conversion disorder

WordNet

1. (psychiatry) a defense mechanism represses emotional conflicts which are then converted into physical symptoms that have no organic basis
2. a spiritual enlightenment causing a person to lead a new life (同)rebirth, spiritual rebirth
3. a successful free throw or try for point after a touchdown
4. act of exchanging one type of money or security for another
5. the act of changing from one use or function or purpose to another
6. an event that results in a transformation (同)transition, changeover
7. a change in the units or form of an expression: "conversion from Fahrenheit to Centigrade"
8. a change of religion; "his conversion to the Catholic faith"
9. interchange of subject and predicate of a proposition
10. bring disorder to (同)disarray
11. a physical condition in which there is a disturbance of normal functioning; "the doctor prescribed some medicine for the disorder"; "everyone gets stomach upsets from time to time" (同)upset
12. a disturbance of the peace or of public order
13. not arranged in order (同)unordered

PrepTutorEJDIC

1. 〈U〉〈C〉(性質・形・機能などの)(…から…への)転換,変換,変化《+『from』+『名』+『into』(『to』)+『名』》 / 〈U〉〈C〉(宗教・主義などの)改宗;(…への)帰依,転向《+『to』+『名』》
2. 〈U〉『無秩序』,混乱,乱雑(confusion) / 《しばしば複数形で》(社会的・政治的な)粉争,騒動 / 〈C〉(肉体的・精神的な)不調,異常,障害 / …‘の'秩序を乱す / 〈心身〉‘に'異常を起こさせる

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/10/14 23:33:10」(JST)

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Conversion disorder
Classification and external resources
ICD-10	F44
ICD-9	300.11
DiseasesDB	1645
MedlinePlus	000954
eMedicine	emerg/112 med/1150
MeSH	D003291

A conversion disorder causes patients to suffer from neurological symptoms, such as numbness, blindness, paralysis, or fits without a definable organic cause. It is thought that symptoms arise in response to stressful situations affecting a patient's mental health. Conversion disorder is considered a psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5).

Formerly known as "hysteria", the disorder has arguably been known for millennia, though it came to greatest prominence at the end of the 19th century, when the neurologist Jean-Martin Charcot, physician and personality theorist Sigmund Freud and psychiatrist Pierre Janet focused their studies on the subject. Before Freud's studies on hysteria, people who suffered from physical disabilities that were not caused by any physical impairments, known as hysterical patients, were believed to be malingering, suffering from weak nerves, or just suffering from meaningless disturbances. The term "conversion" has its origins in Freud's doctrine that anxiety is "converted" into physical symptoms. Though previously thought to have vanished from the west in the 20th century, some research has suggested it is as common as ever.

The DSM-IV classifies conversion disorder as a somatoform disorder while the ICD-10 classifies it as a dissociative disorder.

Definition

DSM-IV defines conversion disorder as follows:

• One or more symptoms or deficits are present that affect voluntary motor or sensory function suggestive of a neurologic or other general medical condition.
• Psychological factors are judged, in the clinician's belief, to be associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit. A diagnosis where the stressor precedes the onset of symptoms by up to 15 years is not unusual.
• The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering).
• The symptom or deficit, after appropriate investigation, cannot be explained fully by a general medical condition, the direct effects of a substance, or as a culturally sanctioned behavior or experience.
• The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
• The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder.

The nature of the association between the psychological factors and the neurological symptoms remains unclear. Earlier versions of the DSM-IV employed psychodynamic concepts, but these have been incrementally removed from successive versions.

The tenth revision of the World Health Organization's International Classification of Diseases uses the term "conversion" as an alternative descriptor for the dissociative disorders class of mental and behavioural disorders (i.e. the F44 class), with the explicit suggestion that dissociative and conversion symptoms probably share common psychological mechanisms. In ICD-10, the dissociative [conversion] disorders class includes 10 disorders that, in addition to specific criteria for each individual disorder, must each meet the following general criteria:

• No evidence of a physical disorder that can explain the symptoms that characterize the disorder (but physical disorders may be present that give rise to other symptoms);
• Convincing associations in time between the symptoms of the disorder and stressful events, problems or needs.

