Dissociative conversion disorder is a group of psychosomatic disorders in which physical symptoms occur after a psychologically traumatizing situation. Diagnosis requires exclusion of any disorders with an organic origin that might explain the symptoms. Treatment is by psychotherapy and forms of behavioral therapy.
What is dissociative conversion disorder?
Psychosomatic disorders are purely psychologically caused disorders that cause physical symptoms because of the connections between the psyche and the body. Some disorders in the psychosomatic field are transient, meaning they are present only temporarily. Dissociative conversion disorder falls into this category. The term is an umbrella term for different disorders that are associated with different symptoms. Although the symptoms may differ to a greater or lesser degree, they share a common characteristic. Instead of a physical illness, a stressful event is the cause of all symptoms of dissociative conversion disorders. Like all other psychosomatic disorders, the form of conversion disorder is characterized by the connection between mental processes or feelings and physical reactions. Tangible changes in morphology occur. Exclusion of physical disease is the most relevant condition for the diagnosis of any dissociative conversion disorder.
Causes
In most cases, dissociative conversion disorder is based on psychological conflicts that the patient is unable or has difficulty coping with. The most relevant conflicts of this type correspond to traumatic events. Such an event may be, for example, the death of a loved one. In order to escape additional stress, the affected person filters out the accompanying stressors in an unconscious way. Instead of dealing with the traumatic event, an apparent illness with psychosomatic symptoms is accepted. In principle, the affected person initially experiences a primary gain of illness within the framework of this procedure. According to researchers, the fact that the patient maintains the physical symptomatology for months or even years is primarily due to the increased attention that the affected person receives from fellow human beings because of the apparent illness. Patients with dissociative conversion disorder thus experience secondary illness gain in addition to primary illness gain, which unconsciously encourages them in the maintenance of their complaints.
Symptoms, complaints, and signs
The expression and manifestation of symptoms is extremely variable in the context of dissociative conversion disorder. Often a single symptom is present, such as partial amnesia. In still other cases, the patient’s motor function is impaired, seizures occur, or sensory disturbances and even paresis manifest. Amnesia is one of the leading symptoms. Most importantly, the patient does not remember the causally stressful event. In addition to this phenomenon, dissociative stupor may occur, affecting posture, muscle tension, and responsiveness to environmental stimuli. In addition to trance and states of possession, dissociative movement disorders may be present, most notably a reduction in movement or a coordination disorder, up to and including ataxia, dystonia, or myoclonia. Dissociative seizures with similarity to epilepsy as well as sensory or sensory disturbances of the skin, vision, hearing or smell are also symptomatic. In combination with conversion disorder, dissociative disorders such as Ganser syndrome may be present. In addition, concomitant personality disorders or anxiety disorders often occur.
Diagnosis
Usually, the first course leads patients with dissociative conversion disorder to a neurologist. In the course of taking the patient’s history or the history of others, the neurologist often already rules out organic causes for the neurological deficits. Only in the rarest cases do the deficits seem so real that imaging is ordered. After the exclusion of organic diseases, the suspicion of a dissociative conversion disorder is obvious in case of corresponding symptoms. For further diagnosis, questionnaires for self-assessment and assessment by others can be used. Somatization disorders must be excluded by differential diagnosis in order to establish the diagnosis of dissociative conversion disorder.In addition, the traumatic experience that triggered the manifestations is ideally determined during the diagnostic process. The prognosis for affected individuals depends primarily on the time of diagnosis and the degree of chronicity of the disorder.
When should you see a doctor?
A doctor should be consulted as soon as physical as well as psychological irregularities develop. After a traumatic experience or in case of problems in the interaction of body and psyche, medical support is needed. If there are sensory disturbances or seizures, a persistent feeling of malaise or a loss of zest for life, a doctor is needed. If everyday private or professional obligations can no longer be performed as usual because the general level of performance is reduced, a visit to the doctor should be made. In case of headaches, a diffuse pain experience, lethargy, listlessness and listlessness, there is reason for concern. Problems of the digestive system, sharp changes in body weight, and general weakness need to be investigated and treated. A physician should clarify symptoms if they persist for several days or weeks and increase in intensity and magnitude. Disturbances in concentration or attention, motor problems as well as coordination difficulties, should be investigated and treated. In case of anxiety, a feeling of fogginess, changes in musculature as well as personality, a doctor should be consulted. Social withdrawal, lowered mood, and a persistent experience of stress should be discussed with a physician. If the symptoms occur after experiencing an intense and formative life event, it is advisable to seek the cooperation of a physician or therapist.
