An Overview of Conversion Disorder: Prevalence, Causes, and Treatment

Abstract

This paper reviews an overall picture of conversion disorder to develop a clear and systematic understanding of its etiology, causes, and treatment.
Keywords: Conversion Disorder; Etiology Treatment; Paralysis; Blindness; Neurological; Organic Cause; Psychoanalysis; Indian Research Studies

Full text

Acta Scientific Neurology (ISSN: 2582-1121)
Volume 3 Issue 10 October 2020
An Overview of Conversion Disorder: Prevalence, Causes, and Treatment
Dhruv Beri1* and K Jayasankara Reddy2
1P.G. Student, Department of Psychology, Christ (Deemed to be) University,
Bengaluru, Karnataka, India
2Professor, Department of Psychology, Christ (Deemed to be) University, Bengaluru,
Karnataka, India
*Corresponding Author: Dhruv Beri, P.G. Student, Department of Psychology,
Christ (Deemed to be) University, Bengaluru, Karnataka, India.
Research Article
Received: September 11, 2020
Published: September 30, 2020
© All rights are reserved by Dhruv Beri and
K Jayasankara Reddy.
Abstract
This paper reviews an overall picture of conversion disorder to develop a clear and systematic understanding of its etiology,
causes, and treatment.
Keywords: Conversion Disorder; Etiology Treatment; Paralysis; Blindness; Neurological; Organic Cause; Psychoanalysis; Indian Re-
search Studies
Introduction
Psychosomatic disorders
-
man Psychiatrist Heinroth in the year 1818. During that period
in Germany, the focus of most researchers and psychiatrists was
towards studying the unconscious mind and dreams. However,
due to rapid advancement in the development of medicine and
science, the philosophical thought of psychology shifted towards
a more medicine-oriented aspect. This provided a climate for the
beginning of diagnoses of psychosomatic disorders [1]. It was in
early 1900s that German physicians during World War-1 received
numerous complaints of illnesses and disorders which did not
have any organic cause. Thus, psychosomatic disorders came to be
-
cal explanation for their point of origin but lack any substantial or
organic cause and are more related to emotional factors. Zegarelli
 
psychoneurotic disorders, psycho-physiologic disorders, person-
ality disorders, and psychotic disorders [2]. Under psychoneurotic
disorders comes the conversion disorder, one of the most popu-
larly researched psycho-somatic disorder.
Conversion disorder
According to the American Psychiatric Association, conversion
    
        
without any substantial organic physiological cause. In simple
  
are characterized by motor or sensory dysfunctions, without any
neurological or medical explanations. There many explanations for
the onset of conversion disorders. The most common and historic
notion of conversion disorder is the psychodynamic explanation
proposed by Sigmund Freud. According to Freud’s psychodynamic
theory, conversion disorders result due the individual’s repressed
childhood traumatic events or aggressive and sexual urges. Because
-
press them. When this anxiety threatens to come into the conscious
awareness, the individual unconsciously converts that in the form
of physical symptoms, thereby avoiding the anxiety. This way of es-
caping from the unconscious anxiety is referred to as primary gain.
Freud’s other explanations suggest that the individual may show
that he/she has serious physiological symptoms of a disease and
might gain sympathy and attention from others. Freud referred to
this tendency as secondary gain [3].
Citation: Dhruv Beri and K Jayasankara Reddy. “An Overview of Conversion Disorder: Prevalence, Causes, and Treatment”. 3.10
(2020): 64-68.

There are social and cultural explanations of conversion disor-
der as well. Such explanations are mainly based on the evidence of
conversion symptoms occurring in lower socio-economic groups
and family backgrounds which have lack of knowledge and aware-
ness about medical diseases. In some research studies using con-
trol groups, it has been found that patients tend to adopt the simi-
lar conversion symptoms that members of their family adopted in
the past and believe them to be a part of the family history (Brady
and Lind, 1961). Some explanations of conversion disorder also
point to sexual abuse in childhood, specially among women. Ac-
cording to Pierre Janet, emotional responses to early childhood
abuse often results in a disrupted state of consciousness. This state
of consciousness sometimes results in a form of hypnosis. Janet
suggested that an individual who suffered sexual abuse/traumatic
events in childhood is likely to use such hypnotic states as a defen-
sive reaction to such traumatic events. Thus, such people are more
likely to develop conversion symptoms in response to traumatic
events in life.
Prevalence rate of conversion disorder
The prevalence rate of conversion disorder in neurological set-
tings is higher as compared to socio-cultural settings. Conversion
symptoms are found to be more prevalent among women and
these develop mostly during adolescence. A high degree of conver-
sion symptoms are also found among soldiers on combat. Patients
with psychogenic non-epileptic seizures also have a prevalence
rate of conversion disorder, which is about 20% around the world.
Patients with dissociative symptoms also have a prevalence rate
of conversion disorder. In other instances, conversion disorder is
common among cultures that emphasize on religious and spiritual
healings. A condition like paralysis or blindness is often considered
to occur due to actions of god in such cultures [3].
Diagnosis of conversion disorder
The diagnostic criteria used by DSM-V and ICD-10 in classify-
ing conversion disorder takes a psycho-social perspective. Both

