A CONVERSION reaction is a rather acute and temporary loss or alteration in motor or sensory functions that appear to stem from psychological issues (conflict).The classic syndromes resemble neurological syndromes. CONVERSION motor symptoms mimic syndromes such as paralysis, ataxia, dysphasia, or seizure disorder (pseudoseizure), and the sensory ones mimic neurological deficits such as blindness, deafness or anesthesia. There also can be disturbances of consciousness (amnesia, fainting spells).Nonneurological syndromes such as pseudocyesis (false pregnancy) or psychogenic vomiting have also been placed under the CONVERSION disorder category. However many clinicians continue to reserve the term CONVERSION reaction for syndromes mimicking a neurological disease. In ICD-10 but not DSM-IV dissociation and dissociative disorders are attached to the somatoform category, closely linked to CONVERSION syndromes. The demarcation between CONVERSION disorder and somatization disorder is not that clear, and CONVERSION symptoms may form part of the constellation of symptoms seen in somatization disorder. Patients with CONVERSION disorder usually present with symptoms suggestive of neurological disease such as muscle weakness, gait disturbances, blindness, aphonia, deafness, convulsions or tremors. About one third of patients diagnosed with CONVERSION disorder presenting with motor symptoms also meet criteria for other Axis I psychiatric diagnoses and 50 percent meet criteria for other Axis II diagnoses. HistoryThe concept of hysteria, derived from the Greek word for womb or uterus, implied an unwanted migration of the organ to higher sites. It was known even to ancient Egyptians. In the middle ages, hysterical symptoms were attributed to demonic influences, and their being placed at the moral level retarded the medical debate. During the Renaissance, hysteria returned to medicine, being considered a somatic disorder by physicians, who implied a connection or pathway between the uterus and brain. By the middle of the nineteenth century, Briquet provided a detailed clinical description of a somatic syndrome affecting young women to which he gave the name hysteria and whose origin he situated in the brain. Charcot described the classic form as “la grande crise hysterique” which included phases such as the “prodromal”, “trance”, and “terminal or verbal” phases. He also proposed the term “functional lesion” in an effort to resolve the absence of physical findings. His followers, Babinsky, Janet, and Freud, continued to place the emphasis on psychological factors. Freud and Breuer jointly reported the first case of hysterical CONVERSION, the case of Anna O.They theorized that symptoms of hysteria represented unwanted emotional distress or conflicts that was suppressed and kept unconscious by the individual, only to appear in the form of medically unexplained bodily symptoms. Freud named this process “somatic compliance” or “CONVERSION” and thus, with the case report of Anna O, both “CONVERSION hysteria” and the “talking cure” were born. Since then, CONVERSION hysteria has gradually lost its central role in psychopathology, being more loosely described as hysteria, hysterical CONVERSION, or simply CONVERSION, and the term is often used in situations without clear evidence of psychological determination.
Somatoform phenomena in classic psychopathology German Berrios maintained that whereas initially the physical and the psychological were dealt with in a unitary fashion, after the nineteenth century somatic symptoms were described nonspecific.Thus the leading psychopathological entities that came as a legacy from the nineteenth century excluded hysteria and hypochondria and included only “melancholia, mania, delirium, paranoia, lethargy, carus and dementia. Berrios also mentioned a somatoform disorder termed “dysmorphophobia” and referred to the French term cenestopathie as precursor of “neurovegetative dystonias” and “psychosomatic syndromes” Kurt Schneider viewed somatic presentations not as a separate group but as key components of other psychopathological syndromes. In Schneider’s psychopathology, somatoform phenomena appear the best fit among his “psychopathic personalities” especially the group he labeled “asthenic psychopaths”. “Somatically labiled” or somatopath individuals who completely focused their attention on their bodies, fatigued easily, and suffered from insomnia, headaches and heart, bladder and mental disturbances. Karl Jasperse mentioned hypochondria, hysteria and the somatopsychic, emphasizing the polarity that existed at that time regarding physical and psychological approaches to these problems. He affirmed that the great majority of physical suffering is due to psychological reflection and not to manifested physical disease. In Jasperse, many of the somatic presentations tend to become fixed and repetitive and can be understood as part of personal experience, situations and conflicts. Henry Ey, an influential French psychiatrist, reflected the influence of psychoanalytic theories on European psychiatry during the first half of the twenties century. In his textbook, he devoted a full chapter to hysteria, which he defined as “the somatic hyper expressivity of unconscious ideas, images and affects”. The Spanish psychiatrist Juan Jose Lopez Ibor was the first to follow Schneider and highlight the somatic component of some forms of anxiety and depression, proposing antidepressant treatments for them in the 1960s.Lopez Ibor also placed “hysteria, “hypochondria”, and “psychosomatic disorders” among his “disorders of mood”. Thus anticipating by a number of years the development of the panic disorder concept in North American psychiatry.