Conversion Disorders

October 18, 2005 5:58 PM

So - what *is* Conversion Disorder? And have people actually been healed of it?

I've seen the phrase 'Conversion Disorder' periodically, especially in relation to bizarre illnesses. In the meantime, I have heard that it is overdiagnosed, underdiagnosed, extremely rare, quite common, etc. (Hell, a local Epilepsy center even has pamphlets on Psychogenic Seizures). But not finding a lot in the way of stories of it being successfully treated. You'd think that if it was such a common disorder, there'd be tales all over the net about it. But, there isn't. So has anyone actually had Conversion Disorder, and were successfully cured of it? As opposed to doctors finally finding an organic cause for the patient's issues?

(Caveat - I am being treated for a bizarre neurological issue, which is where this came up.)

posted by spinifex23 to health & fitness (6 comments total)

I don't know if you can say if any mental illness truly "exists." It depends on what perspective you adopt in defining mental ilnness. The DSM-IV-TR criteria for a conversion disorder specify that the physical symptoms must be associated with the onset of a specific stressor, must involve voluntary motor or sensory function, and must not be explained by a general medical condition.

I'm not sure of the incidence/prevalence rates, but I'm certain that many people have had this happen and have been successfully treated. I would imagine that once an individual is able to successfully cope with the associated trauma, the conversion disorder will most likely abate.

A quick Google Scholar search for "conversion disorder" turned up these results. You might also do a PsycINFO search if you are affiliated with a university.

I think that discussion of "healing" someone with a conversion disorder is probably misleading -- you'd most likely want to address the trauma/stressor rather than actually treating the physical symptoms. It's worth noting that even if someone doesn't meet the criteria for a conversion disorder, per se, there are cultural and social components to the manifestation of mental disorders. For example, depression in China is often associated with lower back pain. It might be easier to consider this an expression of a body/mind holism rather than a discrete mental disorder.
posted by trey at 6:06 PM on October 18, 2005

Pretty wide spread in prognosis here - Prognostic studies differ in outcome, with recovery rates ranging from 15-74%. Hope everything works out okay with your bizzare thing spinifex23.
posted by tellurian at 6:31 PM on October 18, 2005

As the epilepsy fellow at UCSF this year, running the inpatient epilepsy monitoring unit, I probably see more conversion disorder per unit time than any other physician in a 300 mile radius. Most of the stuff I see indeed takes the form of psychogenic non-epileptic seizures. (caveat: I wrote that wikipedia link myself, and no one else has edited it much.)

I have countless recordings of these events, video and brainwaves, and in some cases have spent hours talking to folks who have this problem. I've learned a bit about it, but frankly it is one of the more baffling things I've ever run across in my entire lifetime, which has been spent mostly collecting bizarre arcana and trivia of baffling neurological interest.

You started this question by asking "What *is* conversion disorder?" I think this is the entirely wrong question to be asking if a person suffers from conversion disorder. Here is why:

a) We don't know, and when I say "We" I mean people who try to help folks with conversion disorder for a living.

b) One of the ways I think of conversion disorder is as a primary disorder of insight. Asking 'What *is* conversion disorder' is an attempt to gain insight. If insight is disordered, though, that's not going to work very well.

c) The studies bear out my gut feeling in b): analytic (insight-oriented) approaches to C.D. don't work. What works are behavioral ('cognitive behavioural' if in the U.K., as distinct from what we call 'cognitive' in the U.S.) approaches, such as hypnotherapy and breathing techniques.

If you'd like more info, my email's in my profile.
posted by ikkyu2 at 7:42 PM on October 18, 2005

I have seen it used in cases where frankly the physician simply did not know what was wrong, and so applied this label. No doubt, like anything difficult, there is misdiagnosis at times, and there is truth at the heart of the matter.

It brings to mind the label of schizophrenic, and how it was widely misapplied at one time.
posted by edgeways at 9:03 PM on October 18, 2005

ikkyu2: How do you know that people with psychogenic non-epileptic seizures aren't consciously faking it?
posted by footnote at 10:10 AM on October 19, 2005

footnote: you never do for sure, of course. In fact, if you want to look at it that way, you could say that their subconscious minds are "faking it."

That said, I know because they tell me so. Also, I know because I know, or think I know, the hallmarks of people who *are* faking neurologic disease. They usually have something to gain from it. Folks with PNES pretty much have their lives wrecked by the disease, just like folks with refractory epilepsy. They may be gaining something, but it's nothing their conscious minds can recognize.

Also, folks with PNES will jump through an incredible number of unpleasant hoops to try to get their seizures cured - just like folks with refractory epilepsy. They'll take medications, deal with really awful side effects, undergo operations.

Basically, though, I think your question contains some assumptions that are not necessarily germane to the way I practice. Why not ask if people with epilepsy are not "faking" both the convulsive movements and the associated abnormal brain waves? Why not ask if I am actually sitting in a room alone and "faking" my experiences of interaction with patients because I get a kick out of it?

When I say that folks with PNES are distinct as a group from both persons with epilepsy and persons with factitious disorder or malingering, I am making a clinical classification based on observable features, for the purpose of figuring out how best to treat them.
posted by ikkyu2 at 8:31 AM on October 20, 2005