conversion disorder symptoms generally appear

Given the popularity of conversion disorder, it is surprising that little research work was done on this topic during the past 10 years. Conversion disorder remains an elusive entity, even though conversion phenomena have been described throughout the medical literature since antiquity. It has engendered much controversy as to its very existence; a great deal of the confusion is due to changing diagnostic criteria and terminology and to the interchangeable use of diagnostic terms throughout the years.

The ubiquitous term hysteria has often been used to refer to conversion hysteria, hysterical personality, somatization disorder, or some combination of all three Note that on occasion these terms will be used interchangeably in this chapter so as to be consistent with the terminology in cited studies, although we do not feel that these terms are in fact interchangeable. Although conversion phenomena were brought to the forefront by Freud, the concept was originally put forward by the Egyptians. The term was derived from the Greek word hustera, meaning ‘‘uterus,’’ because the ancient Egyptians and Greeks attributed a number of physical symptoms in women to the ‘‘wandering of the uterus’’. In the seventeenth century, the concept of conversion was further developed by Sydenham, who emphasized that hysterical phenomena could mimic almost all known physical diseases. In 1856, a French physician, Paul Briquet, published a comprehensive monograph on 430 clinical cases.

Although Briquet’s investigation attempted to provide a clearer and more systematic definition of hysteria than previously achieved, his work ultimately provided more support for somatization disorder than conversion disorder. Around the same time, Jean Martin Charcot was credited with some of the seminal ideas regarding hysteria. Charcot’s contributions included the view that hysteria was a special type of consciousness, whereby individuals actually experienced the lack of physical functioning because they were highly suggestible. Charcot went on to postulate that conversion symptoms were attributable to an inherited degenerative process of the nervous system. He also became famous for his theatrical use of hypnosis, and, in fact, he indicated that hypnotizability was pathognomonic for the condition of hysteria. Pierre Janet, a student of Charcot, extended the theoretical formulations of hysteria to include a description of dissociative phenomena. A dissociated system represents a system of ideas and functions that, although no longer available to consciousness, could continue to be active and exert sensory and motor effects via unconscious mechanisms. Sigmund Freud, who was also a student of Charcot for a brief period, used hypnosis with conversion patients to demonstrate that the recollection of past memories and experiences could alleviate conversion symptoms. Freud developed the theory of conservation of psychophysical energy, which proposed that emotions not expressed or discharged lead to physical symptoms. Freud added that affect associated with a traumatic event that could not be expressed because of moral or ethical concerns would be repressed and converted to a somatic-hysterical symptom that was symbolic of the original trauma in some way. The repression of affect later became known as la belle indifference, one of the mainstays of hysterical conversion. Freud also noted that repressed ideas, affects, and conflicts were often sexual.