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February 4th, 2012
10:34 AM ET

Taking the 'mystery' out of conversion disorder

When 12 students at a high school in New York suddenly developed strange symptoms like stuttering, uncontrollable twitching movements and verbal outbursts, the community was concerned. Was there something in the environment? Was it a virus of some sort spreading dangerously? Three students and one adult have since also exhibited the same symptoms. Doctors at DENT Neurologic Institute have now diagnosed some of the girls with "conversion disorder," leaving people even more confused.

What is conversion disorder?

A person with conversion disorder has neurological symptoms that aren't related to any known neurological condition, according to the American Psychiatric Association. The symptoms could appear as uncontrolled motions or verbal outbursts, like the students in New York, or as anything from weakness or paralysis to a loss of vision or hearing.

In diagnosing conversion disorder, doctors must first rule out other neurological diseases and determine that the symptoms are not being intentionally faked. Often the symptoms are inconsistent with typical signs of a neurological disease – either physical signs or those that might show up on a diagnostic test.

What causes conversion disorder?

Stress is the main underlying cause of conversion disorder, says Dr. Jay Salpekar, director of the Neurobehavioral Program at Children's National Medical Center in Washington. That stress can be physical or psychological, and the amount that would cause the disorder varies in every person.

"The bottom line is that this stress is somehow converted into a physical symptom," Salpekar says. "Everybody has their breaking point."

Stress can also aggravate another underlying medical condition that was previously undiagnosed – and may never be. "We have many tools available with modern medicine, but we don't know everything."

What's the difference between conversion disorder, mass psychogenic illness and mass hysteria?

The official name for this disorder is still being debated. The American Psychiatric Association's current Diagnostic and Statistical Manual – or DSM-IV – calls it "conversion disorder."

The new version, DSM-5, which is set to publish in May 2013, is proposing a change to call it functional neurological disorder. In the past, the disorder has been called mass psychogenic illness or, more simply, mass hysteria. All the names describe the same disorder.

It's important to note that conversion disorder is not a group diagnosis, but an individual one.

"It's very unusual to have conversion symptoms that are 'contagious,' " Salpekar says.

Psychiatrists often refer to cases like the one in New York as a conversion reaction – or a group's reaction to conversion disorder.

Has this happened before?

Conversion disorder on an individual basis is common, Salpekar says. Conversion reaction hasn't been well documented. Most of the people involved in group incidents don't seek mental health help and are never officially diagnosed with conversion disorder.

Conversion reaction can be cultural, as it was in Trinidad in 2010 when students at a secondary school started screaming and collapsing. The phenomenon was attributed to demonic possession, according to a local newspaper, which may have helped it spread.

In 2007, nine students and a teacher at William Byrd High School in Roanoke, Virginia, complained of "involuntary movements in the extremities," according to The Roanoke Times. Environmental tests done at the school came up clean. While the principal told CNN that six students were determined to be faking, the Virginia Department of Health did an investigation and concluded the students' symptoms were consistent with "mass psychogenic hysteria."

In 2004, 31 chorus members at Starpoint High School in Lockport, New York, fell ill within an hour. Tests on the students and the building couldn't determine a cause, and everyone recovered quickly, according to a local news report.

The list goes on: in 2007, 14 female high school students in Florida  who developed sudden loud breathing problems; in 1982, 100 people in Los Angeles who  thought they had food poisoning, but didn't; in 1977, factory workers in West Virginia who passed out by the dozens.

Is it always women?

Many of these examples involve a group of young female students. But Salpekar warns against taking that as a sign conversion disorder or reaction only happens to women. Females are just more likely to seek help or bring attention to their symptoms, he says.

Are we sure it's not just a hoax?

Some people obviously do fake symptoms – psychiatrists call them maligners. These people always have something to gain from doing so, whether it's money in a lawsuit or a long stint off from work. But few people intentionally make up symptoms that make their lives more difficult for no reason, Salpekar says.

"To say that they're faking, it's just inappropriate. People do not fake things that adversely affect their life in such a way. ... [Conversion disorder] is simply a reflection that something is wrong in the mind, brain and body."

Can it be treated?

Yes. First, doctors treat any underlying medical or psychological conditions. Anti-anxiety drugs can be prescribed to help with the stress, according to the Mayo Clinic. Counseling is used to calm symptoms and teach stress management techniques. Other treatments include physical therapy to help with uncontrollable movements, hypnosis and/or magnetic stimulation in the brain.


soundoff (93 Responses)
  1. Jayceeg Vernies

    I do enjoy the way you have presented this specific situation plus it does indeed present us some fodder for thought. Nonetheless, through everything that I have personally seen, I really trust as the actual comments pack on that folks continue to be on point and don't get started on a soap box regarding the news of the day. Yet, thank you for this superb piece and even though I do not really concur with the idea in totality, I regard your point of view.

