Conversion disorder

Conversion disorders are a group of mental disorders that have in common the presence of symptoms and signs, mainly neurological, without there being an objective disease or physical cause that could explain them. grouped under the diagnosis of hysteria.

Definition

At present, and according to the DSM-IV classification system, the basic aspect of this disorder is the presence of symptoms or unintentional deficits that affect voluntary motor or sensory functioning, which suggests the existence of a overall pathological state. Psychological factors are involved in its onset or exacerbation.

It is a conversion because the patient converts the psychological conflict into a physical disorder (inability to move certain parts of the body or use the senses in a normal way).

History

Towards the end of the 19th century, several psychologists and neurologists began to study these disorders: Pierre Janet, Jean-Martin Charcot, Josef Breuer, and Sigmund Freud. Before, the vast majority of people diagnosed were women. This historic sexual disparity is often explained in sociological terms, as is the drastic drop in the rate of the syndrome.^{[citation needed]} The term hysteria is still occasionally used, but usually without reference to any specific underlying mechanism. At first it was thought that hysteria was a pathology exclusively for women, hence its name: the word comes from the ancient Greek ὑστέρα (hystéra) which means uterus.

Freud initially theorized that conversion disorder stems from an emotion of anger, disgust, or unresolved conflict. He used hypnosis to treat this disorder. It was then superseded by the cathartic method of abreaction and, for a brief period, by the so-called "prompt method," in which Freud placed his hand on his patients' foreheads and "prompted" them to remember. With these three methods the cure of the patient was not achieved, but only a discharge of the accumulated conflicts. Later, Freud began to apply the method of free association that overcomes the difficulties arising by allowing the identification of the key reasons for the emotional conflict in the person.

Currently the axis of the concept dissociative disorder is based on the loss of control of the normal integration between certain memories of the past, consciousness, certain immediate sensations, one's own identity and control of body movements.

Clinical picture

In this type of neurosis, two classes are clearly identified:

• Type conversivein which symptoms include neuromuscular and sensory systems.
• Type dissociativein which the disorders of consciousness appear.

In some cases there is the impression that the patient obtains benefits from his state of disability, which leads him to confuse the disease with malingering. The main symptoms of hysterical neuroses are not under the patient's conscious control, so true malingering may become a manifestation of a personality disorder. It has been proven that in some cases, patients present isolated visual hallucinations not accompanied by false thoughts.

The conversion hysteria type presents an enormous variety of diffuse symptoms, such as motor paralysis or blindness, disorders of the nervous system, including tremors and localized paralysis, paresthesias, and variable states of epileptic-like seizures.

Dissociative states arise from the sudden emergence of the conscious state of primary destructive impulses; these states occur with some frequency after the patients have committed a violent act and become problems in the trial.

Classification

According to the ICD-10 classification, it is divided into:

• Dissociative Amnesia
• Dissociative smoke
• Dissociative spirit
• Trance and possession disorder
• Disorder of voluntary motility and sensitivity
  • Dissociative disorder of motility
  • Dissociative seizures
  • Dissociative sensory anesthesia and losses.
• Multiple personality disorder

According to the DSM-IV-TR (A.P.A. 2002) the diagnostic criteria for conversion disorder are:

• A. One or more symptoms or deficit that affect the voluntary or sensory motor function and suggest a neurological condition or other general medical condition.

• B. Psychological factors are considered to be associated with symptom or deficit because the initiation or exacerbation of both is preceded by conflicts and other stressors.

• C. Symptom or deficit does not occur intentionally or in a fined manner (such as in a factual disorder or simulation).

• D. After proper clinical examination, the symptom or deficit cannot be fully explained by a general medical condition, by the direct effects of a substance or by a culturally normal behavior or experience.

• E. Symptom or deficit causes discomfort or clinically significant deterioration at the social, labor or other important areas of operation of the subject, require medical care.

• F. Symptom or deficit is not limited to pain or sexual dysfunction, it does not occur exclusively during the course of the somatization disorder and is not best explained by another mental disorder.

Explain type of symptom or deficit:

• With symptom or motor deficit.

• With symptom or sensory deficit.

• With crisis and seizures.

• Mixed symptomatology.