Conversion disorder

Abstract

The condition now known as conversion disorder has been described since the time of Hippocrates. It was of great interest to many pioneers of neurology and psychiatry in the late 19th and early 20th century, such as Charcot and Freud. Since this time, despite being a relatively common condition often leading to severe and persistent disability, it has received relatively little attention from the scientific community. Consequently there has been little progress in understanding its pathogenesis and in finding effective treatments. The focus of this article is the management of motor and sensory conversion disorder, primarily from the perspective of the psychiatrist. The historical context and terminology of the condition are reviewed to minimize confusion and aid communication with both patients and other professionals. Diagnostic issues are explored along with potential psychological and neural mechanisms, revealing evidence for previous emotional trauma as a risk factor and the possible role of stressful life events preceding symptom onset. A guide to assessing suspected conversion disorder is provided, paying particular attention to what it is necessary to check before the assessment begins In order to maximize the chances of therapeutic engagement. The clinical features that help exclude neurological disorder and support conversion disorder are explained. There are no proven treatments specifically for conversion disorder, but current practice is reviewed along with the limited evidence base.