What is conversion disorder?
Originally called with neurosis hysterical, conversion disorder definition is one types of somatoform disorder which is signed by the loss of or difficulties in physical functioning, but not found a clear organic cause. Traditional Freudian theory mentioned the conversion disorder definition is actually a psychic energy that was cut off from unacceptable impulses and then converted into physical symptoms. Physical symptoms usually appear in a sudden, especially in full-pressured conditions and stress. The appearance was also not intentionally made or called malingering.

According to DSM IV, conversion symptoms like neurological or general medical condition that involves various problems with the voluntary motor function or sensory function. Some patterns of symptoms associated with conversion of the classic symptoms of paralysis, epilepsy, coordination problems, blindness, and tunnel vision (only could see what was directly in front of the eye), loss of sense of hearing or smell, or loss of feeling in limbs (anesthesia). A physical symptom of the body which was found in conversion disorder is often not in accordance with medical conditions which  have been connected previously. For example, the conversion of epilepsy, epilepsy patients do not like the truth, the patient can maintain control at the disposal of relapse. In the conversion of blindness, the patients could even walk to the doctor without touching the furniture.

Etiology
The theory that explains conversion disorder causes is explained by the theory of psycho analysis and behavioral theories.

Psychoanalytic Theory
(1895/1982), Breuer and Freud: Conversion disorder is caused when a person experiences events that cause a large increase in emotion, but its effects can’t be expressed and memories of the event are removed from consciousness

Behavioral theory
Ullman & Krasner (in Davidson, Neale, Kring, 2004), conversion disorder occurs because the individual adopts a symptom to achieve a goal. Individuals strive to behave in accordance with their views on how a person with a disease will affects motor skills or sensory as they will react.

Epidemiology

conversion disorder

in nineteenth century, more women suffer from conversion disorder. While in the 20th century, more conversions suffered by men as battle casualties during world war is checked, there were many who experienced conversion. According to the DSM-IV report, conversion disorder rate increased from 10/100, 000 to 300/100, 000 was found in the general population sample and it is stated that conversion symptoms have been reported as the focus of treatment in 1-3% of referrals to outpatient mental health clinic.
Conversion disorders usually occur at children age (end) until adulthood (early). This disorder rarely occurs before age 10 years and after 35 years.

Conversion Disorder Symptoms
Conversion disorder DSM IV criteria:
A.  At least there is one symptom or deficit voluntary involving motor function or sensory function that indicates a physical disorder.
B. Assessed psychological factors associated with the disorder because of the onset or recurrence of physical symptoms related with its emergence.
C. That person does not intentionally create these physical symptoms, or pretends to have it with a specific purpose.
D. Symptoms can not be explained as a cultural ritual or pattern of response, nor can it be explained by any physical disturbance through a proper test platform.
E. Symptoms can cause significant emotional distress and affect one or more areas of functional area such as social or work function, which in turn require a medical examination.
F. Symptoms are not limited to complaints of pain or problems with sexual function, nor can it be caused by other mental disorders. Some people with conversion disorder often showed a surprising indifference to current symptoms, this phenomenon is known as la belle indifference (ignorance is beautiful).

This type of symptom or deficit in this conversion disorder can be divided into 4:
-By symptom or motor deficit
-With sensory symptom or deficit
-With seizures or convulsions
-With mixed picture

As symptoms of physical disorder occurs in somatization disorder disorder, conversion disorder symptoms might also become very disturbing and may put individuals in risky conditions. This risk can become complication occurs in a medical or surgical treatment is not necessary and the risk of excessive costs.

Conversion Disorder Diagnosis:
Differential diagnosis is a diagnosis of somatic disease. Somatic illness in the form of psychological disorder, leads to the emergence of another diagnosis of a disease on patients because of complaints suffered by them who come with somatic disease are  similar to patients with common diseases.

When a somatic disorder can’t be identified, a diagnosis of conversion disorder should not be made unless there is clear evidence that the symptoms serve a psychological function. Conversion symptoms can occur as one component of somatization disorder. When this happens, the diagnosis of conversion disorder is not done yet. Conversion disorder is common in patients with dissociative  identity disorder, sometimes in condition that occur in patients with schizophrenia.

