Conversion and somatoform disorders in general medical practice

What are dissociative (conversion) disorders

The term conversion is used for some types of dissociative disorders. This occurs in cases where a person experiences a state of passion caused by an insoluble life situation or a serious conflict. Often a person suffering from dissociative disorders does not want to admit their problems and attributes them to somatic symptoms.

Dissociative (conversion) disorders usually have a close temporal relationship with various incidents that have a negative impact on a person’s consciousness: unresolved conflict situations, severe breakups, wars, natural disasters, etc. Women and adolescents are most often exposed to dissociative disorders, among the male half of humanity and In middle-aged people, they are recorded less frequently.

Dissociative (conversion) disorders have the following divisions: dissociative stupor, dissociative movement disorders, dissociative amnesia, dissociative amnesia, trance and possession, dissociative convulsions, dissociative anesthesia or loss of sensory perception.

First signs and symptoms of the disorder

Tearful, capricious, prone to exaggeration, self-centered and demonstrative patients with conversion neurosis can convincingly “feign” many bodily illnesses.

Endless complaints of nausea, headache, numbness in various parts of the body, burning, itching are demonstrative in nature. Patients faint and complain of being blind or deaf. Thus, a person attracts attention to himself and tries to gain profit thanks to the disease. The patient presents symptoms in such a way that makes others sympathize with him.

The classic manifestation of this disorder is dissociative seizures - patients scream, bang their heads on the floor, and twitching of various muscles of the body is noted. Conversion pain in various parts of the body, paralysis, memory loss are possible, followed by the ability to restore the events of psychotrauma using psychotherapeutic methods.

An important sign of the disorder is the absence of identified body diseases, an uncharacteristic combination of complaints that do not fit into the “logic” of the disease demonstrated by the sufferer. Sometimes, they “borrow” symptoms from friends or remember their own illnesses.

Such people often go to doctors, looking for real somatic changes in themselves. It should be understood that the person suffers from this disorder and needs help.

If the symptoms of conversion disorder are stable, often repeated, appear and intensify when relatives appear, then consultation with a psychiatrist is necessary.

What triggers / Causes of Dissociative (conversion) disorders

The origin of dissociative disorders can be different: psychological, biological or social. Biological origin - this includes hereditary predisposition and constitutional characteristics of a person. Some types of diseases and age-related crisis periods (menopause, puberty) can cause dissociative disorder.

The psychological nature of the disorder is spoken of in cases where it was caused by childhood mental trauma, excessive suggestibility of a person, or imbalance of relationships in married couples.

Dissociative (conversion) disorders of social origin occur in cases where dissociated upbringing is applied to a child, i.e. the parents’ demands are so contradictory that the fragile child’s psyche is simply not able to cope with it; This also includes the individual’s desire for a rental mindset.

Possible symptoms

In most cases, the indicators of the disorder are not subject to the control of the patient’s consciousness, and often terrify him. Signs of the disease most often have an abrupt onset, but there are options for gradual deterioration.

• Pseudoparalysis . An infected patient is unable to use much of his own body or limbs. The position does not correspond in any way to typical models in anatomy and most often changes after the next examination.
• Pseudosensory syndrome . Patients often notice muteness or loss of sensation in different areas of the body. The loss of sensitivity, for the most part, corresponds to the patient's knowledge of simple anatomy, and not to the recognized properties of the patient's nervous system.
• Pseudo-seizures . These are some of the serious properties of CR, which are difficult to distinguish from their true derivatives. Up to 35% of those who seek help with pseudo-seizures suffer from epilepsy. Changes in the level of prolactin in the blood serum give the doctor the opportunity to distinguish this situation from epileptic seizures
• Pseudocoma . An equally difficult case, since a true coma will likely indicate a life-threatening abnormality, and the patient will have to receive the usual methods of treatment.
• Psychogenic mobility disorders . They can reproduce parkinsonism, dyskinesia, myoclonus, tremor and dystonia. For patients with possible psychogenic mobility disorder, doctors occasionally give placebo tablets.

Pathogenesis (what happens?) during Dissociative (conversion) disorders

Dissociative states usually begin and end suddenly, and this is observed quite rarely, if you do not take into account some specially developed methods of influence or procedures, for example, hypnosis. In these cases, the dissociative disorder changes or disappears depending on the duration of the session or procedure.

Any type of dissociative disorder may recur after some time (we are talking about several weeks or even months). In those cases where the onset of the disorder was preceded by insoluble problems or disrupted interpersonal relationships, it takes on a chronic form, especially with regard to paralysis and anesthesia.

Conversion disorder - a disease or a sham?

