With conversion disorder subconscious conflicts are converted without insight on behalf of the patient into musculoskeletal symptoms or symptoms resembling neurological diseases.
Neurological and imaging tests are all normal.
Typical symptoms are blindness in one eye, simulated seizures, deafness, difficulties swallowing, breathing problems(hyperventilation), urinary retention, a lump in the throat. All of the symptoms can be traced back to psychological conflicts or to socially stressful events. The symptoms are distressing enough to cause disruption socially, at work or at home.
Statistics and course of conversion disorder
It is relatively rare with a rate of about 150 in 100,000 people. Outpatient mental health clinics report a frequency of about 2% of conversion disorder in their clientele. It occurs in the majority of cases usually between the ages of 10 and 35 years. It happens usually acutely, but it mostly resolves within 2 weeks. Recurrent episodes are common with 25% reoccurring within 1 year. Signs for a good prognosis are: a clearly identifiable psychological cause; acute onset of the conversion disorder; quick start of therapeutic intervention and a patient with above average intelligence. Twin studies have shown that there is an increased risk in first degree relatives of patients with conversion disorder.
Treatment of conversion disorder
The purpose of the treatment is to show the patient the connection between the symptoms and the psychological stressor. However, as the symptoms are brought on by subconscious thought processes, a conscious conventional psychotherapeutic session will be not very fruitful.
On the other hand, hypnotherapy, which accesses the subconscious, has been successfully used in many cases of conversion disorder (Ref.9). Often hypnotherapy can be utilized to start an internal communication process within the patient where the root of the conversion disorder is detected under hypnosis, and further counseling involving the conscious aspect of the patient is used subsequently to resolve the problem. At other times some carefully worded posthypnotic suggestions can help the patient to react normally next time the same psychological stressor is encountered. When some positive reinforcements like this are experienced, the patient’s self confidence is built up again and this too helps to overcome this disorder. Other techniques involve behavioral therapy and cognitive therapy.
1. Dr. David Burns: “Feeling good –The new mood therapy”, Avon Books, New York,1992.
2. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV),American Psychiatric Association, Washington,DC,1994.
3. Dr. Shaila Misri at the 46th St. Paul’s Hosp. Cont. Educ. Conference, November 2000, Vancouver/B.C./ Canada.
4. JM Loftis et al. J Neurochem 2000 Nov 75(5): 2040-2050.
5. B. Zilbergeld et al. “Hypnosis – Questions& Answers”, W.W. Norton & Co, New York,1986: 307-312.
6. MH Erickson & EL Rossi:”Hypnotherapy, an exploratory casebook”, Irvington Publishers Inc., New York, 1979: chapter 8, 314-363.
7. G Steketee et al. Compr Psychiatry 2001 Jan 42(1): 76-86.
8. DS Mennin et al. J Anxiety Disord 2000 July-Aug 14(4): 325- 343.
9. J Hartland: “Medical &Dental Hypnosis and its Clinical Applications”, 2nd edition, Bailliere Tindall,London,1982, page: 326-336.