Treatment and therapy
Patients with dissociative conversion disorder are treated causally. This means that the therapist begins treatment by addressing the cause of the disorder. Once the stress of the event is no longer perceived as distressing, and the trauma is thus largely overcome, the individual symptoms of the disorder diminish. Symptomatic therapy would only treat the symptoms. Symptomatic therapy steps to alleviate the individual symptoms are available, for example, in the form of conservative drug treatments with substances such as benzodiazepines. This medication is a tranquilizer that currently reduces the high level of suffering experienced by patients with dissociative conversion disorder. However, in modern therapy, drug therapy is used at most as an adjunct to make the patient’s distress controllable until he or she is causally cured, thereby improving his or her current quality of life. The main focus of treatment for patients of dissociative conversion disorder is behavioral therapy, which enables the patient to make a new assessment of situations and his own behavior. Psychotherapeutic discussions also attempt to free the patient from self-inflicted isolation as early as possible and bring him back to reality. Otherwise, there is a risk of the disorder becoming chronic, requiring longer-term treatment and making recovery much more difficult.
Outlook and prognosis
The prognosis of dissociative conversion disorder is considered unfavorable. Many patients experience multiple mental disorders that worsen the prospect of recovery. If Dissociative Conversion Disorder is diagnosed along with an affective disorder, dependence disorder, eating disorder, as well as personality disorder, a course of illness over several years or decades is to be expected. In some cases, recovery does not occur. The symptoms of Dissociative Conversion Disorder may develop suddenly after a triggering event and may also completely resolve in the further course. However, permanent relief is often not provided. When experiencing a new life-critical event or processing repressed traumatic circumstances, the symptoms reappear. These can differ in their extent as well as their intensity from the known complaints. In general, a late diagnosis leads to a less favorable prognosis. In patients who do not experience a cure of the symptoms, the treatment goal is directed towards the integration of the complaints in everyday life. The decision of the therapy goal depends on the cause of the conversion disorder as well as on the personality of the patient.Through integration, an overall improvement in well-being is achieved, as a way of dealing with the disease is established and trained in behavioral therapy. The affected person learns how to respond well to situations in life as well as the needs of his body.
Prevention
Dissociative conversion disorder can be prevented by prophylactically working through psychologically stressful situations and traumas in the company of a professional.
Aftercare
In this disease, aftercare proves to be very difficult in most cases. In the first place, the disease must be comprehensively examined by a psychologist and further also treated, whereby it cannot come to a self-healing. The earlier this conversion disorder is recognized, the better is usually the further course. For this reason, an early diagnosis is important in the case of conversion disorder. Furthermore, it is also important that the relatives or friends also deal with this disease and inform themselves about the symptoms and their effects. Only through a comprehensive knowledge of the disease can they help the affected person. Intensive and above all loving conversations with the affected person are also very important in order to alleviate the symptoms. In many cases, patients with conversion disorder are also dependent on taking medication. It is important to ensure that the correct dosage is taken and that the medication is taken regularly. In the case of severe symptoms, relatives can also persuade the affected person to undergo treatment in a closed institution. As a rule, the patient’s life expectancy is not reduced by this disease.
What you can do yourself
Since Dissociative Conversion Disorder is a mental disorder, the options for self-help are very manageable for the sufferer. Part of the symptomatology of the disorder is the lack of insight into the illness. It is not possible to change the thoughts and the actions on one’s own initiative in such a way that relief can occur. Therefore, the affected person should seek professional help. Once the diagnosis has been made, it is advisable to obtain comprehensive information about the course of the disease. Through educational work, changes and improvements can be achieved. Since it is often the people in the close social environment who are directly confronted with the sufferer’s complaints, these people should also be adequately informed about Dissociative Conversion Disorder. The knowledge about the characteristics of the mental disorder helps all participants of the closer environment in everyday life to avoid conflicts. The understanding for shown behavior increases and it becomes more comprehensible for the relatives or friends. Personal emotional injuries decrease as soon as dealing with the disorder has been learned. Despite all adversities, a stable social environment is important for maintaining life satisfaction. For this reason, an open approach to the mental disorder is recommended. Withdrawal behavior is not beneficial, as it triggers further problems.
