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Conversion Disorder

If you are suffering from attacks of convulsion (seizure), you need the help of neuro physicians; but if you suffering from conversion (pseudo seizure) attacks, you need to visit neuropsychiatrist for proper management.


Often lay people find difficulty in identifying the nature of symptom of conversion disorders, and are cheated, improperly treated & unnecessarily intervened & investigated a lot, before visiting neuropsychiatrist.

Often lay people find difficulty in identifying the nature of symptom of conversion disorders, and are cheated, improperly treated & unnecessarily intervened & investigated a lot, before visiting neuropsychiatrist.
If someone especially an young adolescent girls & boys, out of sudden start suffering from symptoms like recurrent fainting attacks, paralysis of limb, rigidity all over body, loss of ability to speak, loss of ability to recall the past, unable to identify others, have become blind of deaf, shows seizure like episodes & so on, these are few seemingly alarming but can be in reality non fatal, totally benign manifestation of conversion disorders.



Conversion Disorder

It is also called functional neurological symptom disorder, is a condition in which patient mostly young adolescent girls show psychological stress in physical ways. The condition was so named to describe a health problem that starts as a emotional crisis - a scary or stressful incident of some kind - and converts to a physical problem.


In India, prominent pattern of conversion symptom include recurrent attack of teeth clenching & recurrent attack of faintness, loss of consciousness, pseudo seizure like episode that superficially mimic a severe neurological emergency, but in reality investigated out to be the result of recent emotional crisis. Other symptoms include loss of memory, paralysis, false seizure like motor abnormalities etc. Parents & guardians become alarmed by suddenness of severe symptom, tend to visit neurophysician for help.

Sudden onset, dramatic nature of symptom, undue care giving role of parents & guardian & above all clinician's tendency to overly investigate & treat the case further complicate the picture & leads to unnecessary wastage of money & undue discomfort to patient.

Dr Satyajeet Singh, Aiims, PatnaIt is only after several year of non-proper treatment, intervention, medication, investigation and when every one get exhausted, the case of conversion disorders come for evaluation by a neuro psychiatrist.

Conversion disorder signs and symptoms appear with no underlying physical cause, and patient

can't control them.

Signs and symptoms of conversion disorder typically affect movement or senses, such as the ability to walk, swallow, see or hear. Conversion disorder symptoms can vary in severity and may come and go or be persistent.

The outcome may be better in younger children than in teenagers and adults.

Conversion disorder is a mental condition in which a person has blindness, paralysis, or other nervous system (neurological) symptoms that cannot be explained by medical evaluation.Conversion disorder symptoms may occur because of a psychological conflict.Dr Satyajeet Singh, Aiims Patna

Symptoms usually begin suddenly after a stressful experience. People are at risk of conversion disorder if they also have:
  1. A medical illness
  2. A dissociative disorder (escape from reality that is not on purpose)
  3. A personality disorder (inability to manage feelings and behaviors that are expected in certain social situations)

People who have conversion disorder are not making up their symptoms (malingering). Some health care providers falsely believe that this disorder is not a real condition and may tell people that the problem is all in their head. But this condition is real. It causes distress and cannot be turned on and off at will.

The physical symptoms are thought to be an attempt to resolve the conflict the person feels inside. For example, a woman who believes it is not acceptable to have violent feelings may suddenly feel numbness in her arms after becoming so angry that she wanted to hit someone. Instead of allowing herself to have violent thoughts about hitting someone, she experiences the physical symptom of numbness in her arms




Symptoms

https://sites.google.com/site/psychiatristaiimspatna/conversion-disorder
Conversion disorder symptoms may appear suddenly after a stressful event or trauma, whether physical or psychological.
Signs and symptoms that affect movement function may include:
  • Weakness or paralysis
  • Abnormal movement, such as tremors or difficulty walking
  • Loss of balance
  • Difficulty swallowing or "a lump in the throat"
  • Seizures or convulsions
  • Episode of unresponsiveness



https://sites.google.com/site/psychiatristaiimspatna/conversion-disorder
Signs and symptoms that affect the senses may include:
  • Numbness or loss of the touch sensation
  • Speech problems, such as inability to speak or slurred speech
  • Vision problems, such as double vision or blindness
  • Hearing problems or deafness






When to visit doctor

It's best to seek medical attention as soon as you notice signs and symptoms that might be caused by conversion disorder. If the underlying cause is something physical, quick diagnosis and treatment may be important. If the diagnosis is conversion disorder, then psychological help may improve the symptoms and prevent future episodes.



https://sites.google.com/site/psychiatristaiimspatna/conversion-disorder
Causes

Episodes of conversion disorder are nearly always triggered by a stressful event, an emotional conflict or another mental health disorder, such as depression. The exact cause of conversion disorder is unknown, but the part of the brain that controls your muscles and senses may be involved. It may be the brain's way of reacting immediately to something that seems like a threat.

