A practical approach to the physiotherapy assessment and treatment of conversion disorders

Conversion disorder is a mechanism of illness by which psychological distress is expressed as a form of physical illness. Conversion disorders are part of a wider group of conditions called somatoform disorders. Somatoform disorders are dominated by somatic symptoms that resemble physical illness; however, the symptoms cannot be fully explained by organic causes. It typically presents with deficits of sensory or voluntary motor function, which may represent a general medical or neurological condition. Psychological factors play an important role in the diagnosis of a conversion disorder; exacerbation of symptoms is often preceded by a stress or inner turmoil. It is important to realise that the symptoms of a conversion disorder are not deliberately produced or simulated by the patient as would be the case in a factitious (assumption of the sick role, which is motivated by obtaining medical assessment and treatment), or malingering (obvious gain to be achieved from sick role such as financial reward, avoidance of duty, etc.) disorder. Originally termed ‘hysteria’, conversion disorders are classified by the DSM-IV into four subtypes