Conversion disorder and “belle indifference”

Sometimes the brain can provoke incredible reactions on a psychological level, almost straight out of a science fiction movie. Conversion disorder or, as it has been renamed in DSM5, functional neurological symptom disorder is an example of this.

Conversion disorder is a perfect example of how body and mind are connected to a high degree. It is a functional disorder, but it manifests itself on a physical level, as if it were an organic disease, although there is nothing to justify it.

What is known today as somatic symptom disorders come from a set of disorders derived from the concept of hysterical neurosis. It was Briquet, in the 19th century, the first to put a certain order to the classification of hysteria, limiting himself to an empirical classification of the symptoms.

We currently know the conversion as symptomatology in which bodily functions, either completely or in areas thereof, stop operating or are seriously impeded. This happens without the existence of somatic damage or as part of a factitious disorder.

It is important not to confuse somatoform disorders, such as conversion, with psychosomatic illnesses. In the latter we do find a known pathophysiological basis or process in which psychological factors are related to the onset or course of the disorder.

Clinical features of conversion disorder

As we have mentioned, conversion disorder It is basically characterized by the loss of some bodily function. In this sense, we can find patients who suddenly become blind in one eye, hoarse, with paralysis of a limb or even with intense headaches.

The latter have come to be called “hysterical nails”. After a medical examination, we found absolutely nothing to explain it. What is it due to then?

As with its classmate, somatization disorder, the conversion usually occurs in histrionic personalities.. A histrionic personality is one with a marked tendency towards suggestibility, superficiality, emotional lability, dependence and egocentrism. However, this type of personality is still much more marked in somatization disorder.

What is extremely characteristic of conversion disorder is the so-called beautiful indifference. It’s about the little concern that the patient feels about the symptoms they are experiencing.

Imagine that one day you wake up with your arm paralyzed. Most likely, you will worry a lot, analyze yourself, visit the doctor and get a little anxious about what may be happening to you.

That’s normal. However, this does not occur in patients with conversion disorder, who remain unperturbed by their apparent misfortune. Something similar to what happens in Anton syndrome, in which the patient goes blind, but conspires by stating that he sees perfectly. We still don’t know for sure why this beautiful indifference occurs, but the truth is that it is very striking.

The symptoms vary significantly, making it a very heterogeneous condition.. The most common are blindness, deafness, paralysis, aphonia and total or partial loss of sensitivity, without any support in medical evidence.

The onset of the disorder is common in adolescence and early adulthood (10-35 years).. It can also occur in childhood and specifically, in children under 10 years of age, the symptoms are limited to gait alterations and seizures.

It is more common in females. A worse prognosis is presented by patients with low socioeconomic status, less psychological sophistication or less education, as well as women under 40 years of age who come from rural areas. Depression is a disorder with which there is great comorbidity.although it is usually masked.

Remission usually happens spontaneously within a few days, with or without treatment, although, obviously, treatment will speed up the process. If the person faces a stressor again, the most normal thing is for the symptoms to reappear. This is why we can talk about a chronic disorder.

Explanation of conversion and treatment

The DSM has explained what the symptom of conversion disorder means around two mechanisms: primary gain, that is, keeping an internal conflict or need out of consciousness, and secondary gain, or avoiding an activity that is harmful to the person. the subject or obtain support that would not otherwise be achieved.

It seems that In most cases, excessive stress is the proximal precipitant that triggers the disorder.. Sometimes, ailments are very closely related to the problem to which they were exposed. For example, there are patients who feel pain in a part of the body that they saw damaged in another person in an accident.

Regarding the secondary gain, it should be said that As occurs in many other disorders, the patient, although unconsciously, can obtain reinforcement with his problem. Attention, care or abandonment of activities such as work, in some people, can constitute a gain that perpetuates the problem. This occurs because in other circumstances they would not have received that attention, so it is nothing more than another way of demanding affection.

Regarding treatment, although as we have commented, It usually disappears spontaneously, it does not hurt to accelerate the process with psychological therapy. In this way we will try to resolve the stressful cause that caused the problem.

Indicators of good prognosis are: identifiable stressor, good premorbid functioning, abrupt onset, absence of other mental or physical disorders, absence of legal proceedings, and short duration of symptoms.

From cognitive-behavioral therapy training in anxiety reduction and stress coping is used aided by techniques such as hypnosis or relaxation. Psychodynamic therapy also provides improvements in this regard and is aimed at resolving underlying intrapsychic conflicts.

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