Chapter 8 . Somatic Symptom and Related Disorders . Conversion Disorder (Functional Neurological Symptom Disorder)

Range of Conversion Disorder Symptoms : Seizures

pseudoseizures, resemble epileptic seizures but well differentiated via modern medical technology such as EEG

La Belle Indifference

"The beautiful indifference" Very little anxiety and fear from that would be expected in a person with a loss of a normal bodily function

Precipitating Circumstances, Escape, and Secondary Gains

*Primary gain* is continued escape or avoidance of a stressful situation. Because this is all unconscious (i.e., person sees no relation between symptoms and stressful situation), the symptoms go away only if stressful situation has been removed or resolved *Secondary gain* refers to any "external" circumstance, such as attention from loved ones or financial compensation, that would reinforce maintenance of disability Unknown the exact nature and timing of these psychological stress factors that cause conversion disorder

Criteria for Conversion Hysteria

A. One or more symptoms of altered voluntary motor or sensory functions B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions C. The symptom or deficit is not better explained by another medical or mental disorder D. The symptom of deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation

Treatment of Conversion Disorder

Behavioral approach, specific exercises are prescribed in order to increase movement of walking, and then reinforcements provided when patients show improvements Any reinforcements of abnormal motor behaviors removed in order to eliminate any sources of secondary gain Hypnosis

Decreasing Prevalence and Demographic Characteristics

Conversion disorders once relatively common in civilian and especially military life Typically occurred under highly stressful combat conditions Decreased prevalence closely related to our growing sophistication about medical and psychological disorders: A conversion disorder apparently loses its defensive function if it can be readily shown to lack a medical basis When it does occur, most likely to occur in rural people from lower socioeconomic circles who are medically unsophisticated More common in women Can develop at any age but most common between early adolescence and early adulthood

Range of Conversion Disorder Symptoms : Motor Symptoms or Deficits

Conversion paralysis is usually confined to a single limb and the loss of function is usually selective for certain functions E.g., person may not be able to write but may be able to use the same muscles for scratching *Aphonia* most common speech related conversion disturbance which person is able to talk only in a whisper although they can usually cough in a normal manner *Globus hystericus* difficulty swallowing or the sensation of a lump in the throat

Range of Conversion Disorder Symptoms : Sensory Symptoms or Deficits

Diagnosed as conversion disorder because symptom in affected area inconsistent with how known anatomical sensory pathways operate E.g., Conversion blindness, person reports they cannot see and yet can often navigate about a room without bumping into things

Important Issues in Diagnosing Conversion Disorder

Distinguishing between conversion disorders and true neurological disturbances: • frequent failure of dysfunction to conform clearly to the symptoms of the particular disease or disorder simulated e.g., little or no wasting away or atrophy of a "paralyzed" limb occurs in conversion paralyses, except in rare and long-standing cases • selective nature of the dysfunction • Under hypnosis or narcosis (a sleeplike state induced by drugs), symptoms can usually be removed, shifted, or reinduced at the suggestion of therapist

Conversion Hysteria

Freud believed the symptoms were an expression of repressed sexual energy, *unconscious conflict* that person felt about repressed sexual desires The repressed anxiety threatens to become conscious, so it unconsciously *converted* into bodily disturbance, thereby allowing person to avoid having to deal with the conflict

Conversion Disorder

Pattern in which symptoms or deficits affecting the senses or motor behavior strongly suggests that the patient has a medical or neurological condition However, through medical examination, pattern of symptoms or deficits cannot be fully explained by any known medical condition Typical examples include partial paralysis, blindness, deafness, and pseudoseizures Historically was grouped together under term *hysteria*

Range of Conversion Disorder Symptoms

Range is practically diverse but useful to think in terms of 4 categories of symptoms: sensory, motor, seizures, mixed presentation of first 3 categories