Comparing Conversion Disorder to Dissociative Disorders


Conversion disorder falls within the broader category of somatoform disorders in the DSM-IV-TR (2000).  Essential features include one or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological condition, accompanied by psychological factors judged to exacerbate or initiate the onset.  The symptoms are not intentionally produced (as in Factitious Disorder of Malingering), nor can they be fully explained by a general medical condition.  Typically someone diagnosed with Conversion Disorder will present with motor deficit (paralysis), sensory deficit (deaf, blind), seizures/convulsions, or some combination of the above (mixed).  (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2000, p. 498)

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“The essential feature of the dissociative disorders is a disruption in the usually integrated functions of consciousness, memory, identity, or perception.”  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 519)  This may manifest in an inability to recall information in dissociative amnesia, or the presence of two or more distinct identities in dissociative identity disorder (DID, formerly Multiple Personality Disorder or MPD).  It may also present as a recurrent feeling of being detached from one’s body or mental processes, as in depersonalization disorder.

Dissociative and conversion disorders share symptoms, may have similar antecedents (high rates of trauma), and both suggest neurological dysfunction.  “If both conversion and dissociative symptoms occur in the same individual (which is common), both diagnoses should be made.”  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 497)  Conversion disorder is classified as a dissociative disorder in the IDC-10.  In a recent and comprehensive comparison of the two disorders, Brown and associates have strongly suggested that “moving pseudo-neurological symptoms (i.e., conversion disorder) back to the dissociative fold would make better sense of the empirical database, help conceptual integration of related areas, and, last but not least, finally bring concordance across DSM and ICD taxonomies.”  (Brown, Cardeña, Nijenhuis, Sar, & van der Hart, 2007, expression CONCLUSIONS AND IMPLICATIONS)  Despite differences in presentation (outlined above), I inclined to agree with proponents of including conversion disorder as part dissociative disorders in the DSM-V.

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References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Brown, R. J., Cardeña, E., Nijenhuis, E., Sar, V., & Van der Hart, O. (2007, Sep/Oct). Should conversion disorder be reclassified as a dissociative disorder in DSM-V. Psychosomatics, 48(5), 369-379. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1333420861&sid=4&Fmt=4&clientId=4683&RQT=309&VName=PQD

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