Johns Hopkins Psychiatry Guide

Conversion Disorder

Margo D. Nathan, M.D., O. Joseph Bienvenu, M.D., Ph.D.
Conversion Disorder is a topic covered in the Johns Hopkins Psychiatry Guide.

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DEFINITION

  • Conversion disorder is most simply defined as the presence of neurological symptoms (motor or sensory) without a known physiological basis.
    • The neurological symptoms must be shown to be incompatible with pathophysiology.
  • When considering this diagnosis, it is important to have a firm understanding of somatization.
    • Somatization is the expression of mental phenomena as physical (somatic) symptoms.
    • There is a continuum of unconscious/non-volitional display of symptoms (patient unaware of the non-physiologic nature of symptoms) to conscious/volitional display (patient aware of the non-physiologic nature of symptoms).
    • Also important is the difference between primary gain (positive internal motivations) vs. secondary gain (positive external motivations).
      • Primary gain example: A patient feels guilty about not being able to perform a task, but if there is a medical condition justifying this inability, the guilt diminishes.
      • Secondary gain example: A patient is allowed to miss work and gets financial compensation as the result of a medical condition.
      • Any given patient with conversion disorder will have primary and/or secondary gains associated.

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Last updated: November 21, 2014