Tag Archives: Conversion Disorder

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

Somatoform Disorders


 

 

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Somatoform Disorders could be summed up in the following statement… “there are more questions than answers.”  (Blaney & Millon, 2009, p. 499)  As a collection of disorders, it appears as though they don’t belong under the same heading or classification.  Many have more in common with Obsessive-Compulsive Disorder (OCD) than they have with each other.

“The common feature of the somatoform disorders is the presence of physical symptoms that suggest a general medical condition and are not fully explained by a general medical condition, nor by the direct effects of substance, or by another mental disorder.”  (Blaney & Millon, 2009, p. 483)  Somatoform can only be diagnosed by the process of exclusion… which seems odd to me.  It represents a “curve ball” for medical and mental health professionals, because the underlying consensus is that the client “believes they have an ailment, but they don’t.”  I don’t use “very, very” very often, but this has to make it very, very difficult to diagnose.  It might give some explanation to the very low prevalence rates.

I would have expected a greater degree of stress or anxiety in a patient that presents with this disorder, as would be typical of someone who presents with symptoms that can’t be explained.  “Patients with these disorders typically experience little or no anxiety, whereas those with so-called preoccupation disorders are excessively concerned or anxious about the notion that there is something physically wrong with their bodies.”  (Blaney & Millon, 2009, p. 483)  Can we use this lack of anxiety as a “flag” for diagnosis?

The “sick role” seems to be an underlying sociological construct among all the somatoform disorders.  Sick role implies granted privileges (staying home from work) and avoidance of obligations because one has to comply with medical instructions.

I was particularly interested and enthralled with the cultural differences in the presentation of Conversion Disorder (CD).  Not only is it more prevalent among rural residents from low socioeconomic backgrounds, but there is remarkable differences between geographical areas.  The text cited frequent cases of “burning hands” in Asia, which are typically never reported in the Western world.  (Blaney & Millon, 2009, p. 487)

Pain disorder is another anomaly.  What surprised me is that typical clients don’t come to treatment because of the degree or intensity of the perceived pain, but are more likely to come seeking respite from the psychological costs of pain management.  I could anticipate that this would be one of the most debilitating somatoform disorders because of its ability to disconnect clients from family, friends, work, and recreation.  (Blaney & Millon, 2009, p. 487)

I was relatively familiar with the concept of hypochondriasis before reading the text, but I was wholly unaware of the underlying theoretical etiology.  The concept of increased sensitivity to innocuous bodily sensations is new to me.  I was aware that some clients have formed selective attention to illness formation, risk perception, and misinterpretation of benign symptoms.  The suggestion that it is triggered by critical incidents, and is predispositioned by parental attitudes rings true to me.  I was also suitably surprised by the transient nature of the disorder, since it can apparently go into full remission and then appear again when a stressor appears.

Body Dysmorphic Disorder (BDD) is fascinating, quite honestly I have never heard of it.  I think this probably has more to do with societal views of “what is beautiful” than we think.  I was not at all surprised by the suggestion that some believe it to be delusional in nature.  I am a “perfectionist type” myself, but I never in my life would have dreamed this could be one of the results of that predisposition.  The text suggests that it may be compounded by being teased or bullied as a teenager (during puberty), leading to a general lack of social skills and self conscious maladaptive behavior.

Factitious Disorder is when “physical symptoms are produced or feigned intentionally to assume the sick role.”  (Blaney & Millon, 2009, p. 492)  The concept of “hospital hopping” in effort to undergo medical procedures, even surgery, is amazing.  The fact that these patients frequently lie about the nature of their symptoms, and life circumstance in general, probably contribute to the difficulty of diagnosing and treating this disorder.  I mean, how can you believe them?  I would question everything that came out of their mouth, it might be increasingly difficult to sort out “real issues” from “fake ones.”

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Reference

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.