Conversion Disorder

What Causes Conversion Disorder?

The cause of CD is not yet known. The disorder often appears after a person experiences an event or situation that produces psychological stress, such as interpersonal conflict, depression, life changes, or emotional trauma. Some scientists believe that physical factors such as infections, migraines, or injuries might cause the disorder to develop. However, the symptoms of CD are, by definition, not directly traceable to a physical cause.

Is Conversion Disorder Hereditary?

Scientists have not identified any inherited genetic factor that increases the risk of CD. Most people with CD do not have a family history of the disorder. Some research suggests that women with a close relative with CD are more likely to develop the condition themselves. However, researchers believe the increased risk is more likely to come from environmental risk factors shared by family members rather than genetics.

How Is Conversion Disorder Detected?

CD most often first occurs in late childhood or early adulthood. However, it can develop at any stage of life. The earliest symptoms vary from case to case. It is important to remember that the symptoms of CD are real and could be the result of a serious neurological problem. Anyone who experiences any of the disorder’s symptoms should promptly consult with a medical professional.

How Is Conversion Disorder Diagnosed?

A doctor will start the diagnostic process with a physical exam to rule out neurological problems that may be causing symptoms. The doctor will consider a CD diagnosis only after other possible causes have been ruled out.

Diagnostic steps may include:

• A physical exam. This exam will rule out physical conditions that could be causing the symptoms.
• Computerized tomography (CT) or magnetic resonance imaging (MRI) scans. These imaging exams can detect potential symptom-causing conditions such as brain injuries, stroke, or brain tumors.
• Electroencephalogram (EEG). This measure of the brain’s electrical activity can identify seizure activity or other abnormalities in brain function.

After these steps in the process, a doctor will consider the diagnostic criteria for CD, which include:

• One or more symptoms affect movement or sensory function.
• No physical cause of the symptoms can be identified.
• No underlying disease or mental disorder explains the symptoms.
• The symptoms cause significant distress or impairment.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Conversion Disorder Treated?

The treatment plan for CD will vary from case to case to address the person’s specific symptoms. However, common treatments often include psychotherapy and other types of therapy to improve the impairments caused by the symptoms.

Types of therapy commonly used to treat CD include:

• Cognitive-behavioral therapy
• Physical therapy
• Occupational therapy
• Speech therapy
• Hypnosis
• Stress management training

How Does Conversion Disorder Progress?

Most people with CD improve with treatment. Many people get better after they are reassured that there is no serious medical disorder underlying their symptoms. However, as many as one-quarter of people with the condition will experience a recurrence of their original symptoms or new symptoms at some point in the future.

Factors that increase the risk of relapses include:

• Lack of prompt treatment
• Slow-developing symptoms
• Symptoms that do not respond quickly to treatment
• Co-existing mental disorders
• The presence of seizures not caused by epilepsy

How Is Conversion Disorder Prevented?

There is no known way to prevent CD. However, prompt treatment after symptoms appear may prevent future relapses.

Conversion Disorder Caregiver Tips

Many people with conversion disorder also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with CD:

• More than a quarter of people with CD also have bipolar disorder.
• More than a third of people with CD have some type of dissociative disorder, including dissociative amnesia or depersonalization disorder.
• CD has also been associated with depression, anxiety, post-traumatic stress disorder (PTSD), and borderline personality disorder.

Conversion Disorder Brain Science

Researchers have attempted to find neurological explanations for the symptoms of CD by examining brain activity in people with the disorder. Studies have found atypical brain function in CD patients, suggesting impaired communication in parts of the brain that control movement and sensory function. Significant findings have included:

• One study noted unusual brain activity in CD patients with a paralyzed arm. In these people, blood flow was lower than expected in the basal ganglia, a part of the brain responsible for both movement and responses to emotion. The researchers suggested that this might indicate that emotional responses were causing the basal ganglia to block brain signals that should trigger the movement of the arm.
• In another study, a patient with a paralyzed leg showed abnormally low activity in the primary motor cortex, the part of the brain that should trigger the movement of the leg. Instead, there was increased activity in the anterior cingulate gyrus, a part of the brain that combines motor function control with cognitive functions, suggesting that this area could be working to block movement triggers.

