Pathophysiology

An illustrative example involves the case of a young wife who is scheduled to visit her debilitated father in the hospital. His recent diagnosis of cancer has left her distraught, and the sight of him depresses her greatly. On the morning of her visit, she suddenly becomes blind.

This example typifies a conversion disorder in which conflict is caused by the patient's intense, but psychically unacceptable, urge to avoid a required action (in this case, visiting her father). The physical symptom (blindness) allows expression of the urge (how can she drive there if she is blind?) without consciously confronting the feelings that led to the wish. At the same time, the symptom imposes morbidity as a punishment for the wish. Often, the presenting symptom will have a symbolic relationship to the conflict, but this is not always the case. In this case, the sight of her father is distressing and therefore loss of sight is the chief complaint. Conversion disorders are often thought of as nonverbal exertion of control on the environment. Two mechanisms are responsible for the symptoms. The first is primary gain, in which the symptom allows patients to avoid confronting their uncomfortable feelings. The second is secondary gain, in which uncomfortable situations are avoided and support is given that might not normally be available. In the aforementioned case, secondary gain would occur if the patient's husband then stayed home from work to tend to his "blind" wife.

Conversion disorders are described as rare, with an annual incidence in outpatient psychiatric settings of 0.01 to 0.02 percent. An incidence of 5 to 16 percent among inpatients with psychiatric consultations has been noted. Most agree that the incidence is declining. Cases predominantly involve neurologic and orthopedic manifestations, and are seen in the military during times of war, in victims of industrial accidents, and in victims of violence. Conversion disorders are much more frequent in women than men, accounting in the former for up to 80 percent of cases in some series. The most common ages of presentation are adolescence or early childhood, although other age groups are also affected. Conversion disorders are more prevalent in rural, lower socioeconomic, and less educated populations. Other predisposing factors include medical illness, depression, anxiety, schizophrenia, somatization disorder, dependent personality disorder (5 to 21 percent of patients), borderline personality disorder, and passive aggressive personality disorder. 23

Was this article helpful?

0 0
Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

Get My Free Ebook


Post a comment