Background Conversion disorder is one of a group of psychological disorders called somatoform disorders. These disorders are marked by the presence of physical symptoms without there being any physical ailment. According to the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, Fourth Edition, Text Revision (DSM-IV-TR) (2000) “the symptoms must cause clinically significant distress or impairment in social, occupational, or other areas of functioning” (485).
Although conversion disorder is in the category of somatoform disorders, C.V. is marked by a deficiency affecting voluntary motor or sensory functioning. Essentially, conversion disorder is a neurological disorder in which physical symptoms are caused unconsciously by a stressful or traumatic event.
Professor of Psychiatry & Emergency Medicine, Seth Powsner, MD,(2006) states that “although defined as a condition that presents as an alteration or loss of a physical function suggestive of a physical disorder, conversion disorder is presumed to be the expression of an underlying psychological conflict or need.” (p. 1)
Psychological factors are not initially present, but after thorough investigation into the history of the patient, the symptoms are discovered. According to PsychCentral.com, “the symptom or deficit cannot, after appropriate investigation, be fully explained by a general medical condition, or by the direct effects of a substance, or as a culturally sanctioned behavior or experience.” These symptoms are almost always the result of unintentional motives and are not knowingly produced. Consequently, this condition is considered not under the patient’s control, and is often misdiagnosed because it can’t be explained by any physical disorder.
Diagnostic Criteria
According to the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, Fourth Edition, Text Revision (DSM-IV-TR) (2000) Diagnostic criteria for conversion disorder are as follows: “
• One or more symptoms or deficits are present that affect voluntary motor or sensory function that suggest a neurologic or other general medical condition.
• Psychologic factors are judged to be associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit.
• The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering).
• The symptom or deficit, after appropriate investigation, cannot be explained fully by a general medical condition, the direct effects of a substance, or as a culturally sanctioned behavior or experience.
• The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
• The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder.” (p. 498)
According to New York University’s Medical Center, “diagnosis of conversion disorder may be difficult initially because physical symptoms are most often caused by a physical disorder. It is important for the physician to consider a physical cause for the symptoms carefully. Patients will often be asked to undergo the following testing to rule out an underlying disease.
• Laboratory testing to rule out hypoglycemia or hyperglycemia, kidney failure, or drug-related causes
• Imaging studies, such as chest x-rays or CT scans
• Electrocardiogram (ECG, EKG) – a test that records heart activity by measuring electrical currents through the heart muscle
• Spinal fluid examination to check for neurological causes
If no physical cause is detected, the patient may either be referred to a neurologist or for a psychiatric consultation.” (Borowski, p. 1)
Prevalence
Research by Owens and Dein showed, “although many in the medical profession have formed the impression that the prevalence of conversion disorders in developed countries is in decline, there is little recent information. Much of the information we have about prevalence is derived from earlier studies, which often suggest that conversion symptoms are relatively common. Farley findings in a study of 100 mothers of new born children suggested a lifetime prevalence of up to 33%. Engl estimated that 25% of patients admitted to general medical services had had conversion symptoms at some time in their lives. Stephansson estimated the annual incidence to be about 22 cases per 100 000.” (Owens & Dein, 2006)
In the United States, incidence has been reported to be 11-300 cases per 100,000 people. It’s also said that cultural factors may play a significant role. Symptoms that might be considered a conversion disorder in the US may be a normal expression of anxiety in other cultures.
Course Familial Pattern
According to the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, Fourth Edition, Text Revision (DSM-IV-TR) (2000) “limited data suggest that conversion symptoms are more frequent in relatives of individuals with Conversion Disorder. Increased risk of Conversion Disorder in monozygotic twin pairs but not in dizygotic twin pairs has been reported.” (p. 496)

Culture/Age/Gender Features
Seth Powsner states in his article that “sex ratio is not known although it has been estimated that women patients outnumber men by 6:1. This is of little help when evaluating an individual patient. Conversion disorder may present at any age but is rare in children younger than 10 years or in persons older than 35 years. Some studies have reported another peak for patients aged 50-60 years. In a University of Iowa study of 32 patients with conversion disorder, however, the mean age was 41 years with a range of 23-58 years. In pediatric patients, incidence of conversion is increased after physical or sexual abuse. Incidence also increases in those children whose parents are either seriously ill or have chronic pain.” (p. 1)
Etiology
While true etiology is unknown, most clinicians presume conversion reactions are caused by previous severe stress, emotional conflict, or an associated psychiatric disorder. These risk factors tend to increase the likelihood of developing Conversion Disorder. Studies have shown that children who suffer physical or sexual abuse tend to develop this disorder as well as children who have family members with a history of conversion reactions are more likely to suffer from conversion disorder.
Assessment and Treatment
In treating any psychological disorder, it’s important to remember that there are no quick fixes. A regiment of both psychotherapy and pharmacological therapy are necessary. Psychotherapy rules out any real physical disorder and is necessary in the diagnosis and treatment of the disorder.
Seth Powsner states that “another treatment technique is suggestive therapy: an authoritative, not confrontative, pronouncement that ‘this problem usually resolves in a few hours’ is often successful, especially with children. Appropriate attention, for example, repeated vital signs plus adjunctive anti-anxiety medication can increase odds of success with adults. Other suggestive therapies for symptom removal include hypnosis and amobarbital interviews. Using a behaviorally oriented treatment strategy, the goals are to unlearn maladaptive responses and to learn more appropriate responses. Attempt to eliminate the patient's belief that the extremity is paralyzed by telling the patient (1) that all tests indicate the muscles and nerves are functioning normally, (2) the brain is communicating with the nerves and muscles, and (3) this apparent lost ability is recoverable. Confronting the patient with the fact that the symptoms are not organic is counterproductive.” (p. 1)

References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revisions. Washington DC: APA; 2000
Borowski, Maria, MA. (2006) Conversion Disorder. NYU Medical Center. Retrieved January 15th, 2007, from New York University Medical Center database.

Comer, R.(2006) Conversion Disorder. Abnormal Psychology, 190.

Grohol, J. (2006) Conversion Disorder. Retrieved February 8th 2007, from http://psychcentral.com/disorders/sx43.htm

Powsner, S. (2006) Conversion Disorder. E medicine. Retrieved January 15th, 2007, from E medicine database.

Owens, C., & Dein, S. (2006) Conversion disorder: the modern hysteria. Advances in Psychiatric Treatment, vol. 12, 152–157.