Risk Factors
  • Recent significant stress or emotional trauma
  • Being female - women are much more likely to develop conversion disorder
  • Having a mental health condition, such as mood or anxiety disorders, dissociative disorder or certain personality disorders
  • Having a neurological disease that causes similar symptoms, such as epilepsy
  • Having a family member with conversion disorder
  • A history of physical or sexual abuse and neglect in childhood


Complications

    In some cases, particularly if not treated soon enough, conversion disorder symptoms can result in substantial disability, similar to that caused by medical conditions.

    Preparing for your Appointment

    You'll likely start by seeing your primary care doctor. If your doctor can't determine a diagnosis, you may be referred to a neurologist or a psychiatrist. In some cases, both a neurologist and a psychiatrist are needed to rule out an underlying neurological condition and to verify that it's a conversion disorder or another psychological condition.

    What you can Do ?

    To prepare for your appointment, make a list of:

    • Any symptoms you're experiencing, including any that may seem unrelated to the reason for your appointment
    • Key personal, family and social information, including any major stresses or recent life changes
    • All medications, vitamins or other supplements you're taking

    Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.

    Prepare a list of questions ahead of time to make the most of your time together. Some basic questions to ask your doctor include:
    • What is likely causing my symptoms or condition?
    • Are there other possible causes?
    • What kinds of tests do I need?
    • What treatment approach do you recommend?
    • If I need to take medications, what are the main side effects?
    • Is there a generic alternative to the medicine you're prescribing?
    • For how long will I need to be treated?
    • What can I do to reduce the risk of my symptoms recurring?
    • Should I see a specialist? Will my insurance cover that?
    • Are there any brochures or other printed material that I can have? What websites do you recommend?

    Don't hesitate to ask your doctor questions during your appointment.

    What You Can expect from your doctor ?

    To make the most of your time, be ready to answer questions your doctor may ask, such as:

    • What are your symptoms?
    • When did you first notice these symptoms?
    • How have your symptoms changed over time?
    • How severe are your symptoms?
    • What do you think may be causing your symptoms?
    • Have you recently experienced significant stress or trauma?
    • Have you been diagnosed with any other medical conditions or mental health problems?
    • Have any of your close relatives been diagnosed with mental health problems?
    • Do you use alcohol or recreational drugs? How often?
    • What do you think you can do for yourself in this situation?
    • test and diagnosis

      To be diagnosed with conversion disorder, you must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual, published by the American Psychiatric Association, is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

      To be diagnosed with conversion disorder:

      • You must have one or more symptoms you can't control that affect body movement or your senses, which can't be explained by a neurological or other medical condition.
      • Your symptoms may be related to a stressful event or trauma, either physical or psychological, even though that may not always be the case.
      • You're not producing symptoms on purpose or getting some intended benefit from the symptoms.
      • Your symptoms aren't fully explained by a general medical condition, drug use or a culturally accepted behavior, such as an experience at a religious ritual.
      • Your symptoms must cause significant stress or difficulty in social, work or other settings.
      • Your symptoms aren't better accounted for by another mental health problem. In this case, psychological tests should be requested by a mental health specialist.

      There are no standard tests to check for conversion disorder. The tests will depend on what kind of signs and symptoms you have - the main purpose is to rule out any medical or neurological disease. Tests may include:

      • Simple tests. These tests don't require any special equipment and are quick and painless. For example, your doctor checks for normal reflexes to help rule out a physical cause for your signs and symptoms.
      • X-rays or other imaging tests. These tests may help your doctor confirm that your symptoms aren't caused by an injury or neurological or other physical conditions that might cause similar symptoms.
      • An electroencephalogram (EEG) scan. An EEG can help rule out a neurological cause of seizure symptoms. This test is a painless procedure to detect electrical activity in your brain. It's used to test for epilepsy and other brain disorders.

