What Is Conversion Disorder?
Conversion disorder is a condition in which you have physical symptoms but no injury or illness to explain them.
For instance, imagine that you were in a car wreck. You were unharmed, but the next day, you can't move your arm. Your doctor does x-rays and tests but can't find anything wrong.
So what's going on? Your body may have converted (changed) the emotional and psychological stress you felt about the wreck into the physical symptom of a paralyzed arm. It might seem strange, but your symptoms are real, and you can’t control them.
A newer name for conversion disorder is functional neurologic disorder (FND). In the American Psychiatric Association (APA) diagnostic manual, DSM-5, conversion disorder and FND are listed as the same condition. But while conversion disorder is linked to stress, FND offers a broader reason. There's an issue with how your brain processes information and sends it to the rest of your body. It's not always because of a traumatic event. One way to think of it is like a computer glitch.
Many years ago, doctors called conversion disorder “hysteria.” This term is no longer used.
Conversion Disorder Types
More research needs to be done on conversion disorder, but so far, experts think that there are two main types.
- Psychogenic nonepileptic seizures (PNES): These may look like seizures caused by epilepsy, but they aren't due to the same reason (abnormal electric signals in your brain). Instead, PNES is believed to be caused by stress or a strong emotional response to an event that you feel unable to cope with. If you're assigned female at birth (AFAB), you're at higher risk of PNES. It often starts in young adulthood.
- Functional movement disorder (FND): This type of conversion disorder affects how your body moves. It can affect just one group of muscles or muscles throughout your body. For instance, you might not be able to move one of your legs or arms. Or, you could have stiff muscles, tremors (shaking), or trouble with balance.
Conversion Disorder Causes
Researchers are still looking for a specific cause for conversion disorder. Many years ago, experts used to think it was a way for your brain to deal with emotional stress. While that may be true for many people, several complex factors are likely at work:
- How your brain naturally works. In people with conversion disorder, areas of the brain that process intense emotion may override or “switch off” other brain functions.
- What has happened to you. Being in a sad or unsafe situation can be a trigger.
- How you feel. For instance, worrying about a symptom can make it worse.
Some cases of conversion disorder are linked to a mental health condition called somatic symptoms disorder. If you have it, you're very worried about any changes to your health, such as extreme fatigue or the onset of pain anywhere in your body. Your worries can become bigger than your symptoms and feel hard to manage, even if a doctor tells you that you're healthy.
One theory about conversion disorder is that physical symptoms are a way your brain tries to ease an internal conflict. For example, if you’re struggling with the desire to hurt someone, conversion disorder may cause you to become paralyzed, so you can't act on that desire.
Conversion Disorder Symptoms
Conversion disorder symptoms are different for everyone. They can affect your senses, how your body functions, or both. Some signs include:
- Not being able to move part of your body
- Tremors (shaking that you can't control)
- Muscle spasms in your face
- Tics (fast, repeated movements that happen all of a sudden)
- Loss of balance
- Feeling dizzy
- Trouble walking
- Trouble swallowing
- Drop attacks (falling to the ground)
- Staring off and not being able to respond to others
- Passing out
- Loss of touch (not being able to feel things, or having a “pins and needles” feeling in a limb)
- Speech issues (such as slurring your words, stuttering, or speaking in a whisper)
- Eyesight changes (such as blurred vision or seeing double)
- Hearing changes
- An “out of body” feeling or feeling like your body doesn't belong to you
- Trouble with your focus, memory, or problem-solving
Symptoms usually start suddenly. And they may happen after a stressful event, although not always. Sometimes, people with conversion disorder may feel unbothered by their symptoms, even if others are concerned.
Conversion Disorder Risk Factors
Conversion disorder is rare. About 4-12 people out of 100,000 are diagnosed with it. Although anyone can have it, most people are over the age of 10.
Some factors that make you more likely to have conversion disorder:
- Being AFAB
- Abuse, especially in early childhood
- Being exposed to a recent stressful or traumatic event
- Having another mental health condition, especially anxiety or depression
- Stressful relationships with family, friends, or people you work with
- Not liking your job
- Somatic symptom disorder
Although much more research needs to be done, some characteristics appear to be common in children who have conversion disorder. Many tend to do well in school, are good-natured, avoid conflict, and don't like to talk about their feelings. It's also not unusual for kids with conversion disorder to compete in a high-pressure activity or sport, such as gymnastics.