Signs and symptoms

Typically conversion syndrome begins with some stressor, trauma, or psychological distress that manifests itself as physical symptoms. Usually the physical symptoms of the syndrome affect the senses and movement. For example, someone experiencing conversion syndrome may become temporarily blind due to the stress of the loss of a parent or spouse. While there can be a wide range in severity and duration, symptoms are typically short-lived and relatively mild

Some of the most typical symptoms include blindness, partial or total paralysis, inability to speak, deafness, numbness, sores, difficulty swallowing, incontinence, balance problems, seizures, tremors, and difficulty walking. These symptoms are attributed to conversion syndrome when a medical explanation for the afflictions cannot be found. Also with these symptoms, typical signs of conversion syndrome are the sudden onset of one or more of the above symptoms. Symptoms of conversion syndrome usually occur suddenly, however symptoms are usually relatively brief, with the average duration being 2 weeks up to years in people hospitalized for conversion syndrome-related presentations. While symptoms do not usually last a long time, recurrence is frequently seen. In fact, about 20% to 25% of conversion syndrome sufferers reported a symptomatic episode within a year. Conversion disorder is typically seen in individuals 10 to 35 years old

Conversion disorder can present with motor or sensory symptoms including any of the following:

Motor symptoms or deficits:

• Impaired coordination or balance
• Weakness/paralysis of a limb or the entire body (hysterical paralysis or motor conversion disorders)
• Impairment or loss of speech (hysterical aphonia)
• Difficulty swallowing or a sensation of a lump in the throat
• Urinary retention
• Psychogenic non-epileptic seizures or convulsions
• Persistent dystonia
• Tremor, myoclonus or other movement disorders
• Gait problems (Astasia-abasia)
• Syncope (fainting)

Sensory symptoms or deficits:

• Impaired vision (hysterical blindness), double vision
• Impaired hearing (deafness)
• Loss or disturbance of touch or pain sensation

Conversion symptoms typically do not conform to known anatomical pathways and physiological mechanisms, but instead follow the individual's conceptualization of a condition. Typically, the less medical knowledge a person has, the more implausible are the presenting symptoms. Persons with more sophisticated medical knowledge tend to have more subtle symptoms and deficits that may closely simulate neurological or other general medical conditions.

Mass psychogenic illness

Main article: Mass psychogenic illness

The DSM-IV-TR does not have specific diagnosis for mass psychogenic illness but the text describing conversion disorder states that "In 'epidemic hysteria,' shared symptoms develop in a circumscribed group of people following 'exposure' to a common precipitant."

Causes

Much recent work has been done to identify the underlying causes of the somatoform disorders as well as to better understand why conversion and hysteria appear more commonly in women. Current theoreticians tend to believe that there is no single reason that people tend to somatize, or use their bodies to express emotional issues. Instead, the emphasis tends to be on the individual understanding of the patient as well as on a variety of therapeutic techniques. While the exact causes of conversion syndrome are unknown, symptoms of the disorder seem to relate to the occurrence of a psychological conflict or stressor. Usually the onset of the disorder correlates to a traumatic or stressful event, There are also certain populations that are considered at risk for conversion disorder including people suffering from a medical illness or condition, people with personality disorder, and individuals with dissociative identity disorder.

The original Freudian model suggested that the emotional charge of painful experiences would be consciously repressed as a way of managing the pain, but this emotional charge would be somehow "converted" into the neurological symptoms. Freud later argued that the repressed experiences were of a sexual nature. As Peter Halligan comments, conversion has 'the doubtful distinction among psychiatric diagnoses of still invoking Freudian mechanisms'

Janet, the other great theoretician of hysteria, argued that symptoms arose through the power of suggestion, acting on a personality vulnerable to dissociation. In this hypothetical process, the subject's experience of their leg, for example, is split-off from the rest of their consciousness, resulting in paralysis or numbness in that leg. Later authors have attempted to combine elements of these models, but none of them has a firm empirical basis.

