conceptually and practically differentiated the symptoms from neurological organic disease it has been presumed to be a psychological. Prominent involvement of truncal muscles arching and pelvic thrusting, as well as lateral rolling of head and body. Aug 07, 2017 however, it is not uncommon for patients with neurological diseases to also have conversion disorder. Conversion disorder is a rare condition in which your brain converts mental stress into physical symptoms. Menstrual disorders reproductive age in the reproductive age, psychologic causes of menstrual disorers involve marital and sex life, a detailed history might reveal significant events that precedes anovulatory episodes.
Conversion disorder is one of a group of psychological disorders called somatoform disorders. Although there is general agreement that treatment should address. Functional neurologic disordersconversion disorder. Treatment success can be enhanced by discussing the possibility of a somatoform disorder with the patient early in the evaluation process, limiting unnecessary diagnostic and medical treatments. Conversion disorder is a disorder in which a person experiences blindness, paralysis, or other symptoms affecting the nervous system that cannot be explained solely by a physical illness or injury. Nov 09, 2015 conversion disorder, as stated in the diagnostic and statistical manual of mental disorders, fourth edition, text revision dsmivtr, involves symptoms or deficits affecting voluntary motor or sensory function that suggest a neurologic or other general medical condition. The focus of psychotherapy is to help the individual understand the. It is sometimes applied to patients who present with neurological symptoms, such as numbness, blindness, paralysis, or fits, which are not consistent with a wellestablished organic cause, which cause significant distress, and can be traced back to a. Aug 18, 2017 for some people, the symptoms of conversion disorder may improve with time, even without treatment. Place in the sage colleges library collection and reproduce for interlibrary loan. Electroconvulsive therapy treatment in patients with somatic symptom and related disorders kawai leong,1 joseph cw tham,2 anton scamvougeras,2 fidel vilarodriguez3 1department of psychiatry, 2bc neuropsychiatry program, department of psychiatry, 3noninvasive neurostimulation therapies laboratory at ubc, department of psychiatry, university of british columbia, vancouver, bc, canada objective. The most important and difficult step in treating conversion disorder is making the correct diagnosis. Conversion disorder is thought to be caused by the bodys reaction to a stressful.
Symptoms of conversion disorder are not feigned or deliberately produced. Conversion and somatic symptom disorders are psychiatric conditions that fall under the somatic symptoms and related disorders category of the dsm5. The focus of psychotherapy is to help the individual understand the emotional. Cognitive behavioral therapy for somatoform disorders. The original dsmiii category of somatoform disorders included somatization disorder, hypochondriasis, conversion disorder, psychogenic pain disorder, and a residual somatoform disorder category apa, 1980. Nowadays, there are different approaches for disorder treatment, depending on the theoretical model used for the intervention. In factitious illness the purpose is to be a patient and under medical care. While the exact cause of conversion disorder is unknown, researchers believe it occurs in response to stressful situations or trauma. Conversion disorder functional neurological symptom disorder. Conversion disorder australia pdf ppt case reports. Conversion disorder, as stated in the diagnostic and statistical manual of mental disorders, fourth edition, text revision dsmivtr, involves symptoms or deficits affecting voluntary motor or sensory function that suggest a neurologic or other general medical condition.
She responded to treatment with valproate and sertraline. For example, speech therapy may benefit the individual if their symptoms include trouble with speaking or swallowing. A conversion disorder can sometimes resolve either on its own or in treatment. Case history and treatment of a conversion disorder tahira yousaf institute of professional psychology bahria university, karachi campus abstract the aim of the present study is to describe the case study and treatment of severe functional impairment in a nineteen year old young female adolescent with conversion disorder. Case history and treatment of a conversio n disorder tahira yousaf institute of professional psychology bahria university, karachi campus abstract the aim of the present study is to describe the case study and treatment of severe functional impairment in a nineteen year old young female adolescent with conversion disorder. How the world treats conversion disorder winston churchill. Electroconvulsive therapy treatment in patients with. Conversion disorder in adults management and treatment. Treatment for conversion disorder typically consists of psychotherapy, physical therapy, andor medication. Diagnosis of conversion disorder is based on identifying particular signs that are common among people with the disorder, as well as performing tests to rule out other causes of the symptoms. Neurologists, psychiatrists, and other professionals should communicate regularly to make sure that they are on the same page about the cause and treatment of various symptoms.
Recognizing and treating conversion disorder journal of. Conversion disorder with conceptual and treatment challenges. In malingering the purpose is to avoid some unpleasantness, such as jail. When conversion symptoms occur in isolation, the primary diagnosis is conversion disorder. For example, poor awareness or concern about symptoms can also occur in people with neurological disorders. History of broken relationships, alcoholism or drug addiction and school or social pressures. Your medical team provides treatment of any medical or neurological disease you may have that might be a trigger for your symptoms.
Since the symptoms of each patient with conversion disorder are different, treatments must be tailored to each individual patient. A brief summarize of conversion disorder treatments. Lower levels of hypochondriacal beliefs and behaviors lower levels of illness anxiety. Electroconvulsive therapy treatment in patients with somatic symptom and related disorders kawai leong,1 joseph cw tham,2 anton scamvougeras,2 fidel vilarodriguez3 1department of psychiatry, 2bc neuropsychiatry program, department of psychiatry, 3noninvasive neurostimulation therapies laboratory at ubc, department of psychiatry, university of british. Patients may express doubt, anger, and disappointment or seek different providers, which negatively affects the doctorpatient relationship.
610 985 44 564 1004 576 1295 1228 780 288 160 424 166 583 735 635 787 714 494 430 1239 581 885 404 204 1607 524 943 642 552 255 1408 1073 407 1312 522