      Diagnosis can be tricky because a doctor must rule out medical conditions with a physical cause. Conversion disorder can mimic a number of other health problems, such as:

      • Myasthenia gravis - a muscle weakness disorder
      • Guillain-Barre syndrome - an uncommon disorder in which your body's immune system attacks your nerves
      • Neurological disorders - for example, Parkinson's disease and epilepsy
      • Stroke
      • Lupus
      • Spinal cord injury
      • HIV/AIDS

What is difference between true seizure and false seizure ?


Convulsion ( True Seizure ) Disorder

  • Seizure is like an electric overshoot in brain can occur at anytime - even when the patient is sleeping
  • Seizure can occur at anywhere - in the home, on the road, among the people, in the jungle, in the forest, in the bathroom or in places where help is not available
  • Injury sustained during seizure attack may due to tongue bite, cheek bite due to teeth clenching or injury due to fall
  • Incontinence of urine or stool during attack can occur
  • No temporal relationship with ongoing stress & strain or no precipitating factors can be found responsible for seizure attack
  • If attention or secondary gain is curtailed, seizure continue to occur
Conversion ( Pseudo - Seizure ) Disorder
  • Pseudo-seizure mostly occur during the period of intense emotional turmoil. Pseudo-seizure is very rare to occur when the patient is sleeping.
  • Pseudo-seizure occur mostly when some one is near to the patient to help him. Pseudo-seizure is very rare to occur when the patient is in isolation.
  • Injury sustained during pseudo seizure attack are very superficial, and are due to accidental fall & not due to illness. Tongue bite or cheek bite will remain absent during pseudo-seizure
  • Incontinence of urine or stool during attack remain absent
  • Temporal relationship with ongoing stress & strain or precipitating factors can be found responsible for seizure attack
  • If attention or secondary gain is curtailed, pseudo seizure fails to occur
    • What is Secondary gain or Attention seeking behaviour ?


All humans require attention. Without getting and giving attention, you could not have a social species. Getting attention is necessary for life's vital enterprises and can be the difference between life and death in a crisis. Therefore, not getting adequate attention can threaten the quality and sustainability of life.

Excessive attention seeking is not a character flaw. It is a brain wiring response to early developmental trauma caused by neglect.

The developing brain observes its environment and wires itself accordingly to survive in that world that it presumes will be like those experiences.

Thus, getting functional social attention is understandable. However, extreme attention seekers go to unhealthy lengths that are driven by emotional desperation.

Attention seeking is behaving in a way that is likely to elicit attention, usually to hearten oneself by being in the limelight or to elicit validation from others.

If you want that your patient to recover from conversion disorder, stop the habit to give attention on her/his condition. In fact giving attention reinforces the maladaptive behaviors and symptom of psychological conflict and make the condition more worse and difficult to treat.

Treatment

For many people, symptoms of conversion disorder get better without treatment, especially after reassurance from the doctor that their symptoms aren't caused by a serious underlying problem, and after referral to a mental health professional.

You may benefit from treatment if you have conversion disorder signs and symptoms that linger or keep coming back, you have severe symptoms, or you have other mental or physical health conditions. Treatment will depend on your particular signs and symptoms and may include:

  • Counseling (psychotherapy). Seeing a psychologist or professional counselor can help treat symptoms of conversion disorder and prevent it from coming back. This can be especially helpful if you also have anxiety, depression or other mental health issues.
  • Physical therapy. Working with a physical therapist may prevent complications of certain symptoms of conversion disorder. For example, regular movement of arms or legs may ward off muscle tightness and weakness if you have paralysis or loss of mobility.
  • Treating related stress and other conditions. Conversion disorder may improve when you get treatment for stress, anxiety or another underlying problem. Your doctor may prescribe anti-anxiety medications, antidepressants or other drugs as part of your treatment plan, depending on your individual health profile.
  • Trans-cranial magnetic stimulation. Some reports show that people with conversion disorder may benefit from this type of treatment, which involves exciting brain activity by using weak electrical currents that are said to alter the brain's biochemistry. However, this approach is still in an early stage regarding its use in the management of conversion disorder.

Prevention

Conversion disorder is usually triggered by a reaction to some kind of stress or trauma. Stress-relieving activities such as meditation and yoga may help reduce reactions to the events that prompt symptoms of conversion disorder. In general, however, the best way to prevent this is to strive for and maintain a good quality of life, a stable family environment, social contacts and work-life balance.

If you have other mental health conditions, make sure you're getting the right treatment. Treatment may include counseling and medications.

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