Conversion disorder
Conversion disorder: Excerpt from Professional Guide to Diseases (Eighth Edition)
A conversion disorder allows a patient to resolve a psychological conflict through the loss of a specific physical function — for example, by paralysis, blindness, or inability to swallow. Unlike factitious disorders or malingering, conversion disorder results in an involuntary loss of physical function. However, laboratory tests and diagnostic procedures fail to disclose an organic cause. The conversion symptom itself isn’t life threatening and usually has a short duration.
Causes and incidence
The patient suddenly develops the conversion symptom soon after experiencing a traumatic conflict that he believes he can’t handle. Two theories may explain why this occurs. According to the first, the patient achieves a “primary gain” when the symptom keeps a psychological conflict out of conscious awareness. For example, a person may experience blindness after witnessing a violent crime.
The second theory suggests that the patient achieves “secondary gain” from the symptom by avoiding a traumatic activity. For example, a soldier may develop a “paralyzed” hand that prevents him from entering into combat.
Conversion disorder can occur in either sex at any age. An uncommon disorder, it usually begins in adolescence or early adulthood.
Signs and symptoms
The history of a patient with conversion disorder may reveal the sudden onset of a single, debilitating sign or symptom that prevents normal function of the affected body part such as paralysis of a leg. The patient may describe a psychologically stressful event that recently preceded the symptom. Oddly, the patient doesn’t display the affect and concern that such a severe symptom usually elicits.
Assessment findings obtained during a physical examination are inconsistent with the primary symptom. For instance, tendon reflexes may be normal in a “paralyzed” part of the body, loss of function fails to follow anatomic patterns of innervation, or pupillary responses and evoked potentials are normal in a patient who complains of blindness.
Diagnosis
For characteristic findings in patients with this condition, see Diagnosing conversion disorder.
A thorough physical evaluation must rule out a physical cause, especially diseases that typically produce vague physical symptoms (such as multiple sclerosis or systemic lupus erythematosus).
Treatment
Psychotherapy, family therapy, relaxation therapy, behavioral therapy, or hypnosis may be used alone or in combination (two or more).
Special considerations
❑ Help the patient maintain integrity of the affected system. Regularly exercise paralyzed limbs to prevent muscle wasting and contractures.
❑ Frequently change the bedridden patient’s position to prevent pressure ulcers.
❑ Ensure adequate nutrition, even if the patient is complaining of GI distress.
❑ Provide a supportive environment, and encourage the patient to discuss the stressful event that provoked his disorder.
❑ Don’t force the patient to talk, but convey a caring attitude to help him share his feelings.
❑ Don’t insist that the patient use the affected system. This will only anger him and prevent the two of you from forming a therapeutic relationship.
❑ Add your support to the recommendation for psychiatric care.
❑ Include the patient’s family in all care. They may be contributing to the patient’s stress, and they’re essential to help him regain normal functioning.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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