Conversion Disorder - Anatomy of Psych

What is conversion disorder?

Conversion disorder, also known as functional neurological disorder, is a characterized by motor or sensory neurologic symptoms that cannot be explained by any known neurlogic disorder. Symptoms can include weakness, paralysis, non-epileptic seizures, movement disorders, speech or visual impairment, swallowing difficulties, sensory disturbancs, or cognitive symptoms. Conversion disorder has an annual incidence of 4-12 of 100,000 individuals.

What does conversion disorder look like?

Signs & Symptoms

DSM-5 Criteria

Criterion A. One or more symptoms of altered voluntary motor or sensory function. Note: Autonomic symptoms such as orthostatic lightheadedness would not meet this criteria.

Criterion B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.

Criterion C. The symptom or deficit is not better explained by another medical or mental disorder.

Criterion D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

Subtypes & Specifiers

Risk Factors

Preceding physical injury in 37% of affected individuals

Prognosis

Average onset is between ages 30-50
25% of individuals have a comorbid neurological disorder

Differential Diagnosis

Neurological disease
Somatic symptom disorder
Factitious disorder, malingering
Dissociative disorders
Body dysmorphic disorder
Depressive disorders
Panic disorder

How is conversion disorder investigated?

Physical exam:
- Hoover's sign
- Weakness
- Tremor entrainment test
- Seizures
- Visual blindness

How is conversion disorder treated?

Education and self-help techniques are first-line treatment, and cognitive behavioral therapy (CBT) is second-line treatment.

Cognitive behavioral therapy (CBT)

Nursing Management

Self-care deficit

Causes & Behaviors:

Need for assistance to carry out self-care activities such as eating, dressing, maintaining hygiene, and toileting due to alteration in physical functioning

Interventions:

Encourage independence as much as possible
Set small, appropriate goals with the client to meet needs for ADLs

References

[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.

[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.

[3] Cock, H. R., & Edwards, M. J. (2018). Functional neurological disorders: Acute presentations and management. Clinical medicine (London, England), 18(5), 414–417.

[4] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.