What is conversion disorder?
Conversion disorder (known today as functional neurological disorder) consists of real neurological symptoms caused by a disturbance in how the brain sends and receives signals to and from the body, without structural damage to the nervous system. This condition was formerly called “hysterical neurosis”, but that term is no longer used.
The word “conversion” means “transformation”: according to the older view, psychological tension is converted into physical symptoms. Today a broader view is taken — although stress and trauma are important factors, a clear psychological cause is not found in every patient. The key point is that the symptoms are real; the patient does not produce them deliberately and cannot control them by will. This is not “imagination” or “putting it on”.
What are the causes and risk factors?
Conversion disorder occurs in people of any educational and social background. Several factors may play a role together in its development.
- Serious psychological trauma experienced in childhood or later
- Severe and prolonged stress
- Depression and anxiety disorders
- The period after a physical injury, illness or operation
- Chronic pain
- Having another neurological condition (for example, epilepsy or migraine)
Some of the cases that people describe as being “possessed by a jinn” are in fact functional seizures of this kind. Such explanations lead to delayed treatment and stigma for the patient.
What are the symptoms of conversion disorder?
- Functional (dissociative) seizures — the person suddenly collapses, their muscles stiffen and they do not respond to questions; sometimes after the seizure they cry, shout or grab at people around them. They may look similar to an epileptic seizure.
- Movement disorders — weakness in an arm or leg, legs “seizing up”, walking difficulties, tremor.
- Sensory disorders — numbness, loss of sensation.
- Vision and voice disorders — temporary blindness, mutism, aphonia (speaking in a whisper).
- Difficulties with memory and concentration, severe fatigue.
Some patients show a strange indifference to their own condition. People around them sometimes think the person is producing the symptoms knowingly, but this is absolutely not the case.
When is emergency help needed?
If sudden weakness, speech or vision problems, or a seizure with loss of consciousness occurs for the first time, it cannot be assumed to be a functional disorder — causes such as stroke and epilepsy must first be ruled out. In such cases call 103.
If the cause of a seizure is not known for certain, give first aid as for an epileptic seizure: protect the person from injury, put something soft under their head, never try to open their mouth or prise their teeth apart with a spoon, and call 103 if the seizure lasts longer than 5 minutes. Read more: First aid for epilepsy.
How is conversion disorder diagnosed?
The diagnosis is not made simply because “nothing was found on examination”. During a detailed neurological examination the neurologist looks for positive signs typical of a functional disorder — for example, weakness that changes when attention is distracted.
It is often impossible to tell conversion seizures from epileptic seizures by appearance alone. Therefore, where necessary, an EEG and video-EEG monitoring are carried out; the diagnosis is made after epilepsy and other neurological causes have been ruled out. It should be noted that the same person may have both epilepsy and functional seizures. In some cases an MRI scan and blood tests are also ordered.
How is conversion disorder treated?
The first step in treatment is a clear explanation of the diagnosis to the patient: understanding that the symptoms are real and related to how the brain functions is often the beginning of improvement. Psychotherapy — especially cognitive behavioural therapy delivered by professionals — is more effective than medication. For movement symptoms, physiotherapy focused on functional disorders is helpful. If depression or an anxiety disorder is present, its treatment is also part of the plan. The doctor draws up an individual treatment plan for each patient, and a neurologist, psychotherapist and physiotherapist often work together.
Advice for everyday life and for families
- Stay calm during a seizure, do not scold the person and do not tell them to “pull yourself together”.
- Build daily habits that reduce stress: a regular sleep pattern, physical activity, rest.
- Note situations that make the symptoms worse and discuss them with the therapist.
- Do not turn to “folk remedies” or psychics on your own — this delays treatment.
Frequently asked questions
Is the patient doing this on purpose?
No. Functional neurological symptoms are not under voluntary control. Deliberately producing symptoms is an entirely different condition.
Does conversion disorder go away?
The course varies from person to person: in some people the symptoms pass in a short time, while in others they last a long time. Early diagnosis and correct therapy improve the outlook.
Which doctor should I see?
First, a neurologist — to rule out other neurological causes and confirm the diagnosis. At a later stage a psychotherapist or psychiatrist joins the treatment.
Do epilepsy medicines help functional seizures?
No, antiepileptic medicines have no effect on functional (dissociative) seizures and can cause unnecessary side effects. That is why correctly identifying the nature of the seizures is so important. If the same person has both epilepsy and functional seizures, the doctor builds the treatment plan taking both into account.
Does conversion disorder occur in children?
Yes, functional neurological symptoms also occur in childhood and adolescence. In such cases the child’s school and family environment and the stress factors they face are also carefully examined, and the family is involved in treatment.