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Stress Related Physical Ailments: Conversion and Somatic Symptom Disorders

Cleveland Clinic

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Conversion disorder is a condition where a mental health issue disrupts how your brain works. This causes real, physical symptoms that a person can’t control. Symptoms can include seizures, weakness or paralysis, or reduced input from one or more senses (sight, sound, etc.). This condition is often treatable through various types of therapy.

What is conversion disorder? Functional neurological symptom disorder — better known as “conversion disorder” — is a mental health condition that causes physical symptoms. The symptoms happen because your brain “converts” the effects of a mental health issue into disruptions of your brain or nervous system. The symptoms are real but don’t match up with recognized brain-related conditions. It’s important to know that conversion disorder is a real mental health condition. It’s not faking or attention-seeking. It isn't just something in a person’s head or that they’ve imagined. While it’s a mental health condition, the physical symptoms are still real. A person with conversion disorder can’t control the symptoms just by trying or thinking about it.

What is the difference between conversion disorder and somatic symptom disorder? Conversion disorder and somatic symptom disorder both fall under the same group of conditions, somatic symptom and related disorders, in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Experts group the two conditions because there’s a great deal of overlap between the two, and it’s possible to have both at the same time. With somatic symptom disorder, you have at least one symptom that severely disrupts or interferes with your life. That causes the following:

  1. You spend a lot of time thinking about your symptom(s).

  2. You feel very worried or anxious about your symptom(s).

  3. You dedicate an unusual amount of time and effort to the symptom(s) in some way. The key feature of conversion disorder is that you have a brain-related symptom (or multiple symptoms). These disruptive symptoms keep you from functioning as you would under normal circumstances. However, you don’t have a neurological (brain-related) condition to explain the symptom(s).

Who does it affect? Conversion disorder can affect people throughout their life, including during childhood. Certain symptoms are more likely at different ages. For example, the average age range for seizures is between ages 20 and 29, while the average age range for other movement-related symptoms is between 30 and 39. Conversion disorder is also much more likely to happen in women and those designated female at birth (DFAB). Available research shows at least twice as many women have conversion disorder compared to men or people designated male at birth (DMAB).

How common is conversion disorder? Conversion disorder isn’t a common problem. Experts estimate that 4 to 12 people out of every 100,000 receive a diagnosis of conversion disorder each year.

How does conversion disorder affect my body? Conversion disorder creates disruptions in your brain that cause physical symptoms. Functional MRI — which lets experts see your brain activity — can see the effects of conversion disorder. People who have conversion disorder usually have less activity or unusual activity in parts of their brain related to their symptoms. Those changes in brain activity aren’t something a person can fake.

Symptoms and Causes

What are the symptoms of conversion disorder? The symptoms of conversion disorder can vary widely depending on the part of the brain involved. Some of the most common symptoms include:

  1. Psychogenic non-epileptic seizures (PNES). Seizures typically happen because of conditions or issues with your brain’s structure or how it’s working. Psychogenic non-epileptic seizures happen because of mental health conditions (the word “psychogenic” means “of mental health origin”).

  2. Sense-related disruptions. Trouble with senses of vision, hearing, smell, taste and touch are all possible with conversion disorder. Some examples include double or tunnel vision, hearing loss or numbness, and the inability to feel something touching your skin.

  3. Pain. People with conversion disorder often feel pain, sometimes with other symptoms and sometimes on its own.

  4. Unusual muscle tension, spasms, twitches and tremors. These all happen because of a disruption in how your brain controls your muscles.

  5. Muscle weakness or paralysis.

  6. Trouble swallowing (dysphagia).

  7. Dizziness.

  8. Fainting or passing out (syncope).

  9. Chronic fatigue or lack of energy. People with conversion disorder often seem like they’re not worried about their symptoms. This phenomenon, “la belle indifference” (which is French for “beautiful ignorance”), happens most commonly with conversion disorder. However, it isn’t necessarily a symptom, and it doesn’t happen with every case of conversion disorder.

What causes conversion disorder? Experts don’t know exactly why conversion disorder happens. However, they do know that it’s more likely to happen along with certain circumstances and some medical conditions. Common circumstances seen in people with conversion disorder include:

  1. A history of childhood abuse.

  2. Having other mental health conditions, especially depression or anxiety.

  3. A recent stressful or traumatic event.

  4. A recent health condition or event acting as a trigger for conversion disorder.

What “inconsistent” means with conversion disorder A defining characteristic of conversion disorder is that your symptoms are inconsistent with a recognized medical condition. Your healthcare provider has to look for ways that your symptoms aren’t consistent with other conditions. That doesn’t mean they don’t believe you or your symptoms aren’t real. It means they have to find the inconsistency to diagnose conversion disorder. Finding an inconsistency might not feel like a good thing, but in this case, it is. Finding inconsistencies between your symptoms and known conditions means your healthcare provider can rule out other — and often more-serious — brain-related problems.

What can I expect if I have conversion disorder? Conversion disorder is a condition that can have major effects on your life, depending on the symptoms you have. Many people who have it experience severe symptoms that keep them from working or doing activities they enjoy. Many people with conversion disorder also struggle with how they feel about their condition and how others treat them. It’s common for people with conversion disorder to feel as if nobody believes them or that people think they’re faking or lying. Often, feeling that nobody believes them or accusations of lying — especially when this involves healthcare providers — keep people from seeking care that could help them

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