Situation: A 20-year-old college student is admitted to the medical ward because of sudden onset of paralysis of both legs. Extensive examination revealed no physical basis for the complaint. The nurse plans intervention based on which correct statement about conversion disorder?
A. The symptoms are conscious effort to control anxiety.
B. The client will experience a high level of anxiety in response to the paralysis.
C. The conversion symptom has symbolic meaning to the client.
D. A confrontational approach will be beneficial for the client.
Correct Answer: C. The conversion symptom has symbolic meaning to the client
The client uses body symptoms to relieve anxiety. Conversion disorder, also known as functional neurological symptom disorder (FND), is a psychiatric disorder characterized by symptoms affecting sensory or motor function. These signs and symptoms are inconsistent with patterns of known neurologic diseases or other medical conditions. Although conversion disorder has no organic basis, the symptoms significantly impact a patient’s ability to function.
Option A: The condition occurs unconsciously. Moreover, the symptoms cannot be controlled at will and not considered to be feigned intentionally by the patient. The term “conversion disorder” was first mentioned in literature by Sigmund Freud (1856-1939). The Austrian neurologist and founder of psychoanalysis believed that functional symptoms that could not be explained by neurologic diseases or other underlying medical conditions reflected an unconscious conflict.
Option B: The client is not distressed by the lost or altered body function. Involving the patient is crucial to building rapport; ask them what they feel is going on. Instead of focusing on what the patient cannot do at the time of the interview, ask them to describe the last time that they remember being symptom-free, and ask them to describe what a typical day looks like for them. The Diagnostic and Statistical Manual of Mental Disorders, 5 edition (DSM-5) categorizes conversion disorder as part of the “somatic symptom and related disorders.” In previous editions of the DSM, clear psychological comorbidities were a required part of the diagnosis, as well as the ability to show that the symptoms were not intentionally produced.
Option D: The client should not be confronted by the underlying cause of his condition because this can aggravate the client’s anxiety. Patients with conversion disorder are more likely to have certain psychiatric disorders (depression, anxiety, and personality disorders) than patients with known neurologic conditions. They are also more likely to have a history of multiple somatic complaints, including symptoms like generalized fatigue, weakness, or pain, without a known cause. Physical injury or actual neurologic illness (such as a stroke or migraine) may “trigger” the symptoms of conversion disorder.