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Conversion disorder is a condition where patients present with neurological symptoms such as numbness, paralysis, or fits, but where positive physical signs of hysteria can be found. It is thought that these problems arise in response to difficulties in the patient’s life, and conversion is considered a psychiatric disorder in the International Statistical Classification of Diseases and Related Health Problems (ICD-10)[1] and Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV).[2] Formerly known as ‘hysteria’, the disorder has arguably been known for millennia, though it came to greatest prominence at the end of the 19th century, when the neurologist Jean-Martin Charcot, and psychiatrists Pierre Janet and Sigmund Freud made it the focus of their study. The term ‘conversion’ has its origins in Freud’s doctrine that anxiety is ‘converted’ into physical symptoms.[3] Though previously thought to have vanished from the west in the 20th century, some research has suggested it is as common as ever.[4]
DSM-IV defines conversion disorder as follows:
The nature of the association between the psychological factors and the neurological symptoms remains unclear. Earlier versions of the DSM-IV employed psychodynamic concepts, but these have been incrementally removed from successive versions. The ICD-10 classifies conversion disorder as dissociative (conversion) disorder, which suggests the symptoms arise through the process of dissociation.
In the 19th century, physicians such as Silas Weir Mitchell in the US and Paul Briquet and Jean-Martin Charcot in France developed ideas about patients sharing unexplained neurological symptoms. Charcot specialised in treating patients who were suffering from a variety of unexplained physical symptoms including paralysis, contractures (muscles which contract and cannot be relaxed) and seizures. Some of these patients sporadically and compulsively adopted a bizarre posture (christened arc-de-cercle) in which they arched their body backwards until they were supported only by their head and their heels.
The term “Conversion disorder” originated with Freud. He viewed these apparently neurological symptoms as a result of the conversion of intrapsychic distress in to physical symptoms. This distress was thought to cause the brain to unconsciously disable or impair a bodily function as a side effect of the original repression, which served to relieve the patient’s anxiety[5]. This is in contrast to recent evidence that patients remain distressed by their symptoms in the long term[6].It has been suggested that at least some of the classic psychoanalytic cases of hysteria, such as “Anna O.”[7], may actually have suffered from organic illness.
Conversion disorder can present with any motor or sensory symptom including any of the following:
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