conversion disorder:
• Neurological symptoms (motor and sensory) and loss of con-
sciousness.
• No substantial evidence of organic causes that can explain
the disease.
• Psychological stressors at the onset of the disease.
• Exclusion of faking symptoms.
This perspective of the diagnostic systems seeks to distinguish
conversion disorder from most neurological disorders [4].
In the Indian context, psycho-social factors in children and
adolescents with conversion disorder have also been assessed. Ac-
cording to the literature, conversion disorder is usually associated
with a psycho-social stressor, unexplainable by any physiological
mechanism. Therefore, the patient experiences distress due to
these stressors and eventually develop symptoms like pseudo sei-
zures and paralysis. These symptoms are most commonly reported
among children and adolescents [5]. Lower literacy rates, poor
socio-economic background, and family factors play an important
role in the development of conversion symptoms. In India, system
of joint family is most commonly followed. Primary caregivers and
       
       
as grandparents and other family members. Constant clashes be-
tween both types of caregivers have been reported which result in
the development of conversion disorder. It is also widely reported
that the status of a child, poor parenting styles, and imitating the
behaviour of people with conversion symptoms also play an im-
portant role in conversion disorder [5].
Methods
Numerous researches have been conducted to understand the
onset and treatment of conversion disorders. As widely reported,
onset of conversion disorder occurs due to early traumatic child-
hood experiences. Therefore, most research studies based on con-
version disorders were found using keywords ‘conversion disor-
der’ and ‘childhood experiences’. Different research articles were
found based on these keywords. Journals used for searching these
research articles included the Journal of Nervous and Mental Dis-
ease, Jstor, and International Journal of Contemporary Medicine
Surgery and Radiology. A lot of neurological studies have also been
done to examine conversion disorder, such as using fMRI studies.
As neurological symptoms are one of the most important diag-
nostic criteria for conversion disorders and are commonly found
among conversion patients, therefore, studies were searched us-
ing keywords ‘neurological symptoms’ and ‘conversion disorder’.



Elsevier, Research gate, and Journal of Neural, Neurosurgery, and
Psychiatry.
65
An Overview of Conversion Disorder: Prevalence, Causes, and Treatment
Citation: Dhruv Beri and K Jayasankara Reddy. “An Overview of Conversion Disorder: Prevalence, Causes, and Treatment”. 3.10
(2020): 64-68.

As many organic symptoms without any pathological evidence
are presented by the patients of conversion disorder, research ar-
ticles focused on the topic ‘the kinds of organic symptoms reported
by conversion patients’ were searched. The journal that included
research articles based on this topic was the Journal of Psycho-so-
matic Research. Numerous articles on the treatment and rehabili-
tation of conversion disorder were also found from same journal
resources. Articles related to the role of emotions in conversion
disorder were also searched using the keywords ‘emotions of pa-
tients with conversion disorder’ on the PLOS Journal. Studies on
conversion disorder in India were also searched to get a clear of its
prevalence. These studies were assessed using the keywords ‘con-
version disorder research in India’. The journals that came up were
Indian Journal of Psychiatry.
Results
Results from all the studies indicated the causes, symptoms, and
treatment among patients with conversion disorder. Most studies
involving early traumatic experiences and childhood abuse were
comparative in nature which involved the use of matched healthy
control groups. These studies showed that patients with conversion
disorder report higher levels of early traumatic events and sexual

