DISSOCIATIVE (CONVERSION) DISORDERS:
There is normally a considerable degree of conscious control over the memories and sensations that can be selected for immediate attention, and the movements. that are to be carried out. In these disorders it is presumed that this ability to exercise a conscious and selective control is impaired, to a degree that can vary from day to day or even from hour to hour.
The common theme shared by dissociative (or conversion) disorders is a partial or complete loss of the normal integration between memories of the past, awareness of identity and immediate sensations, and control of bodily movements.
Psychodynamics and Etiology:
In conversion disorder although the disturbance is not under voluntary control, the symptoms occur in organs under voluntary control, serve to meet the immediate needs of the patient, and are associated with a secondary gain. Patients with conversion disorder benefit by primary and secondary gain. Primary gain is obtaining relief from anxiety by keeping an internal need or conflict out of awareness. Secondary gain is any other benefit or support from the environment that a person obtains as a result of being sick. Example of secondary gain are attention, love, financial regard and sympathy.
The term 'la belle indifference' is used to describe patient reaction such as indifference to the symptoms and displaying no anxiety. This is because the anxiety has been relieved by the conversion disorder. The conversion symptoms serve the purpose of non-verbal communication of the stress or suffering and also function as non verbal means of controlling or manipulating others. An emotionally charged feeling or idea, blocked from expression by personal or cultural restraints is expressed in the form of conversion symptoms. Patients with more frequently recurring conversion symptoms have been reporte'd to have significantly higher number of problems in their private life.
Age of onset for conversion disorder is usually'adolescence or early adulthood but it may occur for the first time during middle age or in later maturity. Conversion disorder is two to five times more common in woman than in man.