About Conversion Disorder Inpatient Treatment

Conversion disorder is a complex mental illness that can be difficult to diagnose and treat due to its involvement with physical symptoms. Treating this disorder at the inpatient level requires ruling out other physical conditions and providing evidence that the symptoms place the patient or others in imminent danger. Understanding what conversion disorder is and how it manifests helps match the right form of treatment to the individual experiencing the symptoms.

Definition

• Conversion disorder is defined through the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000) as a somatic disorder. Somatic disorders involve the manifestation of physical symptoms as the body's response to a mental or emotional stressor.

  Specifically, conversion disorder involves symptoms that appear as a neurological condition, most often taking the form of paralysis of a specific body part. Other ways these symptoms can appear are losing sensation in large parts of the body (e.g., numbness on one side), loss of other senses like vision or hearing and seizures.

History and Significance

• Conversion disorder in its early definition was known as hysteria. The Encyclopedia of Mental Disorders provides information on its origins. Two 19th -entury neurologists were studying what at the times was known as hysteria and concluded that the symptoms were rooted in psychological trauma or stress.

  A similar examination of conversion disorder symptoms was born out of World War I combat soldiers who were presenting with paralysis and loss of senses. Labeled "combat neurosis," the treatment provided was the same as that given to women with "hysteria"--hypnosis and narcotics.

  The recognition of physical symptoms being rooted in psychological stress is important, as otherwise conversion disorder is difficult to recognize. The Encyclopedia of Mental Disorders reported information from one study on health-care utilization citing that up to 72 percent of office visits to a physician are the result of somatic symptoms.

Diagnostic Criteria

• The DSM-IV-TR provides specific criteria for diagnosing conversion disorder:

  1. At least one symptom that affects voluntary movement or the senses, appearing as a neurological condition.
  2. The beginning or worsening of the physical symptoms happens after a major stressor.
  3. The symptom is not produced on purpose or faked.
  4. The physical symptom cannot be explained by a general medical condition, substance use or behavior related to the individual's culture.
  5. The symptom is serious enough to impact the individual's daily functioning (e.g., school, social events or work, requiring frequent medical attention).
  6. The symptom is not limited to pain or better explained by another mental disorder.

  Because any medical condition must be ruled out, conversion disorder can be hard to diagnose.

Treatment Options

• The Merck Online Medical Dictionary reports that inpatient hospitalization (in a medical hospital) often results in symptoms going away in two weeks. However, in up to 25 percent of cases, symptoms recur within a year and may become chronic without long-term treatment.

  Inpatient psychiatric hospitalization only occurs when the person is in imminent danger to themselves or other people; most of the time conversion disorder can be treated on an outpatient basis.

  Outpatient counseling will help explore the underlying reasons for the development of conversion disorder, including other potential issues such as anxiety or depression. Counselors or physicians may refer the patient to a psychiatrist who can help explore psychotropic medication to help regulate mood and anxiety.

  Hypnosis has also been found to be helpful. Hypnosis is conducted by licensed hypnotherapists and will help guide a person through imagery and past events with the purpose of identifying and resolving stressful situations that may be causing the conversion disorder symptoms.

Neurological Connections and Treatment

• The Mayo Clinic reports that there is a correlation between conversion disorder symptoms and neurological patterns in the brain. People who experience any of the four types of symptoms have brain activity that mimics heightened arousal or the virtual shutting down of certain parts of the brain. The theory is that the brain is attempting to protect the body from potential harm; the brain is converting psychological stressors into physical distress.

  As a result, a more unconventional form of treatment identified it transcranial magnetic stimulation. Weak electrical currents are run through magnets attached to a person's head with the purpose of altering brain chemistry. The idea is that this alteration in chemistry will trick the brain into halting the signal to paralyze an arm or trigger seizures.