“Pain is real when you get other people to believe in it.  If no one believes in it but you, your pain is madness or hysteria.” – Naomi Wolf

Conversion disorder, in the past known as “hysteria”, is a condition in which individuals ‘convert’ psychological stress (a mental or emotional crisis) into physical symptoms. Although arguably having existed for many hundreds of years it came to greatest prominence at the end of the 19^th century.  It is typically characterized by presenting symptoms of voluntary motor (movement) or sensory functioning problems, such as the ability to walk, swallow, see or hear, that would suggest an underlying neurologic or medical condition, but after medical evaluation are inconsistent with any known biological cause or explanation.  Conversion disorder symptoms can be severe, but for most people, they get better within a couple of weeks.

Conversion disorder symptoms usually appear suddenly after some sort of stressful experience, an emotional conflict, or another mental health disorder such as depression.  Some of the more common symptoms can include:

• Problems or inability speaking
• Difficulty swallowing
• Periods of significant loss of hearing
• Seizure-like behaviors
• Paralysis of the legs and/or arms
• Poor balance or coordination, which can lead to difficulty walking
• Numbness
• Visual problems

And, extensive diagnostic testing does not find any physical cause for the symptoms.

It is important to understand that patients suffering from conversion disorder are not making up their symptoms (known as malingering).  As far as the patient is concerned these conditions are very real, and can cause extreme distress.  As is the case with infectious disease outbreaks the disease oftentimes seems to begin with a single person who comes down with the symptoms and then spreads to people associated with that person.  Many mental health experts believe that in many cases of conversion disorder these first “index” cases are often people who actually have symptoms caused by a physical illness, but ensuing cases are in fact a result of subconscious imitation.  It is however important to remember that these individuals cannot consciously turn their symptoms, or its associated distress, on and off at will.

Recently, there has been much media attention focused on fifteen teenage girls from a small town in upstate New York who all began demonstrating mysterious symptoms of facial tics, spasms, and verbal outbursts.  A few years ago some fifty adults in Northern California reported bizarre symptoms, including a sensation of crawling skin.  In 2002 almost a dozen teenage girls in a rural North Carolina town experienced seizures and fainting.  In early 2007 a mysterious illness moved through a Catholic boarding school causing some six-hundred girls to experience leg weakness, some of which was so severe that many were actually unable to walk.  Later that same year almost a dozen high school girls in Virginia developed bizarre twitching, similar to the symptoms seen recently in the girls from upstate New York.  In each and every one of these cases extensive testing of the patients, as well as in many cases costly investigations of the school’s environment, demonstrated no medical findings whatsoever which would explain the symptoms, nor were any environmental causes ever found.

Because the sufferers of conversion disorder truly believe, and in their minds experience, significant symptoms and distress it is understandable that many of them, and their families, have great difficulty in accepting the fact that their “problems” are as a result of a stress-induced psychological disorder.  In the recent cases of the teenage girls from upstate New York physicians and mental health experts familiar with the patients’ treatment are clear in their belief that there is no medical/neurologic basis for their symptom presentation.  One frank example of a patient in that cohort demonstrated a girl with uncontrollable jerking of the arms that would abruptly stop when she would apply her eyeliner, and then once again began twitching around once she was done.  According to Jose Maldonado, M.D., Chief of Psychosomatic Medicine at Stanford University, “It’s almost impossible to conceive of a true neurological disorder that can allow for that complexity of switching back and forth…It also looks very purposeful.  I’m not saying she’s making it up.  I’m just saying that it doesn’t look neurological.”

The exact cause of conversion disorder is unknown, but the parts of the brain that controls muscles and senses may likely be involved.  The physical symptoms, from a psychological perspective, are thought to be an attempt to resolve the conflict the person feels inside.  It may also be the brain’s way of coping with something it perceives to be a threat.

Although conversion disorder can affect anyone, the following risk factors tend to strongly increase its likelihood:

• Female, as women are much more likely to experience conversion disorder

• Recent significant emotional trauma or stress
• Having another mental health condition
• A family history of conversion disorder
• Being an adolescent or young adult as conversion disorder is much more common during this stage of life
• A history of physical or sexual abuse

For most people, symptoms of conversion disorder get better with little more than supportive reassurance that they do not have a serious underlying health problem.  However, symptoms can worsen over time, or may resolve only to return some time later.  That is why it is important to seek the appropriate mental health treatment as soon as possible following the appearance of symptoms and the negative results of a thorough medical evaluation.

So, if you believe a friend or loved one may be afflicted with conversion disorder, encourage them, and/or through their primary care physician, to seek appropriate psychiatric treatment.  There are many highly qualified and capable psychiatrists, psychologists, and therapists with the Tri-Counties area that can effectively assist those suffering from this disorder.