Conversion Disorder

Conversion disorder is classic hysterical neurosis, as described by Freud in his famous studies. It is marked by loss or alteration of normal physical function, typically paralysis, but sometimes convulsions, cramps, or uncontrolled behavior. Motor symptoms of hysteria include paralysis of normally voluntary muscles, tremors, tics, and other disorders in movement or in walking. Neurological symptoms often do not conform with medical knowledge of nerve distribution, as the pain or sensations in conversion disorder are in a patient’s head and therefore can show up anywhere. Other symptoms described have been blindness, deafness, loss of sensation in arms and legs, a feeling of “pins and needles” in one’s limbs, increased sensitivity to pain, and high suggestibility.

Conversion disorder is one of the oldest described mental illnesses, and may present very differently in different cultures. In many African and Caribbean cultures, it’s often blamed on malicious magic like witchcraft. And in North American history, the most famous likely case of conversion disorder was the mass hysteria that swept New England in the end of the 17th century, resulting in the Salem witch trials and the witchcraft trials in Connecticut.

The hysterical symptoms of conversion disorder occur in settings of extreme psychological stress, and usually appear suddenly. Some people recover within a matter of days, but others may be ill for years or even decades. Hysteria is named after the female organs because it most often, in Freud’s time, showed up in women, and historically and today conversion disorder is much more likely to appear in women.

Freud believed that hysteria was linked with fixations. For instance, arrested stages in the individual’s early psychosexual development was believed to cause it. Freud believed highly in Oedipus and Electra complexes, where the child is fixated on the parent of the opposite sex as a sex object; psychotherapists today tend to believe instead that conversion disorder is related to trauma experienced during a highly formative stage in childhood. Regardless of the origin, it is not an organic disease and is generally treated with psychological rather than pharmacological methods. While drugs can serve a palliative purpose, they should not form the core of the treatment.

Like other forms of somatoform disorder, conversion disorder may be a method used subconsciously by the patient to gain a psychological advantage in social relationships. This may take the form of getting sympathy and special treatment or of shirking burdens such as obligations and withdrawing from threatening or emotionally complex situations. Because of this, conversion disorder is fairly difficult to treat, and impossible to cure without addressing the underlying causes.

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