    July 16, 2012 at 05:15 | Report abuse | Reply
  2. fndhope

    This is a very misunderstood disorder. It is as common as MS and can be as debiliting as Parkinsons. yet there is very little treatment. Would a parkinson's or MS patient be sent home to learn to igonore their symptoms? This is what is happening to many of these patients. I am appauled at the amount misleading information being distributed by "experts" in this field that are not even up to date with the current research that is available. There is more than likely a name change happening because half the time these patients do not have any psychological reason for the symptoms nor has a psychological disorder manifested from it. Yet people are physicallly debilitated from it. This disorder is surrounded by unethecal dilemas. I could go on for days and could cite you research to prove it. Unfortunately if this does not effect you or someone you love it is easier to turn and walk away, leave an uneducated remark, or pretend it doesn't excist. I do hope more people will stand up not allow this inhumane treatment anymore. There is a non profit organization I beilive the only one officially registed in the world for this disorder. if you are interested in more information please visit fndhope.org there is also informational youtube videos with statistics not video of episodes. under fndhope.org please dont judge just educate. Knowledge is power.

    September 19, 2012 at 14:01 | Report abuse | Reply
    • TM

      fndhope – Your comment is most commendable. And, for the article to even suggest "faking," is to add fodder to ignorance.

      February 1, 2013 at 21:36 | Report abuse |
  3. FNE/CD Survivor

    As someone who went through nearly 6 years of testing, therapies, and numerous physicians before being diagnosed with "Conversion Disorder" and having lived with it for an additional 6 years I understand how someone could "think" it was "faked" just as I KNOW how difficult it is to "accept" that a psychological issue could be SO physically debilitating and the underlying cause of SO much pain and distress. Better understanding, awareness, and knowledge of FNEs would benefit everyone involved. I saw a range of frustration, confusion, doubt, concern and was even told, "I am sorry, this is the last thing I even know to try and am not sure if it will even help." Personally, I had a wonderful good-paying job and finally weekends off for quality time with my daughter for three years before waking up one morning with a migraine and stiff-neck. There was and hasn't been any upside, no personal gain only pain and loss of everything I had worked so hard to build a nice home for my daughter and I. The entire situation was made that much worse, because as much as I tried, I was unable to keep it from affecting those I love; particularly my daughter. Logically, I understood the illness yet, still felt that because it was psychological I should have some control over it; it wasn't until a recent visit with a new NeuroPsychiatrist that I learned to stop blaming myself and realized, for me, it was a psychological coping mechanism that enabled me to function mentally. Just as I would never wish the underlying events that led to my CD on anyone else, I would never wish FNE on anyone else and cannot imagine anyone being able to "fake" the elevated blood pressure caused from the pain or there muscles getting so stiff they literally tear ligaments. Finding doctors that understand and know how to help has been the best thing for me; just wish it hadn't taken 12 years to do. Also, thank you so much, fndhope for the website link because it is great to see light at the end of this long dark tunnel and being able to find others that are going through similar situations. Hopefully, by sharing a glimpse into my experiences others will be able to have a better understanding of what it is like to be on the inside.

    February 20, 2014 at 10:01 | Report abuse | Reply
  4. Treva Aragpn

    Almost a week ago, I wasn't feeling well so I went to the clinic in a little Colorado town. I presented with chest pain, shortness of breath, cold sweats and dire pain in my left neck and shoulder. I was immediately taken to their small ER and put on all types of monitors , oxygen and they were running tests thinking it was a heart attack. They gave me aspirin, and nitro which did nothing to help my high blood pressure or high pulse. Then..... my right side of my face turned numb. Inside and out felt like I had just been given a shot ofnovacain. 5 min later I'm paralyzed on my right side. They treat me for a stroke, giving me a Med that made my nose and ears start yo bleed then loaded me on a helicopter for Denver. All my tests came back great, so no heart attack and no stroke whew, bit what the hell was happening to me?? I'm in ICU waiting on answers, and just loose it. I'm angry, yelling, swearing at the nurses and crying uncontrollable. This happens 3 more times in my 4 day stay at the hospital!! Finally a diagnosis!! Conversion Disorder!! Google hadbeen my best friend since those words were released from that dr mouth! Now at home, highly my medicated, I'll slowly learn to deal with my emotions!! Scary

    April 2, 2014 at 23:33 | Report abuse | Reply
    • Imnotcrazy

      I woke up and my legs couldn't move, hands numb and clinched, and since my father has MS was completely terrified! Now, after 6 ER visits, spinal tap, 4 MRIs, CT scan, and dozens of blood tests....I have been told it is conversion disorder. I couldn't walk for 3 days!!! Was told there showed no reason to admit me, ARE YOU SERIOUS??? So I urinated in bed since I was isolated and couldn't move without my bf carrying me. I was treated like a drug seeker for complaining of the severe pain (never even asked for anything). It is so sad that there is not more informative doctors to care and assist with this disorder:(. I would like to know what medications you are being treated with if you could tell me. I'm scared, but cannot keep trying different ones constantly that could affect my migraines I constantly have as well. I pray you have found relief.

      April 13, 2014 at 22:47 | Report abuse |
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