relationships. Studies involving neurological mechanisms to study
conversion disorders found that conversion symptoms were as-
sociated with abnormal levels of cerebral processing, particularly
involving emotional processes and sensory networks. Some of the
studies also found that patients with conversion disorder were also
suspected to suffer from one or more neurological disorders. Sus-
pected cancer is also considered to be a contributing factor in the
development of psychogenic nonepileptic seizures.
Studies that assessed the role of emotions among conversion
patients using fMRI studies found that amygdala is highly active in
 -
cantly higher among conversion patients as compared to normal
control group. Related to emotions, some studies also found the

in recognizing emotional expressions) and conversion disorder. A
high correlation was found between alexithymia and conversion
disorder [6]. Conversion disorder is also found to have high cor-
relations with other mental disorders. Binzer., et al. [7] found that
    -
chiatric syndromes, personality disorders, as well as depression.
Studies that focused on the neurological symptoms of conversion
disorder have used various neuroimaging methods like fMRIs, Pos-
itron Emission Tomography, and Photon Emission Computerized
Tomography. These studies have found abnormal functioning in
the brain circuits, such as cingulate cortex, that result in the devel-
opment of neurological symptoms [8].
Studies that assessed the rehabilitation and management of
conversion disorder suggested that operant behavioral treatment
was highly successful in treating the symptoms of conversion dis-
   [9]. Physical
therapy has also found to be effective in the successful rehabilita-

         
which patients were praised for each correct movement.
Within the Indian context, the results of the studies suggested
the role of family, relationships and problems in school among ado-
lescents. Some of the commonly reported motor symptoms includ-
ed dizziness, paresis, and limb paralysis [10].
Discussion
The main objective of this paper was to review the overview of
conversion disorder: its symptoms, causes, and treatment. Over

         
      
conversion disorder. Conversion disorders occur when an indi-
vidual complains of having symptoms of a disorder or an illness
such as blindness, paralysis, physical pain, etc., which do not have
an organic cause. It is reported that these symptoms occur due to a
psychological factor or stressor. Since its historical roots have been
traced to psychoanalysis, conversion disorder has been extensively
researched to identify its neurological as well as physical causes.
A review of many research articles, books, and review pa-
pers done to get an overall picture of conversion disorder. By go-
ing through the literature provided through these sources, it was
found that the total prevalence rate of conversion disorder across
the world is approximately 20%, which is higher among women
and occurs more in neurological conditions than social or cultural
conditions. In the India, conversion disorders are more often re-
ported among adolescents. Different explanations of conversion
disorders were formulated in this review article, starting with
the psychoanalytic theory proposed by Freud. Some of the other
66
An Overview of Conversion Disorder: Prevalence, Causes, and Treatment
Citation: Dhruv Beri and K Jayasankara Reddy. “An Overview of Conversion Disorder: Prevalence, Causes, and Treatment”. 3.10
(2020): 64-68.

explanations of conversion disorder were based on socio-cultural
factors, emotional experiences, and neurological and physiological
explanations.
Under the neurological and physiological mechanism, research-
es point towards abnormal functioning of cerebral processing and
high levels of fear response and negative emotions. Most popularly
reported causes of conversion disorder are early childhood trau-
matic experiences and sexual abuse. Cognitive, sensory, and motor
processes are dissociated due to these early traumatic experiences
which in the long-run result in conversion disorder [11]. For the

-
tion and shaping have been found to be effective. These therapeu-

patient for showing improvement and help them unlearn the mal-
adaptive behaviour. Sometimes confronting the patient regarding
his/her false beliefs of the illness/disorder also helps in treating
 
treating conversion disorders were electrical stimulation and EMG

pain that the patient experiences. It is combined with behaviour
[9,12-21].
Conclusion
This review paper provides an overall picture of conversion dis-
order, in terms of its etiology, causes, and treatment. Various etio-
logical explanations, such as the psychoanalytic and socio-cultural
explanations have been covered up which provides the basis for
the various causes of conversion disorders. The onset of this dis-
order points to early childhood traumatic experiences and sexual
abuse, abnormal neurological and emotional functioning, and role
of social factors such as socio-economic backgrounds, literacy level,
and family environment. Treatment and rehabilitation of conver-
sion disorders included some of the therapies focused on reinforce-
  
    
perspective by including various researches done in exploring con-
version disorder, involving Indian population.
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An Overview of Conversion Disorder: Prevalence, Causes, and Treatment
Citation: Dhruv Beri and K Jayasankara Reddy. “An Overview of Conversion Disorder: Prevalence, Causes, and Treatment”. 3.10
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