Conversion Disorder Diagnosis
The APA has set standards for symptoms to be diagnosed as conversion disorder:
There’s no test to diagnose conversion disorder. Instead, your doctor will have to rule out all other physical, mental, or neurological causes of your symptoms. You'll probably have:
A physical exam. Your doctor will examine you and ask questions about your symptoms. They may ask if you’ve had any recent stressful events. They could also do:
- Blood tests
- Imaging tests (such as a CT scan or MRI)
- Cardiac tests (such as an EEG)
- Evoked potential tests (noninvasive tests that measure electrical activity in your brain)
A psychiatric exam. If your doctor can't find a physical reason for your symptoms, they may refer you to a mental health expert. In private, you'll talk about your thoughts, feelings, and habits. Conversion disorder can sometimes happen along with other mental health issues, such as mood disorders, panic disorders, generalized anxiety disorder, or post-traumatic stress disorder.
It can take a while to be diagnosed with conversion disorder. Having many tests could make your symptoms worse or make you worry more. Finding a doctor and mental health expert you trust can make a positive difference.
Conversion disorder isn't life-threatening, but its symptoms can look like signs of many other serious conditions, such as epilepsy and multiple sclerosis. That's why your doctor will need to be thorough in doing tests and gathering information about your health.
Conversion Disorder Treatment
Get help from your doctor early on. Sometimes, learning that you don’t have a serious physical condition can be enough to lessen your symptoms.
The treatments you could have include:
- Psychotherapy: Talking with someone about your stress can help you better manage your stress. You could talk to someone one-on-one, or your doctor may suggest group therapy, where you can connect with others with conversion disorder. Sometimes, working through issues as a family is helpful as well.
- Medication: If you're diagnosed with another condition, such as anxiety, your doctor can prescribe medication to treat it. Medicines could also help relieve your pain or some symptoms such as headaches or insomnia.
- Physical therapy: A trained expert can help you manage pain and improve how well you move.
- Stress reduction or distraction techniques: Your symptoms may improve when you don't focus on them. A counselor or other trained expert can help you find ways to distract yourself, such as texting a friend or tapping a part of your body.
- Noninvasive brain stimulation (NIBS): For instance, magnetic fields outside your body can activate nerve cells in your brain and help improve depression and anxiety.
- Cognitive behavioral therapy: This type of therapy is often used to treat conversion disorder. It helps you learn to spot and change negative thought patterns that affect what you do.
- Treating other mental health conditions: For instance, about one-third of people with conversion disorder have major depression. Treating the depression could lessen your physical symptoms.
Conversion Disorder Complications
Conversion disorder isn't fatal. But if not treated, your symptoms can start to affect your quality of life. Over time, your pain could increase. So could other symptoms such as fatigue, trouble sleeping, anxiety, and depression.
Call 988 (the Suicide and Crisis Hotline) or go to the nearest ER if you have thoughts about harming yourself or someone else. If you feel that you're in urgent danger or pose an urgent threat to someone else, call 911.
Conversion Disorder Outlook
Symptoms of conversion disorder can last a few days or several months. They might go away as quickly as they came on. In 20%-25% of people, symptoms return within a year, usually triggered by a stressful event.
It's common to put off getting care because you worry no one will believe your symptoms are real. No one wants to be told, “It's all in your head.” But when you have conversion disorder, your physical symptoms are real and you can't control them.
The earlier you seek treatment, the better your outlook. Try to find a doctor you can talk openly with and who listens to you. Once you do start treatment, follow through with your doctor's advice and go to all your follow-up visits. If you have a mental health condition, take your medications as directed. As your mental health starts to improve, your physical symptoms should begin to lessen.
Conversion disorder (functional neurological disorder) is a complex mental health condition in which your brain doesn't send the right messages to your body. This can cause many physical symptoms that can be painful and upset your daily life. Treatments such as talk therapy and medication can relieve your symptoms, improve your mental health, and help you learn how to manage this condition.