Some support for the Freudian model comes from findings of high rates of childhood sexual abuse in conversion patients and from a recent neuroimaging study showing abnormal emotion processing of a traumatic event linked to motor processing of the affected limb, in a patient with conversion. Support for the dissociation model comes from studies showing heightened suggestibility in conversion patients, and in abnormalities in motor imagery.

There has been much recent interest in functional neuroimaging in conversion. As researchers identify the mechanisms which underlie conversion symptoms it is hoped these will allow the development of a neuropsychological model. A number of such studies have been performed, including some which suggest that blood flow in patients' brains may be abnormal while they are unwell. These have all been too small to be confident of the generalisability of their findings, however, so no neuropsychological model has been clearly established.

A 2007 review stated that conversion disorder and dissociative disorders are statistically associated, share features such as a history of abuse and high suggestibility, and likely have common underlying causes. It recommended that DSM should follow ICD-10 and reclassify conversion disorder from a somatoform disorder to a dissociative disorder.

An evolutionary psychology explanation for conversion disorder is that the symptom may have been evolutionarily advantageous during warfare. A non-combatant with these symptoms signals non-verbally, possibly to someone speaking a different language, that she or he is not dangerous as a combatant and also may be carrying some form of dangerous infectious disease. This can explain that conversion disorder may develop following a threatening situation, that there may be a group effect with many people simultaneously developing similar symptoms (as in mass psychogenic illness), and the gender difference in prevalence.

Diagnosis

The diagnosis of conversion disorder involves three elements: the exclusion of neurological disease, the exclusion of feigning, and the determination of a psychological mechanism. Each of these has difficulties.

Exclusion of neurological disease

Conversion disorder presents with symptoms that typically resemble a neurological disorder such as stroke, multiple sclerosis, epilepsy or hypokalemic periodic paralysis. The neurologist must carefully exclude neurological disease, through examination and appropriate investigations. However, it is not uncommon for patients with neurological disease to also have conversion disorder.

In excluding neurological disease, the neurologist has traditionally relied partly on the presence of positive signs of conversion disorder — certain aspects of the presentation that were thought to be rare in neurological disease, but common in conversion. The validity of many of these signs has been questioned, however, by a study showing that they also occurred in neurological disease. One such symptom, for example, is La belle indifférence, described in DSM-IV as "a relative lack of concern about the nature or implications of the symptoms". In a later study no evidence was found that patients with "functional" symptoms are any more likely to exhibit this than patients with a confirmed organic disease.

Another feature thought to be important was that symptoms would tend to be more severe on the non-dominant (usually left) side; there were a variety of theories such as the relative involvement of cerebral hemispheres in emotional processing, or more simply just that it was "easier" to live with a functional deficit on the non-dominant side. However, a literature review of 121 studies established that this was not true, with publication bias the most likely explanation for this commonly held view. Although agitation is often assumed to be a positive sign of conversion disorder, release of epinephrine is a well-demonstrated cause of paralysis from hypokalemic periodic paralysis.

The process of exclusion is not perfect, so misdiagnoses will occur. In a highly influential study from the 1960s, Eliot Slater demonstrated that misdiagnoses had occurred in one third of his 112 patients with conversion disorder. Later authors have argued that the paper was flawed, however, and a meta-analysis has shown that misdiagnosis rates since that paper are around 4%, the same as for other neurological diseases.

Exclusion of feigning

Conversion disorder is unique in DSM-IV in explicitly requiring the exclusion of deliberate feigning. Unfortunately, this is only likely to be demonstrable where the patient confesses, or is "caught out" in a broader deception, such as a false identity. One neuroimaging study suggested that feigning may be distinguished from conversion by the pattern of frontal lobe activation; however this is a research, rather than a clinical technique. True rates of feigning in medicine remain unknown, though neurological presentations of feigning may be among the more common.

Establishing a psychological mechanism

The psychological mechanism can be the most difficult aspect of the conversion diagnosis. DSM-IV requires that the clinician believe preceding stressors or conflicts to be associated with the development of the disorder, though how this might come about is still the subject of debate.

