simple explanations of interesting brain conditions

Conversion Disorder: Stress into Sickness

A 12 year old boy begins at a prestigious new school. He can’t keep up with the high academic standards and soon falls behind the other students. His teacher decides to punish him by ridiculing his work in front of the class. Most of us would have been pretty traumatized by this at such a volatile age, maybe we would cry or lose our temper, but this boys reaction was much worse. This boy developed a walking disorder [1].

It took 5 months of extensive investigation at a general hospital, and then further 10 months of therapy before the poor young man could return to school. But how could psychological trauma effect his walking pattern so severely? To many of us this seems counter-intuitive. How could that possibly work?

Well, the boy was officially diagnosed with conversion disorder; a disorder in which patients convert psychological stress into physical symptoms. The symptoms vary but patients may experience things like:

  • loss of sight, hearing or touch
  • an inability to speak
  • weakness
  • paralysis
  • seizures

Concrete causes of conversion disorder remain unclear, there are however a number of indicators that many patients seem to have in common, including:

  • a traumatic event that triggered the disorder
  • negative home/school environments
  • a history of depression/anxiety
  • other unrelated illnesses/injuries

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Wait a Minute

But it gets more complicated from here. Because the disorder is a psychological one, these patients don’t actually have any physical explanations for their symptoms. For example, an eye expert who inspects a blind conversion disorder patient will find no apparent reason for their blindness. And then there have been observations of patients who seem to display certain inconsistencies in their symptoms, such as:

  • patients who display movement problems may have variations in their problems day to day
  • patients who suffer seizures may seem to choreograph their fall when experiencing an episode
  • patients suffering blindness may seem amused when shown a humorous television show

Things really don’t look good for conversion disorder at this point, so why does the World Health Organization does classify conversion disorder as the real deal? And why do neurologists diagnose it?

One really good study [2] interviewed 35 UK neurologists on how they dealt with conversion disorder. The neurologists were divided; some thought the disorder had nothing to do with conscious faking, some thought that some or all of their patients were faking, and some thought conscious faking was perhaps part of the disorder itself. Another study [3] was published which seemed to suggest differences in brain activity between conversion disorder patients and test subjects trained to fake it. However the consensus seems to be that further research is required to validate these findings.

So what is the truth here, is conversion disorder a thing or not? Is the term just something that neurologists use when they can’t diagnose anything else? Are there real sufferers mixed in with others who are fakers? Could this simply be a condition we don’t fully understand yet? I’m in no position to make a claim either way, but I’ll leave you with a video that does.

Today Tonight Adelaide: Conversion Disorder (2013)

References

All images produced by the author unless otherwise specified.

  1. M. Leary. (2013) Chapter 94 – Conversion disorder, In: Olivier Dulac, Maryse Lassonde and Harvey B. Sarnat, Editor(s), Handbook of Clinical Neurology, Elsevier, Volume 112, Pages 883-887, ISSN 0072-9752, ISBN 9780444529107, http://dx.doi.org/10.1016/B978-0-444-52910-7.00010-6.
  1. Richard Kanaan, David Armstrong, Simon Wessely. (2009) Limits to truth-telling: Neurologists’ communication in conversion disorder, Patient Education and Counseling, Volume 77, Issue 2, Pages 296-301, ISSN 0738-3991, http://dx.doi.org/10.1016/j.pec.2009.05.021.
  1. J. Stone, A. Zeman, E. Simonotto, et al. (2007) fMRI in patients with motor conversion symptoms and controls with simulated weakness. Psychosom Med, 69, pp. 961–969
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