Conversion disorder is a medical condition where its sufferers present neurological symptoms such as paralysis, numbness, blindness or fits without a known neurological trigger. Conversion disorder, formerly known as hysteria is considered a psychiatric disorder by the Diagnostic and Statistical Manual of Mental Disorders, which classifies it as a somatoform disorder. Contrary, World Health Organization’s International Classification of Diseases
(ICD-10) classifies it as a dissociative disorder.
The diagnosis of this neurological disorder has been problematic in the past, since doctors have conceptually and practically differentiated its symptoms from those of neurological diseases for which it is known to be. Most psychologists have presumed the conversion disorder to be a psychological disorder, but the psychological mechanism, and how this varies from conscious simulation has eluded most of them. Present diagnostic systems demand that conscious simulation or feigning be excluded and that symptoms be explained psychologically. Truth is during diagnosis, conscious simulation is very hard to prove, and a psychological explanation in most instances cannot be found. Childhood and adult psychological precipitant studies tend to support the idea of stressful life events to have happened prior to symptoms onset, but in individual cases, stressful life events are not a major cause. Therefore, these contradictions highlight serious practical and theoretical issues in the current diagnostic systems and the concept of the disorder itself. Advanced physiology, psychology and functional imaging techniques have been applied on the higher side in attempts to clearly explain the neurobiology of conversion disorder and to differentiate it from conscious simulation, but still the formal diagnostic techniques remain to be of limited clinical value.
The diagnosis of conversion disorder involves three elements all of which present some degree of controversy. These three elements are: the exclusion of neurological disease, feigning and finally the determination of a psychological mechanism. During the first stage, conversion disorder may resemble neurological disorders such as multiple sclerosis, stroke or epilepsy therefore they must be carefully excluded through appropriate examinations. In rare cases, patients with neurological disease may also have conversion disorder, which further complicates the determination of the degree of the conversion disorder in the patient. Exclusion of conscious simulation is only possible where a patient confesses or is caught out in a broader deception. Lastly, establishment of a psychological mechanism is the most difficult aspect of conversion disorder diagnosis. DSM-IV recommends that clinicians assume preceding stressors to be associated with the progress of the disorder which is still a subject of debate.
Notably, cultural influences have been noted to affect the somatoform disorders. Cultures such as...