Treatment

There are a number of different treatments that are available to treat and manage conversion syndrome. While occasionally symptoms do disappear on their own, many people benefit from a variety of treatment options. Treatments for conversion syndrome include hypnosis, psychotherapy, physical therapy, stress management, and transcranial magnetic stimulation. Treatment plans will consider duration and presentation of symptoms and may include one or multiple of the above treatments. This may include the following:

1. Explanation. This must be clear and coherent as attributing physical symptoms to a psychological cause is not accepted by many educated people in western cultures. It must emphasize the genuineness of the condition, that it is common, potentially reversible and does not mean that the sufferer is psychotic. Taking an etiologically neutral stance by describing the symptoms as functional may be helpful but further studies are required. Ideally, the patient should be followed up neurologically for a while to ensure that the diagnosis has been understood.
2. Physiotherapy where appropriate;
3. Occupational Therapy to maintain autonomy in activities of daily living;
4. Treatment of comorbid depression or anxiety if present.

There is little evidence-based treatment of conversion disorder. Other treatments such as cognitive behavioral therapy, hypnosis, EMDR, and psychodynamic psychotherapy, EEG brain biofeedback need further trials.

Prognosis

The DSM-IV-TR states that conversion symptoms will in most cases disappear within 2 weeks in those hospitalized. One-fifth to one-quarter will have a recurrence within a year with this also predicting future recurrences. Acute onset, clearly identifiable stress at this time, and short time between onset and treatment are associated with a favorable prognosis.

Epidemiology

Frequency

Information on the frequency of conversion disorder in the West is limited, in part due to the complexities of the diagnostic process. In neurology clinics, the reported prevalence of unexplained symptoms among new patients is very high (between 30 and 60%) However, diagnosis of conversion typically requires an additional psychiatric evaluation, and since few patients will see a psychiatrist it is unclear what proportion of the unexplained symptoms are actually due to conversion. Large scale psychiatric registers in the US and Iceland found incidence rates of 22 and 11 newly diagnosed cases per 100,000 person-years, respectively,

Culture

Although it is often thought that the frequency of conversion may be higher outside of the West, perhaps in relation to cultural and medical attitudes, evidence of this is limited. A community survey of urban Turkey found a prevalence of 5.6%. Many authors have found occurrence of conversion to be more frequent in rural, lower socio-economic groups, where technological investigation of patients is limited and individuals may be less knowledgeable about medical and psychological concepts.

Gender

Historically, the concept of 'hysteria' was originally understood to be a condition exclusively affecting women, though the concept was eventually extended to men. In recent surveys of conversion disorder (formerly classified as "hysterical neurosis, conversion type"), females predominate, with between 2 and 6 female patients for every male.

Age

Conversion disorder may present at any age but is rare in children younger than 10 years or in the elderly. Studies suggest a peak onset in the mid-to-late 30s.

History

Conversion disorder has been described as early as the time of Hippocrates.

In the 19th century, physicians such as Silas Weir Mitchell in the US and Paul Briquet and Jean-Martin Charcot in France developed ideas about patients sharing unexplained neurological symptoms. Charcot specialised in treating patients who were suffering from a variety of unexplained physical symptoms including paralysis, contractures (muscles which contract and cannot be relaxed) and seizures. Some of these patients sporadically and compulsively adopted a bizarre posture (christened arc-de-cercle) in which they arched their body backwards until they were supported only by their head and their heels.

The term "conversion disorder" originated with Freud. He viewed these apparently neurological symptoms as a result of the conversion of intrapsychic distress into physical symptoms. This distress was thought to cause the brain to unconsciously disable or impair a bodily function as a side effect of the original repression, which served to relieve the patient's anxiety. However, some have claimed that patients do remain distressed by their symptoms in the long term

It has also been suggested that at least some of the classic psychoanalytic cases of hysteria, such as "Anna O.", may actually have suffered from organic illness. In fact, in Studies On Hysteria in which Breuer's Anna O. case was first presented, Freud wrote this: "Others of the patient's symptoms were not of a hysterical nature at all. This is true, for example, of the neck cramps, which I consider a modified version of migraine and which as such are not to be classified as a neurosis but as an organic disorder. Hysterical symptoms, however, regularly become attached to these." Freud believed that all hysterical symptoms ultimately have some organic components.

