New approaches to conversion hysteria

Functional imaging may improve understanding and reduce morbidity

Patients with hysterical conversion, now called conversion disorder by the main US psychiatric glossary,1 often present with striking neurological symptoms such as weakness, paralysis, sensory disorders, or memory loss, in the absence of any pathology that could be responsible. Most patients will be referred to a neurologist or psychiatrist after consulting their family doctor.

As many as 4% of those attending neurology outpatient clinics in the United Kingdom have been estimated to have conversion disorders.2 Similar rates have been reported for both in and outpatient clinics in other European countries.

Empirical research on hysterical conversion has lagged behind theoretical speculation. Recent advances in functional imaging (positron emission tomography scanning) and cognitive neuropsychology have, however, made the field more amenable to investigation.3 Key clinical and theoretical problems remain over case definition and differential diagnosis, the psychological mechanisms underlying conversion hysteria, and how patients are best managed.

Despite attempts over the past century to abolish and reinstate the condition by using different labels, conversion hysteria continues to attract controversy. …