when the body expresses emotional discomfort with physical symptoms – NIUS

  • Conversion disorder is one of the psychopathologies that best illustrates the bidirectional relationship between mental health and physical health.

  • The term ‘conversion’ refers to the transformation of a psychological discomfort into a physical alteration

  • The physical symptoms are not consciously or voluntarily caused or feigned to evade obligations or be the center of attention

Conversion disorder is one of the most illustrative examples of this bidirectional and complex relationship between mental health and physical healthbetween mind and body. In line with the definition of health of the World Health Organization “a state of well-being physical, mentaland social” more and more experts prefer not to make this distinction between physical and mental health.

Mental and physical health are related because each of them generates and influences the human being to a greater or lesser extent. A) Yes, a healthy mind makes the body work better, and a healthy body generates emotional well-beingwhich is the basis for good mental health.

Seen this way, everything seems very coherent and makes sense: but the reality is that, in general, among people there is a lot of resistance to accept that a physical pain or a physiological symptom has a psychological rather than organic origin. Socially, physical weakness is better seen than psychological weakness: as if the physical does not depend on our will and the psychological does. This resistance makes many people spend years of their life as a specialist looking for an organic explanation for their illness before going to a psychologist or psychiatrist.

The body manifests a psychological discomfort

In the article A case of conversion disorder analyzed from the perspective of hospital interconsultation Luis Javier Sanz Rodriguez and Begoña Torres López explain the case of a 62-year-old patient who, during her hospital stay for an acute coronary problem, suffered an episode of hemiparesis (weakness) on the left side of her body. After carrying out numerous tests, they ruled out any organic origin of his problem.. The patient, explains the article, was very reluctant to accept that the weakness she suffered from on the left side of her body had a psychological origin.

However, after some assessment consultations in the mental health unit of the hospital, the patient was able to become aware of her problem. The fact of being hospitalized for a coronary issue made her feel tremendously guilty: subconsciously this woman felt that she was failing her family. That emotional discomfort, that internal conflict, in a person like her, very little given to expressing her emotions, became a physical symptom. His body manifested through a hemiparesis that great psychological discomfort.

Conversion disorder is the maximum expression of this complex and bidirectional relationship between mind and body.

Another example is that of the parents of Antonio, a 14-year-old adolescent who was spending an emotionally delicate situation after the death in an accident of one of his best friends. These parents were reassured when they were told that their son’s paralysis in his right arm was not due to any neurological failure, but rather a conversion disorder. They were very quiet, but they did not understand what was happening to their son and the reason for this paralysis. They believed that Antonio was inventing that paralysis to get his attention. It took several visits to the mental health service for Antonio’s parents to understand that the fact that there was no physically detectable neurological anomaly, did not mean that your child was ‘making up’ that symptom. As the experts explain, people who suffer from this condition suffer from real anguish, they do not fake the symptoms, so it is not advisable to tell them that common phrase of “what happens to you is not real, it is only in your head”.

As we can see, conversion disorder is the maximum expression of this complex and bidirectional relationship between mind and body. The term conversion is used to refer to the ability of a particular patient to unintentionally transforming or converting a psychological disturbance into a physical disturbance or difficulty.

Conversion disorder is a type of somatoform disorder, according to the WHO International Classification of Diseases (ICD-10). Somatoform disorders should not be confused with psychosomatic disordersin which, although they are also psychological in origin, there is detectable involvement at an organic level, as we explained in this NIUS article.

What is a conversion disorder

Conversion disorder refers to a set of symptoms that take the form of a neurological condition and that interfere with the patient’s behavior but that do not correspond to any diagnosed physical alteration nor can they be justified by any other disease.

The main feature of this disorder is appearance of these symptoms or motor and/or sensory difficulties involuntarily but associated with psychological factors or alterations; that is, to diagnose this conversion disorder there must be an emotionally complex episode close in time in the patient’s life. In fact, there is usually a clear temporal relationship between the stressful event the patient faced and the onset of conversion symptoms.. The main symptoms of a conversion disorder are the following:

  • Motor symptoms: Lack of coordination and balance, paralysis and localized muscle weakness, tremor, aphonia, difficulty swallowing, sensation of a lump in the throat, urinary retention and seizures.
  • sensory symptoms: Sensation of anesthesia or analgesia, double vision, blindness, blurred vision, tunnel vision, deafness, loss of smell and taste, and hallucinations.

In order to prepare a diagnosis as accurate as possible, it is necessary for the patient to present the following diagnostic criteria included in the Diagnostic and Statistical Manual of Mental Disorders (DSM):

  • Presence of one or more difficulties that interfere with motor or sensory functions that suggest the presence of a neurological or medical disorder.
  • existence of previous events, experiences or conflicts that may be associated with symptoms.
  • These symptoms are not consciously or voluntarily provoked as in factitious disorder, in which the person consciously fakes the symptoms to avoid obligations or be the center of attention.
  • symptomatology not justified by the presence of another alteration or medical conditionor by substance use.
  • The symptomatology causes a clinically significant, interfering in the different areas of the patient’s daily life and requiring medical attention.
  • The set of symptoms not restricted to pain or deficits in sexual function does not appear during a somatization disorder and is not due to the appearance of another sexual disorder.

the beautiful indifference

Another of the most characteristic and peculiar symptoms of conversion disorder is the so-called beautiful indifference: the little concern the patient feels about the symptoms they are experiencing even though these can be very flashy.

Anyone who wakes up one morning with a paralyzed arm or seeing everything blurry is normal to worry and rush to the doctor to find out what’s wrong. However, this is not usually the case in patients with conversion disorder, who usually are undisturbed or indifferent to your problem. This reaction is so common that beautiful indifference is considered one more symptom of conversion disorder, although The reason for this reaction is still unknown.

As we said, conversion disorder always appears associated with a stressful event, which is also very close in time to the onset of symptoms. The remission of these symptoms usually occurs spontaneously in a few days., when the stressful event disappears or ceases to be so present in the patient’s life; either because the stressor disappears or because the person has learned to manage it with psychotherapy.

If the person faces a stressor again, but has not learned to relate to him in a less emotionally damaging way, the most normal thing is that the symptoms reappear; so we would talk about a chronic disorder.

The psychological explanation for conversion

Psychology explains the existence of conversion disorder by one of these two mechanisms: primary gain or secondary gain.

The primary gain it means that the person suffering from this disorder unconsciously obtains some benefit in return, for example, keeping a conflict or worry out of their consciousness. The primary profit often associated with traumatic experiences, stress, or sexual and physical abuse. In fact, on many occasions, the symptoms that appear are related in a surprisingly direct way to the problem to which they were exposed. For example, pain may be felt in the same part of the body that another person was seriously injured in a traumatic accident that the patient witnessed.

The secondary gain means that the person, too unconsciously, you can get reinforcement with your problematic, such as avoiding an activity that is harmful to him or her or getting the support and attention of others, which otherwise would not be possible. This gain could be that of Antonio who, secondarily, with his paralysis I would be unconsciously looking for space and time (missing school, leaving their daily activities) necessary to be able to prepare the duel for the death of his friend.

In either of the two types of gain, conversion disorder tells us about this very complex and bidirectional relationship between mind and body and the need to understand ourselves as complete beings where there is no such distinction between physical health and mental health; where health is always one.

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