Definition

Conversion disorder presents as disturbances of voluntary motor or sensory function that cannot be medically explained after thorough investigation (see Table 8-2). DSM-IV-TR specifies that symptoms must be associated with psychological factors that include conflicts or other stressors that precede the development or worsening of the conversion symptom. As in other somatoform disorders, the symptom must not be consciously feigned and must produce clinically significant distress or impairment in functioning. The symptoms must be viewed as abnormal within the individual's own culture.

The term conversion derives from the psychoanalytical concept that the somatic symptom is the re sult of an unconscious resolution of a psychological conflict—commonly a sexual or aggressive impulse— in which the mind "converts" psychological distress into a physical symptom. This "self-hypnosis" acts as a defense mechanism against overwhelming stressful or traumatic events (Roelofs et al. 2002). The resulting reduction in anxiety may explain in part the phenomenon of la belle indifference, or the apparent lack of concern sometimes observed in patients with conversion disorder. However, la belle indifference is not always seen in children with conversion disorder; in fact, one study found that less than 8% of children with conversion disorder displayed this phenomenon (Spierings et al. 1990).

Primary gain is obtained by keeping the psychological conflict out of consciousness and minimizing anxiety. The symptom allows the partial expression of the forbidden wish, but in a disguised form so that the patient does not need to consciously confront the unacceptable impulse or feeling. Secondary gain in the form of receiving increased attention from care-givers or being excused from various pressures or responsibilities may also contribute to the development or continuation of conversion symptoms.

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