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Conversion Disorder

Updated : February 21, 2024





Background

Conversion disorder is a psychiatric condition defined by sensory or motor function abnormalities. “Conversion” refers to substituting a suppressed thought for a physical symptom.

The associated symptoms are not consistent with any neurological disease. Although the conversion disease has no organic cause, it still impacts a patient’s motor functions.

Additionally, the symptoms that patient exhibits cannot be predicted or controlled; hence it is believed to be consciously pretended by the patient. There are currently few studies with sufficient sample sizes examining the brain mechanisms behind conversion disease.

Epidemiology

The incidence rate of conversion disorder in various countries ranges from 4-12 per 100,000 persons per year. Adult females diagnosed with conversion disorder outweigh adult males by a ratio ranging from 2:1 to 10:1. Recent evidence suggests that about 20-25% of hospitalized patients have either one or more symptoms, and only 5% of patients meet the criteria for the complete diagnosis.

The prevalence of this disorder has a significant difference when compared between developed and developing countries. The prevalence rate estimated in developing countries is up to 31%. Patients with low socioeconomic status and minimal education have higher incidence rates.

Ethnicity is not a significant factor. Recent studies have concluded that conversion disorder in children is uncommon before age five and generally develops in puberty or adolescence. The incidence rate in the pediatric population over 10 years of age represents a female to male ratio of 3:1.

Anatomy

Pathophysiology

According to neurobiological hypotheses, conversion disorder is caused by abnormalities in high-order cortical processing. The broad theory is that emotional stress activates the frontal and the subcortical parts of the brain, leading to inhibitory basal ganglia-thalamocortical circuits that inhibit motor processing or conscious sensory.

The activity of the left dorsolateral prefrontal cortex is reduced in individuals with conversion disorder. The left dorsolateral prefrontal cortex performs the role of intention and command activity

Etiology

Conversion disorder is caused by psychological, social, and biological variables. Trauma, unfortunate life events, and acute or chronic stressors often trigger symptoms. Several patients have a history of emotional and sexual abuse in childhood. Poor coping aptitudes and psychological challenges are two additional psychological elements that contribute to conversion disorder.

Patients with this disorder usually have psychiatric conditions such as anxiety, depression, or personality disorders. The psychodynamic disease model suggests that conversion disorder results from emotional conflict. The unconscious mind suppresses the emotional conflict and becomes a symptom. It is hypothesized that this scenario functions as a defense mechanism against the undesirable emotions that the emotional conflict could ordinarily bring forward.

The cognitive-behavioral model suggests that an individual, when exposed to specific symptoms through any visual or verbal information, creates a representation of the symptom in memory. Conversion disorder occurs when this representation in the memory is activated or triggered when the individual gets anxious and compares the symptom to self. This activation crosses a mental threshold, dominating sensory information and becoming a symptom.

Genetics

Prognostic Factors

The prognosis of this disorder is poor; it depends upon multiple factors such as early diagnosis, shorter duration of symptoms, lack of clinically comorbid psychiatric condition, and observable stressors.

Patients with a significant history of physical functioning impairment have higher chances of poor prognosis. Routine visits, cognitive-behavioral therapy, and physiotherapy (for motor impairments) have yielded significant improvement.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

1.https://www.ncbi.nlm.nih.gov/books/NBK551567/

2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479361/#

Conversion Disorder

Updated : February 21, 2024




Conversion disorder is a psychiatric condition defined by sensory or motor function abnormalities. “Conversion” refers to substituting a suppressed thought for a physical symptom.

The associated symptoms are not consistent with any neurological disease. Although the conversion disease has no organic cause, it still impacts a patient’s motor functions.

Additionally, the symptoms that patient exhibits cannot be predicted or controlled; hence it is believed to be consciously pretended by the patient. There are currently few studies with sufficient sample sizes examining the brain mechanisms behind conversion disease.

The incidence rate of conversion disorder in various countries ranges from 4-12 per 100,000 persons per year. Adult females diagnosed with conversion disorder outweigh adult males by a ratio ranging from 2:1 to 10:1. Recent evidence suggests that about 20-25% of hospitalized patients have either one or more symptoms, and only 5% of patients meet the criteria for the complete diagnosis.

The prevalence of this disorder has a significant difference when compared between developed and developing countries. The prevalence rate estimated in developing countries is up to 31%. Patients with low socioeconomic status and minimal education have higher incidence rates.

Ethnicity is not a significant factor. Recent studies have concluded that conversion disorder in children is uncommon before age five and generally develops in puberty or adolescence. The incidence rate in the pediatric population over 10 years of age represents a female to male ratio of 3:1.

According to neurobiological hypotheses, conversion disorder is caused by abnormalities in high-order cortical processing. The broad theory is that emotional stress activates the frontal and the subcortical parts of the brain, leading to inhibitory basal ganglia-thalamocortical circuits that inhibit motor processing or conscious sensory.

The activity of the left dorsolateral prefrontal cortex is reduced in individuals with conversion disorder. The left dorsolateral prefrontal cortex performs the role of intention and command activity

Conversion disorder is caused by psychological, social, and biological variables. Trauma, unfortunate life events, and acute or chronic stressors often trigger symptoms. Several patients have a history of emotional and sexual abuse in childhood. Poor coping aptitudes and psychological challenges are two additional psychological elements that contribute to conversion disorder.

Patients with this disorder usually have psychiatric conditions such as anxiety, depression, or personality disorders. The psychodynamic disease model suggests that conversion disorder results from emotional conflict. The unconscious mind suppresses the emotional conflict and becomes a symptom. It is hypothesized that this scenario functions as a defense mechanism against the undesirable emotions that the emotional conflict could ordinarily bring forward.

The cognitive-behavioral model suggests that an individual, when exposed to specific symptoms through any visual or verbal information, creates a representation of the symptom in memory. Conversion disorder occurs when this representation in the memory is activated or triggered when the individual gets anxious and compares the symptom to self. This activation crosses a mental threshold, dominating sensory information and becoming a symptom.

The prognosis of this disorder is poor; it depends upon multiple factors such as early diagnosis, shorter duration of symptoms, lack of clinically comorbid psychiatric condition, and observable stressors.

Patients with a significant history of physical functioning impairment have higher chances of poor prognosis. Routine visits, cognitive-behavioral therapy, and physiotherapy (for motor impairments) have yielded significant improvement.

1.https://www.ncbi.nlm.nih.gov/books/NBK551567/

2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479361/#