Conversion Disorder (Functional Neurological Symptom Disorder)

Functional neurological symptom disorder is listed under the category “somatic symptom and related disorders” in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Symptoms of functional neurological disorder manifest similarly to symptoms of neurological conditions and can include motor dysfunction like paralysis or abnormal movements, sensory symptoms such as blindness or deafness, and nonepileptic seizures, varying widely in presentation and severity. Though they aren’t associated with a neurological disorder, conversion disorder symptoms can cause significant distress.¹ 

These symptoms usually occur suddenly, often following a stressful event or psychological trauma. Below are some common symptoms of conversion disorder, grouped by the body systems they affect.

Motor symptoms

People with functional neurological disorder may experience motor symptoms, such as the following:

• Weakness or paralysis
• Abnormal movements, such as tremors or difficulty walking
• Loss of balance
• Difficulty swallowing or a sense of having a lump in the throat

Sensory symptoms

Below are sensory symptoms of conversion disorder: 

• Blindness or visual disturbances
• Deafness or hearing problems
• Loss of touch or pain sensation
• Speech problems, like an inability to speak or slurred speech

Seizure-like symptoms

Some symptoms of conversion disorder may seem like seizures, such as the following: 

• Episodes resembling seizures or convulsions
• Loss of consciousness
• Body shaking

Neurological-like symptoms

Symptoms that mimic neurological disorders may include the following: 

• Amnesia or other memory disturbances
• Hallucinations

Individuals living with conversion disorder often present with one or more of these symptoms, which can significantly interfere with daily activities. The symptoms are not intentionally produced and are not linked to any recognized medical or neurological condition. According to the Diagnostic and Statistical Manual of Mental Disorders, an episode of conversion disorder is acute if symptoms last for fewer than six months and persistent if they last six months or more. The DSM-V also states that the symptoms must not be caused by other mental health or medical conditions.

Notably, the symptoms can vary in severity and may come and go. Distractions can also influence them and may cause symptom improvement when the client is reassured that no serious neurological condition is present. Despite the lack of a clear medical explanation for these symptoms, they can cause distress and functional impairment to the individual, warranting the necessity of treatment.

Conversion disorder does not have a definitive cause but is often associated with psychological factors and stressful life events. It represents a complex interplay between physical, psychological, and social factors that lead to physical symptoms. It can be important to recognize that while the symptoms of conversion disorder are not attributable to any conventional neurological or medical condition, they are genuine and can cause significant distress and disability, requiring treatment similar to a range of other medical disorders.

Psychological factors

The most widely accepted theory behind the development of conversion disorder is that symptoms occur as a response to stressful or traumatic life events. Physical symptoms can be seen as a way the mind expresses emotional distress. Individuals with conversion disorder may also have a history of mental health conditions such as mood, anxiety, personality, or dissociative disorders.² These conditions may increase vulnerability to developing conversion disorder.

Physical factors

A physical illness or injury may cause some cases of conversion disorder. The resulting physical symptoms, however, are not directly attributable to the condition or injury.

Social factors

Specific cultural and societal influences may contribute to the presentation of conversion disorder. For example, in societies where expressing emotional distress is stigmatized, individuals may unconsciously convert this distress into physical symptoms.

The diagnosis of conversion disorder is typically a diagnosis of exclusion, made only after a thorough medical evaluation has ruled out other neurological or medical conditions that could explain the symptoms. The relationship between these risk factors and symptoms is complex and often requires a multifaceted approach to treatment.

The treatment approach for functional neurological symptom disorder is tailored to the individual, considering the specific symptoms, severity, and the presence of any associated psychological conditions. The primary goal of treatment is to alleviate symptoms, improve functional abilities, and address underlying psychological challenges that may be contributing to the disorder. Treatment often involves collaborative care with healthcare providers, focusing on managing symptoms effectively to enhance overall quality of life.

Medication

While there's no specific medication to treat conversion disorder, medications can be used to manage any coexisting conditions or symptoms:

• Antidepressants: If a mood disorder, such as depression or anxiety, is present alongside conversion disorder, antidepressants can be beneficial.
• Anti-anxiety medications: These drugs can be used on a short-term basis to reduce anxiety, which can, in turn, help individuals manage conversion disorder symptoms. While medication may offer relief, it's important to recognize that it is not a standalone solution and is most effective when combined with therapy or other forms of support.