Case Illustration
A woman aged 47 years; married was in the room psychiatric consultation unit. She believed that she had an accident. He fainted at his home and was taken to hospital for treatment of paralysis which occurs at the right side of  her  body. On examination, her right arm and right leg has a normal reflex. All other aspects of the neurological examination were also normal. Patients seemed indifferent to the conditions and difficulties and can chat quietly with fellow staff and patients.

Laboratory studies, CT scans and MRI also show normal results.
Patients expressed a series of brutal argument between husband and son. The second oldest child victims evicted from home by their father after a physical conflict occurred repeatedly. The same pattern seems to be repeated on the youngest child. Patients, although describing that he was never angry, vows that he will not let her husband drive her youngest child.

But a series of conflicts occurred, and her husband was threatened to physically assault against their youngest child. One night, the patient discovered that her husband and children were involved physical fights. As she felt anger and fear, the patient struck with her own thoughts that she felt hate them and thus be wanted to drive them out. At that time, the patient suddenly felt weak in her right arm and fell to the floor.

The woman turned out to have two episodes of conversion symptoms in the context of the same family conflict. He describes a childhood history of physical violence, witnessing  family violence and neglected.

Conversion disorder treatment
The aims of conversion disorder treatment are:
1) Prevent the pain’s adoption,  invalid  (make sure that the symptoms happen in mind and not only in real life.
2) Minimize the costs and avoid complications by conducting diagnosis tests, treatments, and and avoid unnecessary drugs.
3) Conducting pharmacological control of comorbid syndromes (aggravating the condition)

Effectiveness of pharmacological interventions to alleviate symptoms of conversion disorder has not been proven, so it is seldom recommended in the treatment of conversion disorder. Most patients treated with a special psychotherapy, such as behavioral therapy and hypnosis.

These conversion symptoms often spontaneously disappear although sometime it may recur. If symptoms do not disappear and frequent relapse, then you should ask for treatment. A variety of effective treatments to overcome this conversion disorder symptoms are:

Counseling (psychotherapy).
Psychologist or professional counselor can help you deals with anxiety, depression or even mental health problems. In addition, psychotherapy can also prevent the symptoms reoccur.

Physical Therapy

It can be done by doing by physical activity like working. The routine movement of arms or legs can prevent muscle tightness and weakness. This therapy can prevent complications of certain conversion symptoms.

Treating stress and other related conditions
Conversion disorder may help you to  get treatment for stress, anxiety or another underlying problems. Your Doctor May prescribe anti-anxiety medications, antidepressants or other drugs as part of your treatment plans, depending on your personal health profile.

Hypnotic
Hypnosis is usually combined with other psychotherapy on treatment of somatoform disorders. By following this therapy conducted by by experts  patients will be assisted in dealing with other psychological problems.

Transcranial Magnetic Stimulation
this exciting treatment involves weak elextrical currents to check the brain activity. This stimulation is believed to alter the brain’s biochemistry and  improve various symptoms of mental disorders.

Strategies and techniques of psychotherapy and psychosocial:
1. Conduct consistent treatment, handled by the same physician
2. Create a regular schedule with an adequate time intervals of arrival
3. Focus on treatment of symptoms gradually to the personal and social problem
4. Acute: convincing, suggestion patients to reduce symptoms
5. Consider narcoanalisis (sedative hypnotics), hypnotherapy, and behavioral therapy.
6. Chronic: further exploration of the interpersonal conflict in patients

Although pharmacology is not effective in the treatment of conversion disorder, but the treatment would be necessary, especially in treating some symptoms. Strategies and techniques and physical pharmacological:
1. Only given a clear indication
2. Avoid drugs that are addiction
3. Consider narcoanalisis (sedative hypnotics). Prognosis would be considered good, if the initial onset of precipitation showing a clear factor, if the intelligence is still good, conduct immediate treatment.It would be considered poor prognosis if it happens otherwise.