Dissociative (Conversion) Disorders

when the other is present. Rare. Many report physical or sexual abuse (up to 95%). Patient often meet the criteria for other diagnoses especially antisocial personality disorders and drug abuse; they also have symptoms of anxiety and depression. Very suggestible.

-Dissociative Trance (Trance and Possession):

Temporary loss of the sense of personal identity and full awareness of the present surrounding. The person acting as if taken over by another personality for a brief period (e.g. religious ritual induced).

-Conversion Disorder:

Psychological cause leading to symptoms or deficit involving voluntary motor or sensory function. Common among people attending doctors. The pattern of symptoms reflects patients’ knowledge and sophistication and influenced by cultural and social factors.

With Motor symptoms:

Limb paralysis (psychogenic paralysis)ànot corresponding to nerves distribution, flexion and extension working simultaneously, wasting is absent. Psychogenic disorder of gait (e.g. astasia-abasia) Psychogenic tremor Globus hysterics

 

With Sensory symptoms:

Anesthesia Psychogenic blindness, deafness

With seizures and convulsions (Pseudo fits)

Distinguish from epilepsy in three ways:

-Does not become unconscious

-No stereotyped movement, incontinence, tongue bite, cyanosis or injury

-EEG normal.

-Interesting Related Syndrome!

Epidemic Hysteria: A dissociative disorder which spread within a group of people as an epidemic, this spread often happens in closed group of young women e.g. schools, nurses home, college resident (e.g. DMC!). Typically the epidemic starts in someone who is highly suggestible, histrionic (centre of attention) or psychotic (rare, refer to previous lectures; shared delusions).

v Differential Diagnoses:

Three ways in which physical disease may be wrongly diagnosed as a dissociative disorder.

1. Symptoms may be of physical disease which has not been discovered (e.g. brain CA) 2. Undiscovered brain disease may ‘release’ hysterical symptoms (e.g. TLE) 3. Anxiety caused by the awareness of the early symptoms of physical disease may act as a non-specific stimulus which provokes additional dissociative symptoms such as fugue.

Examples of differential diagnoses:

Organic disease of the CNS Parietal complex seizures Histrionic personality(under stress) Malingering.

To minimize error in diagnoses:

1. Usually does not appear after 40 2. Provoked by stress 3. Secondary gain 4. Belle indifference (hysterical indifference): less distress than would be expected of someone with the presenting symptoms. v Prognosis:

Most recover quickly but if longer than one year becomes difficult and last for several years.

v Treatment: Resolve stressful circumstances Suggestion Do not encourage behavior Abreaction in extreme cases using hypnoses or IV barbiturate

Reference:

1. Boyle D, Davies S. Psychiatry, Mosby’s crash course 2002.

2. Steple D. Oxford 2.Handbook of Psychiatry, Oxford University Press, 2006

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