Mental Illness

Conversion disorder, earlier called hysteria, involve neurotic pattern in which symptoms of some physical malfunction or loss of control appear without any underlying organic pathology.

The term hysteria was derived from the Greek word meaning “uterus”. It was thought by Hippocrates and other ancient Greeks that this disorder was restricted to women, and that it was caused by sexual difficulties, particularly by the wandering of a frustrated uterus to various parts of body because of sexual desires and a yearning for children. Thus the uterus might lodge in the throat and causing choking sensations or in spleen, resulting in temper tantrum. Hippocrates considered marriage the best remedy. Freud used the term conversion hysteria for these disorders because he believed that the symptoms were an expression of repressed sexual energy – that is the psychosexual conflict seen was found to be converted into a bodily disturbance. For example a conflict over masturbation might be “solved” by developing a paralyzed hand. This was not done consciously and person was not aware of the origin or meaning of the physical symptoms.

In contemporary psychopathology, reactions of this type are no longer interpreted in Freudian terms as the “conversion” of sexual conflicts or other psychological problems into physical symptoms. Rather the physical symptoms are now usually seen as serving a defensive function, enabling an individual to escape or avoid a stressful situation without having to take responsibility for doing so.

Conversion disorders were once relatively common in civilian and especially in military life. In World War I, conversion disorder was the most frequently diagnosed psychiatry syndrome among soldiers; it was also relatively common during World War II. Conversion disorders typically occur under highly stressful combat conditions and involved men who would ordinarily be considered stable. Here conversion symptoms – such as being paralyzed in legs – enabled a soldier to avoid an anxiety arousing combat situation without being labeled a coward.

The clinical picture in conversion disorder has three categories of symptoms: sensory, motor, and visceral.

1.Sensory Symptoms – The most common forms are
Anesthesia – loss of sensitivity
Hypesthesia – partial loss of sensitivity
Analgesia – loss of sensitivity to pain
Paresthesia – exceptional sensation, such as tingling

2.Motor Symptoms – The motor disturbance usually involves either paralysis or abnormal movements. The paralysis may be monoplegia, paraplegia or quadriplegia. Examination shows normal or voluntarily increased tone and normal reflexes. The prolonged paralysis leads to the development of contractures.
The ‘abnormal movements’ range from tremors, choreiform movements, gait disturbances to convulsive movements. These movements either occur or increase when attention is directed toward them and may disappear when the patient watch unobserved.

3.Visceral Symptoms – Visceral conversion reaction including headaches,
“Lump in the throat” (formerly known as globus hystericus) and choking
Sensation, coughing spells, difficulty in breathing, cold and clammy
Extremities, belching, nausea, vomiting and so no. Occasionally persistent
Hiccoughing or sneezing occurs.