Understanding conversion disorder

Conversion disorder — now diagnosed as functional neurological symptom disorder (FND) — is a complex condition characterized by neurological symptoms with no medical explanation. Research shows that it’s common, with up to one in six new outpatient neurology referrals being people affected by this condition. 

Conversion disorder can be frustrating to live with because you may be facing painful or uncomfortable symptoms without fully understanding why. You may seek answers that medical professionals simply can’t give you. But these symptoms are real, your experience is valid, and conversion disorder requires treatment, just like any other neurological condition.

What is conversion disorder?

Conversion disorder is a psychiatric disorder characterized by neurological symptoms that can’t be explained by a medical condition. It’s now officially diagnosed as functional neurological symptom disorder, according to the Diagnostic and Statistical Manual (DSM). Previously, it was referred to as “hysteria” — a negative and stigmatizing label no longer in use.

The symptoms of conversion disorder are often linked to traumatic or highly stressful life events, which may lead to physical symptoms. This illustrates how interlinked mental and physical health is — stress and trauma can have a biological impact on the brain, resulting in neurological symptoms. 

For example, someone might suddenly feel like they can’t move their legs, but X-rays and other medical studies find no medical explanation for it. The person may notice that these instances of paralysis tend to come after highly stressful events in their life.

This is different from a related condition called somatic symptom disorder, which causes non-neurological symptoms (like fatigue, chronic pain, or hair loss) with no medical explanation along with distressing thoughts and feelings.

To be diagnosed with functional neurological symptom disorder, you must experience at least one neurological symptom that doesn’t have any other medical cause and that causes significant distress or impairment in your life.

People assigned female at birth are much more likely to live with FND. Most people start to experience symptoms in their late 20s to 30s, although it can affect people of all ages.

What types of conversion disorder are there?

There are no formally recognized subtypes of conversion disorder, but two presentations of it are most common: functional movement disorder and functional seizure disorder.

If you have functional movement disorder, you may experience symptoms related to your muscles or movement. For example, you might feel paralyzed in certain parts of your body, experience trembling or tremors, or feel pain.

FND can also look very similar to a seizure, which is diagnosed as functional seizure disorder. For example, you may have a seizure-like episode or moments in which you suddenly lose consciousness.

What do symptoms of conversion disorder feel like?

According to the DSM, the symptoms of functional neurological symptom disorder include:

• Motor symptoms or deficits: These can include weakness or paralysis, abnormal movement (e.g., tremors or dystonic movements), difficulty swallowing, or abnormal gait.
• Sensory symptoms or deficits: This may involve altered skin sensation, numbness, or problems with vision, hearing, or speech (e.g., slurred speech or sudden muteness).
• Seizure-like episodes: These episodes resemble seizures or convulsions, often without the characteristic neurological patterns of epilepsy.
• Incompatibility with medical findings: The symptoms can’t be explained by any medical condition or neurological disorder after appropriate evaluation.
• Significant distress or impairment: The symptoms cause notable distress or interfere with daily functioning, such as work, school, or personal relationships.

The exact symptoms can look different for everyone. Some common neurological symptoms that people with conversion disorder may experience include:

• Tremors
• Difficulty swallowing
• Paralysis in parts of the body
• Sudden blindness or loss of hearing
• Numbness or tingling in the limbs
• Dizziness or fainting
• Speech difficulties like slurred speech
• Seizure-like episodes

What can cause conversion disorder?

We don’t yet fully understand what causes conversion disorder, or FND. It’s thought to sometimes be triggered by traumatic or stressful events — although at other times, symptoms might seem to come out of nowhere. There’s some research suggesting conversion disorder might be how the brain expresses psychological distress, but we need more research to be able to say for sure.

The symptoms could arise as a result of the way stressful events or mental health symptoms affect the brain. These effects could make you experience neurological symptoms like tremors, nerve pain, or sensory impacts.

In addition, having an existing neurological condition, like chronic pain, increases your risk of developing conversion disorder. This can make diagnosis more complex because your health provider will need to differentiate between the symptoms of your existing health condition and FND.

In children, some risk factors for FND include:

• Family dysfunction
• Bullying
• Peer pressure
• Abuse

How can conversion disorder affect your health?

Some people might label the symptoms of functional neurological symptom disorder as just being “in your head.” But one of the hardest parts of living with this condition is that these symptoms are very real. This can have significant negative effects on your health and your life. For example, if you’re experiencing difficulties with movement, you may not be able to go to work or commit to a healthy exercise routine.

Conversion disorder also appears alongside many other mental health conditions; up to 95% of people with FND have one other psychiatric condition. In most cases, the mental health condition precedes conversion disorder — for example, you might live with post-traumatic stress disorder (PTSD) and end up developing neurological symptoms. But in some cases, living with FND could make these mental health conditions worse. For example, you may become more depressed after experiencing these painful symptoms.

How is conversion disorder diagnosed?

Conversion disorder can be tricky to diagnose. Typically, people with conversion disorder symptoms see a medical professional, usually a neurologist, for these symptoms. A neurologist should rule out any potential medical explanation for the symptoms. One of the requirements for being diagnosed with FND is that there’s no other reasonable explanation for these symptoms. Other conditions can typically be ruled out through a variety of tests, including MRIs.

If health professionals don’t find another reasonable explanation for these neurological symptoms, they may diagnose you with FND. In these cases, you may be referred to a mental health provider as well as other types of treatment.

Unfortunately, due to many factors, some people may be misdiagnosed with FND. If you disagree with your FND diagnosis, it’s important to advocate for yourself. Whether you live with FND or another neurological condition, your therapist can help you get to the right diagnosis and find ways to cope with the impacts of your symptoms.

Getting diagnosed with FND doesn’t mean that your symptoms aren’t real or your distress isn’t valid. People with FND experience very real symptoms with functional impairments to their lives. Regardless of whether a medical condition or FND is causing these symptoms, you deserve support.

What are the treatment options for conversion disorder?

Fortunately, FND can be treated. For some, learning about conversion disorder, its symptoms and causes, and receiving assurance that you don’t have a neurological condition may help reduce stress about your symptoms and, over time, help your symptoms go away. Finding a therapist who can help you with this process can be an important part of your healing.

If you live with an associated neurological condition, taking medication for it can help reduce functional symptoms as well.

Many people benefit from different types of therapy, including mental health therapy. Some options your medical provider might recommend include:

• Psychotherapy, including cognitive behavioral therapy
• Physical therapy
• Occupational therapy
• Speech therapy

Find care with Rula

Conversion disorder, or FND, can have serious impacts on your life. Regardless of a medical explanation for your neurological symptoms, these symptoms are real — and therefore have real consequences. Different types of therapies, including psychotherapy, can help you develop coping skills and self-care techniques. 

Rula has connected patients and therapists for millions of successful therapy sessions. We have 10,000+ licensed therapists with expertise in over 80 clinical specialties, including somatic disorders like FND.

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