See also

• Body-centred countertransference
• Conversion syndrome
• Hysterical contagion
• Mass hysteria
• Somatization disorder

References

UpToDate Contents

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• 1. 成人における転換性障害：臨床的特徴、評価、および合併症 conversion disorder in adults clinical features assessment and comorbidity
• 2. 成人における転換性障害：治療 conversion disorder in adults treatment
• 3. 成人における転換性障害：用語、診断および鑑別診断 conversion disorder in adults terminology diagnosis and differential diagnosis
• 4. 成人における転換性障害：疫学、病因、および予後 conversion disorder in adults epidemiology pathogenesis and prognosis
• 5. 腕を動かさない小児の評価 evaluation of the immobile arm in children

English Journal

• Neuropsychological predictors of dementia in late-life major depressive disorder.

• Potter GG, Wagner HR, Burke JR, Plassman BL, Welsh-Bohmer KA, Steffens DC.SourceDepartment of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC; Center for the Study of Aging and Human Development, Duke University, Durham, NC; Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham, NC. Electronic address: guy.potter@duke.edu.
• The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.Am J Geriatr Psychiatry.2013 Mar;21(3):297-306. doi: 10.1016/j.jagp.2012.12.009.
• OBJECTIVE: Major depressive disorder is a likely risk factor for dementia, but some cases of major depressive disorder in older adults may actually represent a prodrome of this condition. The purpose of this study was to use neuropsychological test scores to predict conversion to dementia in a sampl
• PMID 23395197

• Conceptual issues in the classification of psychosis.

• Phillips J.SourceDepartment of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.
• Current opinion in psychiatry.Curr Opin Psychiatry.2013 Mar;26(2):214-8. doi: 10.1097/YCO.0b013e32835d9f0f.
• PURPOSE OF REVIEW: To provide an update on the conceptual status of attenuated psychosis syndrome (APS) as a psychiatric disorder.RECENT FINDINGS: In May 2012, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Task Force announced that the planned introduction of APS as a new diagnos
• PMID 23370275

Japanese Journal

• 「満ち足りた無関心」の態度が見られた転換性障害者への心理療法

• 佐伯 明子
• 心理臨床学研究 30(2), 129-139, 2012-06
• NAID 40019362253

• 研究と報告 Aripiprazoleが奏功した緘黙を伴う転換性障害の1例

• 菊池 章,鈴木 志欧也
• 精神医学 54(1), 39-44, 2012-01
• NAID 40019144256

Related Links

• Conversion disorder - Wikipedia, the free encyclopedia

Conversion disorder causes patients to suffer apparently neurological symptoms, such as numbness, blindness, paralysis, or fits, but without a neurological cause. It is thought that these problems arise in response to difficulties in the patient's ...

Related Pictures

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★リンクテーブル★

リンク元	「転換性障害」
関連記事	「disorder」「conversion」

「転換性障害」

　　[★]

英

conversion disorder

関

神経症性障害、解離性障害

ICD-10

• F44 Dissociative disorders 解離性障害, conversion disorders 転換性障害

国試

• 102G060

「disorder」

　　[★]

• 障害：個人的苦痛や機能の障害があるので「疾病」とは言えるものの、その背景にある臓器障害がもう一つはっきりしない場合に用いられる。(PSY.9)

• n.

• an untidy state; a lack of order or organization (⇔order)
• violent behaviour of large groups of people
• an illness that cause a part of the body to stop functioning correctly

• 注意

disease <> illness <> disorder

• vt.

• 乱す、乱雑にする。(人)の(心身の)調子を狂わせる。

• vi.

　 　 　 　

「conversion」

　　[★]

• n.

• 転換、変換

関

changeover、convert、diversion、interconversion、shift、switch、switching、transform、transformation