Conversion Disorder

Conversion Disorder describes impairment in sensory or motor function resulting from unknown neurological origin. Examples of sensory function include vision, hearing, and skin sensation; examples of motor function include weakness, tremors, or abnormal movements. The symptoms that manifest must be incompatible with a recognized neurological or medical disorder. However, just because an “unknown” or “bizarre” condition is present, this does not warrant a diagnosis of Conversion Disorder. The individual’s symptoms must also suggest that they are not arising from an organic neurological impairment; rather, they demonstrate a degree of inconsistency due to their enigmatic source.

Historically, this disorder was termed “hysteria” by Freud after observing similar symptoms in his patients. For example, a woman might present with a paralyzed right arm for no apparent reason. Freud suggested that these symptoms were expressions, or “conversions,” of unconscious cognitive or emotional material that were unacceptable to the conscious mind or contained conflict. Today, while the medical model has crossed oceans in attempts to abandon Freudian thought, this is one of the topics that still holds mystery and lies in the wake of our repressed Freudian shores. While medical doctors do not understand Conversion Disorder in terms of unconscious material, most professionals would agree that there is a considerable psychological and emotional component. Stress and trauma are ghosts that mysteriously elicit these physical symptoms.

Criteria for Conversion Disorder:

1. One or multiple symptoms of altered voluntary motor or sensory function.
2. Clinical examinations suggest incompatibility between the symptoms and recognized neurological or medical conditions.
3. The symptoms are not better explained by another medical condition or mental disorder.
4. Symptoms or deficits cause significant distress and impairment in social, occupational, or other important areas of functioning.

Regardless of the source of these symptoms, it is important for patients and doctors to remember that the suffering is real. Conversion Disorder does not mean that the individual is “faking it” or looking for “secondary gain” (e.g., attention). Physical symptoms are present and experienced with the same degree of intensity and discomfort, and deserve the same careful observation and professional care. Individuals might also want to consider seeing a mental health professional, due to the interrelationship between these symptoms and psychological/emotional maladies.

Examples of Impairments

Conversion Disorder is also referred to as “Functional Neurological Symptom Disorder,” referring to the “functional” impairments in behavior, rather than neurological abnormalities, per se. Some examples of “functional” impairments associated with Conversion Disorder are described below.

Possible Motor Symptoms:

• Weakness
• Paralysis
• Abnormal movements
  • Tremors or dystonia (abnormal muscle contractions/movements)
• Gait abnormalities
• Abnormal posture
• Limb shaking resembling seizures
• Reduced or absent speech or articulation
• Sensation of a lump in the throat

Possible Sensory Symptoms:

• Abnormal, reduced, or absent:
  • Skin sensation
  • Vision (e.g., blurred vision, seeing double)
  • Hearing
• Unresponsiveness resembling fainting or coma

Material summarized from:

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5^th ed.). Arlington, VA: American Psychiatric Association.

*Note: This article has replaced a previous version from 2002 by author Mark Dombeck, Ph.D., in order to reflect updated material in the new DSM-5.