Conversion Disorder: A Cognitive Neuropsychiatric Approach

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Conversion disorder (?hysteria?) is a very common, very disabling condition, which is thought to occur when emotional problems are ?converted? into physical symptoms such as paralysis or blindness. Though it is as common and as disabling as ever, there has been very little research on it since the 19th century. The process by which it occurs remains mysterious, and there are no established treatments. Most patients with the disorder do not believe they have it, and do not see their problems as mental at all. We wish to examine this conversion process to see if it has some basis in modern neuroscience. If the conversion model is correct, then we would expect patients to have more life stresses of certain types leading up to their developing the disorder. This can be difficult to prove because of the unreliability of people?s recall, and because we know this group tend to deny the relevance of such stresses. We propose to address this with a standardised interview, the Life Events & Difficulties Schedule, which is a valid and reliable way of accessing problems from subjects? pasts. The conversion model proposes that these experiences are emotionally repressed. Using brain scanning, we wish to examine patients while they recall those experiences to see if they do recall them in a less emotional way than other people, even though this may be something they do not acknowledge. We will also examine whether recall brings on their symptoms - making their paralysis worse, for example. If this is successful we expect it will make the diagnosis much more acceptable and understandable to patients, and open the field to the research it sorely needs.