Conversion Disorder Research

Title: Neuroimaging Biomarkers of Prognosis in Motor Functional Neurological Disorders

Stage: Recruiting

Contact: David L Perez, MD, MMSc

Massachusetts General Hospital

Boston, MA

Functional Neurological Disorder (FND/ Conversion Disorder) is a highly prevalent and disabling neuropsychiatric condition. Motor FND symptoms include Nonepileptic Seizures, Functional Movement Disorders, and Functional Weakness. Clinical research across these motor FND subtypes, including research studies from the candidate’s laboratory, suggests that these populations share many clinical and phenotypic similarities that warrant increased research integration. Furthermore, despite the prevalence of motor FND, little is known about the underlying neuropathophysiology of this condition, which is a prerequisite for the development of biologically informed prognostic and treatment response biomarkers. Across 3 published neurobiologically focused articles, the candidate proposed a framework through which to conceptualize motor FND. It is suggested that motor FND develops in the context of structural and functional alterations in neurocircuits mediating emotion awareness/expression, bodily awareness, viscerosomatic processing, and behavioral regulation. The overall goal of this project is to comprehensively investigate structural and functional magnetic resonance imaging (MRI) biomarkers of prognosis across motor FND. Multimodal structural and functional MRI techniques (including voxel-based morphometry, cortical thickness, resting-state functional connectivity, and diffusion tensor imaging tractography) will be used to probe brain-prognosis relationships systemically. Novel aspects of this proposal include the study of the full spectrum of motor FND, consistent with a trans-diagnostic approach.

Title: Modulation of Sense of Agency With Non-invasive Brain Stimulation and Mindfulness-based Stress Reduction Therapy

Stage: Not Yet Recruiting

Principal investigator: Selma Aybek, MD

University Hospital Inselspital

Berne, Switzerland

A conversion disorder is a dysfunction of the nervous system in which no structural or organic damage can be demonstrated. However, it must be distinguished from other psychiatric disorders such as psychosis or depression. There are various signs of the disease, such as muscle paralysis, uncontrolled tremors, or cramps. In rarer cases, blindness, deafness, or numbness may occur. Diagnosing this complex disorder has always been a challenge for neurologists and psychiatrists.

This study investigates the effects of transcranial magnetic stimulation (TMS) on the general well-being and symptoms of conversion disorder and other neurological disorders compared to healthy subjects. The TMS method allows targeting specific areas of the brain using magnetic fields. This technique is not painful and does not have long-lasting effects.

In addition, the study investigates the effects of mindfulness-based stress reduction on the general well-being and symptoms of conversion disorder and other neurological disorders and compares them to healthy subjects. This technique is not painful and has no long-lasting effects.

The study includes a maximum of seven sessions in total (five sessions of approximately 1.5-2 hours each and two sessions each overnight). The planned study methods include TMS, Magnetic resonance tomography of the brain (MRI “tube”), questionnaires, blood, saliva, and motion sensors (e.g., fitness bracelet), and participation in the 8-week mindfulness program.

Title: Neuroimaging Biomarker for Seizures (NIBMSZS)

Stage: Recruiting

Principal Investigator: Jerzy Szaflarski, MD, PhD

University of Alabama

Birmingham, AL

Numerous Veterans and civilians have seizures, which can be epileptic or nonepileptic in nature. Epileptic seizures are caused by abnormal brain cell firing. Nonepileptic seizures appear similar to epileptic seizures but are associated with traumatic experiences and underlying psychological stressors. Unfortunately, both types of seizures are common and disabling, and many patients with seizures do not have adequate control resulting in loss of quality of life.

In this proposed 3-site study (Providence, RI, and Birmingham, AL), which are epilepsy centers with expertise both in epilepsy and psychogenic nonepileptic seizures (PNES), we will enroll 88 patients with video-EEG confirmed PNES and 88 with confirmed post-traumatic epilepsy (PTE) and will obtain functional neuroimaging before and after they receive a behavioral treatment – Cognitive Behavioral Therapy for Seizures. The functional neuroimaging studies in these patients will be compared to patients with a traumatic brain injury without seizures to test the hypothesis that the faulty processing of emotions and stress in patients with PNES/PTE and abnormal brain connectivity have unique signals in patients with seizures compared to Veterans without seizures and that the neuroimaging signatures can be modified using behavioral intervention.

Impact: This grant application for the first study investigating mechanisms of PNES and PTE will provide increased understanding of neural circuitry in PTE and PNES, which can inform PTE and PNES treatments and could change clinical neurologic and psychiatric practice for PTE and PNES.

Participants will be recruited at the Providence VA Medical Center, Rhode Island Hospital, and the University of Alabama, Birmingham (UAB).