Consult a medical doctor before starting, changing, or stopping any of your medications.

Other treatment options

These techniques may reduce stress and anxiety, which may alleviate the symptoms of conversion disorder and improve the client’s ability to fully engage in life.

• Hypnosis: This approach involves a therapist guiding the patient into deep relaxation, followed by suggestions for reducing symptoms and coping with stress.
• Relaxation techniques: Methods such as progressive muscle relaxation, deep breathing exercises, and mindfulness may decrease symptoms and stress.

Self-care

In addition to professional treatments, self-care practices can play a vital role in managing conversion disorder:

• Regular exercise: Physical activity can reduce anxiety and improve mood, potentially reducing conversion disorder symptoms.
• Healthy eating: A well-balanced diet can contribute to overall well-being and better stress and anxiety management.
• Sleep hygiene: Adequate sleep can be vital in maintaining emotional and physical health.
• Stress management techniques: These might include yoga, meditation, guided imagery, and other relaxation techniques. Such practices may reduce anxiety and potentially lessen the physical symptoms of conversion disorder.

By combining these approaches, people with conversion disorder may improve significantly and return to normal daily activities. The involvement of a multidisciplinary team, including mental health professionals, physical and occupational therapists, and primary care physicians, is often beneficial in ensuring comprehensive care.

One of the primary treatment options for conversion disorder is therapy, particularly cognitive-behavioral therapy. Availability of professional help is crucial, and online therapy platforms like BetterHelp allow you to connect with licensed therapists from the comfort of your home. 

In addition to therapy, numerous resources can provide further information and support. Government websites like the National Institute of Mental Health (NIMH) and the National Institute of Neurological Disorders and Stroke (NINDS) offer reliable, research-backed information about the disorder. These platforms can help individuals understand the disorder and stay informed about the latest research and treatment approaches.

Organizations like the American Psychiatric Association and the American Psychological Association also offer resources on their websites, including information about mental health conditions, treatment options, and ways to find a healthcare provider.

The National Library of Medicine has a detailed fact sheet on conversion disorder, with information about risk factors, symptoms, and the subtypes that are laid out in the Diagnostic and Statistical Manual of Mental Disorders.

For support and shared experiences, consider looking for local or online support groups. These platforms can provide a safe space to share your experiences, learn from others going through the same journey, and receive emotional support. You are not alone, and help is available.

Please see our Get Help Now page for more immediate resources.

Emerging research on functional neurological symptom disorder has provided intriguing insights into potential treatment methods and underlying causes.

A study published in the Journal of Neuropsychiatry investigated the effectiveness of cognitive-behavioral therapy (CBT) alongside standard medical care in treating conversion disorder. The study found that individuals who received CBT demonstrated more significant symptom improvement and decreased healthcare utilization, supporting CBT as a promising treatment for this condition.

Research is also exploring the potential neurological basis of conversion disorder. There are ongoing studies utilizing functional magnetic resonance imaging (fMRI) to better understand brain function in individuals with conversion disorder. Preliminary results suggest that these individuals may exhibit different patterns of brain activity during symptom episodes, potentially offering a neurological explanation for these unexplained physical symptoms.

These studies illustrate the growing body of research to improve understanding of conversion disorder, which may lead to more targeted and effective treatment approaches.

With appropriate treatment, such as CBT, up to 80% of patients may show significant improvement or complete resolution of symptoms

Cognitive-behavioral therapy (CBT) and other forms of psychotherapy may be a highly effective treatment option for conversion disorder. A study in the Journal of Neurology, Neurosurgery, and Psychiatry found that 80% of clients who use these treatment options show significant improvement or complete symptom remission. ¹

¹Journal of Neurology, Neurosurgery, and Pscyhiatry

Below are more statistics on conversion disorder or functional neurological symptom disorder:

• According to a study in the Journal of Neurology, Neurosurgery & Psychiatry, the incidence of conversion disorder in the general population is approximately four to 12 per 100,000 people and 50 per 100,000 at the outpatient neurology clinics.
• Conversion disorder is more prevalent in women, with the female-to-male ratio being about 2 to 3:1 in adults.
• Nearly 30% of individuals with conversion disorder may experience recurrent symptoms, emphasizing the importance of ongoing monitoring and management.