Does a loved one complain about their health, often visit doctors, take tests and self-medicate, while hearing from a therapist, cardiologist and neurologist that there is no reason to worry? Do not rush to accuse a relative of malingering: perhaps we are talking about conversion disorder - a diagnosis that will require the help of a psychotherapist

jogarner.com
Conversion is a protective mechanism of the psyche, as a result of which mental tension caused by stress is converted (transformed) into symptoms of a somatic disease.
This distracts a person from unresolved vital issues and shifts his attention to his physical condition, which can always be “corrected” if desired. “Conversion symptoms are
a symbolic expression of psychological problems that have been troubling the patient for a long time, ”
explains
psychotherapist, head of the department of the City Clinical Psychiatric Dispensary Anna Golubich. — There are cases when, due to stress, the patient’s movements in the limbs (for example, in the legs) disappeared, although examinations by a neurologist, including using modern methods, did not show any abnormalities.
Also, after severe stressful situations, a conversion disorder such as psychogenic amnesia can occur: a person simply forgets about what happened to him. For centuries, such complaints were not taken seriously, being called “hysterical” and the patients themselves being called shams. But only

In the 19th century, French psychiatrist and founder of a new doctrine about the psychogenic nature of hysteria, Jean-Martin Charcot, proved that people can indeed experience symptoms of non-existent diseases. The prevalence of conversion disorders in the world today does not exceed 1-2% among the population of any country, and women suffer from them 6-8 times more often than men. Due to frequent attempts at self-medication and distrust of doctors who convince patients that their physical health is fine, such people often become dependent on tranquilizers, painkillers and other drugs.

The book by psychiatrist, Doctor of Medical Sciences, Professor Roman Evsegneev describes the following case: in a neurological hospital, a patient was repeatedly examined - a 34-year-old woman, an economist by training. From a prosperous family, married, does not experience financial difficulties. Convulsive twitching of the arms and head is disturbing, sometimes the legs give way, it can be difficult to walk and stand. She was examined by neurologists many times, but no pathology was detected. And only after taking a more detailed history (after the doctors at the neurological hospital had consulted a psychiatrist) did it become clear that not everything in the patient’s life was as smooth as it seemed at first glance. The relationship with her husband is tense, on the verge of divorce, her financial well-being is determined not so much by her own earnings, but by the help of her parents, who strongly dislike their son-in-law. A career that had begun successfully soon slowed down, including due to the woman’s frequent absence from work due to frequent sick leave. That is, the cause of physical illness was serious mental problems.

Conversion disorders are represented by numerous diagnoses, some of which are quite interesting. For example, a dissociative fugue is when a person suddenly but purposefully moves to an unfamiliar place, settles there, finds a new job and completely forgets all information about himself, down to his name, sincerely considering himself a different person. Such disorders are often played out in TV series and films about war. One example is the film “The Return of Budulai”.

Surely many people know the story of American Billy Milligan - the first person in history to be acquitted in a trial due to a proven diagnosis of dissociative identity disorder (the so-called split personality). The causes of this disease (by the way, very rare) are severe emotional trauma in early childhood, repeated extreme physical, sexual or emotional abuse, as well as other mental illnesses that were not previously identified.

It happens that the patient is diagnosed with dissociative stupor - this is the name of a movement disorder that is characterized by a decrease or absence of voluntary movements. A person can lie down or sit motionless for a long time, he experiences mutism - lack of speech, as well as a narrowing of consciousness. He does not answer questions addressed to him or responds with a delay.

— Treatment of dissociative disorders can only be complex: the use of medications and psychotherapy,

- explains Anna Golubich.
“In addition, the correct behavior of others, primarily the patient’s family members, is of great importance.
In the process of psychotherapy, in a soft form that is understandable and accessible to the patient, a relationship is established between existing unresolved psychological conflicts and emerging symptoms, and then, gradually, a strategy to eliminate them is developed and implemented. TO THE POINT

Medicine knows of cases where people who have experienced heartache (we are talking about divorce, separation or death of a loved one) complained of severe pain in the chest area - ordinary people call this “broken heart syndrome.” Or patients who were faced with serious insoluble problems in their lives began to suffer from lower back pain - so the burden of what was happening “pressed” on them.

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Diagnosis of dissociative (conversion) disorders

If dissociative (conversion) disorders are suspected, the following conditions are necessary to make an accurate diagnosis: the patient must have clinical symptoms characteristic of certain types of disorders; it is important to exclude disorders in the physical and neurological condition that could cause these manifestations; there must be a clear temporal relationship between psychogenic conditioning and stressful events.

In cases where there is a history of disturbances in the functioning of the central nervous system, caution should be exercised when making a diagnosis of dissociative (conversion) disorders.

Which doctors should you contact if you have Dissociative (Conversion) Disorders?

The doctor to consult for symptoms indicating the presence of dissociative (conversion) disorders is a psychiatrist. If you suspect dissociative (conversion) disorders in yourself or your loved ones, the best specialists in the field of psychiatric medicine conduct consultations at the Mosmed clinic. They will provide you with detailed information about treatment methods and methods, signs and symptoms of disorders, preventive measures and rehabilitation.

Primary appointment with a neurologist: 1850 RUR.

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