Conversion Disorder in a Depressed Patient: The Analysis of Paralysis

Abstract

Pat ients present ing with neurologic and pseudoneurologic symptoms present both a diagnostic and treatment challenge. This case report describes the ER course ofa man who presented wi th aphonia and paralysis, his medical clearance, transfer to the psychiat ric ER and subsequent recovery. Th e history qf conversion disorder and its characteristics are briefiy reviewed, and the etiology qf thi s patient 's symptoms and a discussion qf effectioe treatment pla ns are discussed. Although the conce pt of conve rsion symptoms dates at least to th e ancient Greeks and was discussed by Freud and Breu er in Studies on Hy steria ( I) in the la te 1890's, it has been an in cr easingly infrequent (although not rare) diagnosis. In cont rast to most other DSM diagnoses , unconscious processes or conflicts a re implicated in the development of conve rsion disorder. Conversion di sorder generally involves a symbolic relationship between an underlying psychological conflict and disturbed physical functioning. "Classic" symptoms include paralysis, aphonia , seizures, malcoordination, dyskinesia, blindness , anesthesia, a nd parasthesias. The disorder has been most com monly described in rural women of lower socio -economic status. The following case des cribes a welleducated man wh o was brou gh t to the Emergency Department after becoming acutely unresponsive (with paralysis and aphonia), and highlights his subse q ue n t course in th e emerge ncy se t t ing .