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Conversion disorder

Definition

Functional neurological disorder (formerly called conversion disorder) is a mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.

Alternative Names

Conversion disorder; Functional neurological symptom disorder; Hysterical neurosis

Causes

functional neurological disorder symptoms may occur because of a psychological conflict.

Symptoms usually begin suddenly after a stressful experience. People are at risk of functional neurological disorder if they also have:

  • A medical illness
  • A dissociative disorder (escape from reality that is not on purpose)
  • A personality disorder (inability to manage feelings and behaviors that are expected in certain social situations)

People who have functional neurological disorder are not making up their symptoms in order to obtain shelter, for example (malingering). They are also not intentionally injuring themselves or lying about their symptoms just to become a patient (factitious disorder). Some health care providers falsely believe that functional neurological disorder is not a real condition and may tell people that the problem is all in their head. But this condition is real. It causes distress and cannot be turned on and off at will.

The physical symptoms are thought to be an attempt to resolve the conflict the person feels inside. For example, a person who believes it is not acceptable to have violent feelings may suddenly feel numbness in their arms after becoming so angry that they wanted to hit someone. Instead of allowing them to have violent thoughts about hitting someone, they experience the physical symptom of numbness in their arms.

Symptoms

Symptoms of a functional neurological disorder include the loss of one or more bodily functions, such as:

  • Blindness
  • Inability to speak
  • Numbness
  • Paralysis

Common signs of functional neurological disorder include:

  • A debilitating symptom that begins suddenly
  • History of a psychological problem that gets better after the symptom appears
  • Lack of concern that usually occurs with a severe symptom

Exams and Tests

The provider will do a physical exam and may order diagnostic tests. These are to make sure there are no physical causes for the symptom.

Treatment

Talk therapy and stress management training may help reduce symptoms.

The affected body part or physical function may need physical or occupational therapy until the symptoms go away. For example, a paralyzed arm must be exercised to keep the muscles strong.

Outlook (Prognosis)

Symptoms usually last for days to weeks and may suddenly go away. Usually the symptom itself is not life threatening, but complications can be debilitating.

When to Contact a Medical Professional

See your provider or mental health professional if you or someone you know has symptoms of functional neurological disorder.

References

American Psychiatric Association. Somatic Symptom and Related Disorders. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition, Text Revision (DSM-5-TR). Washington, DC: American Psychiatric Association Publishing; 2022.

Gerstenblith TA, Kontos N. Somatic symptom disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 24.

Last reviewed November 6, 2022 by Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

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