Understanding the Differences: Conversion Disorder vs. Somatic Symptom Disorder

This article will offer a detailed and informative examination of the differences between conversion disorder and physical symptom disorder, offering a thorough understanding of what their symptoms are and how these conditions are treated.

Difficulties diagnosing conversion disorder vs. somatic symptom disorder

Conversion disorder, also called functional neurological symptom disorder, is a disorder that is related to somatic symptom disorder. It presents with neurological symptoms that are not explained by other neurological conditions, whereas somatic symptom disorder can present with other somatic symptoms like fatigue or pain that are not quite as severe but are primarily psychological.

Given their relationship, it can be difficult and complex to properly diagnose conversion disorder vs somatic symptom disorder.

If one element is overlooked or not noted during an assessment, it can result in a misdiagnosis.

The harm of misdiagnosis for somatic symptom disorder vs conversion disorder

A misdiagnosis for somatic symptom disorder vs conversion disorder is particularly problematic for patients because the treatment varies for conversion disorder versus somatic symptom disorder, and with the wrong treatment or mismanagement of the condition, individuals don’t learn to change or control symptoms.

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Conversion disorder versus somatic symptom disorder: common differences

Somatic symptom disorder is a diagnosis under which are found several related disorders including conversion disorder and illness anxiety disorder. All of these have a similar feature, which is somatic symptoms that cause significant distress and impairment.

Individuals with somatic symptom disorder could have several concurrent somatic symptoms that result in significant disruptions to their daily lives. Sometimes, this can be a specific symptom like localized pain or a nonspecific symptom like general fatigue. These symptoms do not have any medical explanation, and while the suffering may be authentic, no other medical explanation can explain the symptoms.

For example, someone who had an uncomplicated myocardial infarction that did not result in any disability or cause any long-term damage might become seriously disabled because of somatic symptom disorder after that myocardial infarction.

Individuals who struggle with somatic symptom disorder usually have high levels of anxiety or concern about their illness. They regularly assess their symptoms as harmful, and they live in fear of even more serious medical conditions. This distress can impact daily life and cause physical and mental impairments.

An individual struggling with conversion disorder will typically have neurological symptoms that are not attributed to any neurological condition. This means that that same patient who had an uncomplicated myocardial infarction that did not result in any disability or cause long-term damage might become seriously disabled with paralysis, abnormal jerks and other movements, problems walking, hearing, and seeing. These neurological symptoms could manifest as a result of conversion disorder despite the fact that the myocardial infarction caused no damage. 

-Symptomatology: Where Symptoms Overlap and Diverge

With conversion disorder vs somatic symptom disorder, there is some overlap in symptoms such that other mental health or physical health concerns cannot explain the symptoms. However, somatic symptom disorder can have pain as the predominant symptom and must exist for at least six months. By comparison, the symptoms of conversion disorder are not held to that same standard.

A bigger difference, though, is that conversion disorder includes somatic symptoms akin to neurological symptoms like seizures, slurred speech, abnormal movements, or weakness, whereas somatic symptom disorder not only has the physical symptoms of a conversion disorder but the psychological symptoms that include excessive thoughts, feelings, or behaviors that disrupt daily life. 

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-Diagnostic Criteria and Assessment

For somatic symptom disorder vs conversion disorder, the diagnostic criteria and assessment are as follows:

Somatic Symptom Disorder

The diagnostic criteria for somatic symptom disorder include the following:

  1. One or more somatic symptoms that cause significant distress or disruptions to daily life.
  2. Excessive behaviors, thoughts, or feelings that relate to somatic symptoms, including at least one of the following:
    1. a disproportionate or continuing thoughts about an individual’s symptoms
    2. b persistently high anxiety about symptoms or General Health
    3. c excessive energy and time devoted to symptoms and health issues
  3.  The state of symptomatic must be persistent for at least six months or more, even if any single somatic symptom is not present continually.

Somatic symptom disorder can also include a characterization with predominant pain where an individual experiences pain as their predominant symptom. The severity is broken down into three categories:

  1. Mild, where only one of the three symptoms listed in section B are fulfilled
  2. Moderate, where two or more of the symptoms in section B are fulfilled
  3. Severe, where all three are fulfilled, and there are complaints of several somatic issues

Conversion Disorder

The diagnostic criteria for conversion disorder include the following:

  1. One or more symptoms of sensory function alteration or voluntary motor alteration.
  2. Clinical findings stipulate that the symptoms are not the result of other medical conditions or neurological conditions.
  3. The symptom is not better explained by other Mental Health disorders.
  4. Symptoms cause significant distress or impairment to very important areas of daily function, occupation, or social engagement.

Conversion disorder can include symptoms such as:

  1. Weakness or paralysis
  2. Abnormal movements such as Tremors or gait disorder
  3. Difficulty with swallowing
  4. Speech symptoms like slurred speech
  5. Attacks or seizures
  6. Sensory loss or anesthesia
  7. Special sensory symptoms, including hearing disturbances, visual issues, or olfactory concerns
  8. Mixed symptoms

Conversion disorder can have a specific psychological stressor, but it doesn’t need to. Symptoms can also be categorized as acute or persistent. Acute symptoms of conversion disorder are those that have persisted for less than six months. By comparison, persistent conversion disorder qualifies symptoms that have existed for longer than six months.

-Treatment Approaches for Conversion Disorder

Treatment is different for conversion disorder versus somatic symptom disorder, given the symptoms that exist in each patient. 

For example, if a patient is struggling with dystonia, treatment might include the administration of general anesthesia or even a placebo administration for dystonia. 

In general, the first step in treatment is to use psychotherapy. There are several types of therapy that can prove useful, but cognitive behavioral therapy can help address the way in which an individual thinks and feels about their situation and the things that influence their behavior. Another treatment used in conjunction with cognitive behavioral therapy is physical therapy. This is better used for those who are experiencing functional motor symptoms. 

Those who are experiencing sensory loss or speech symptoms might participate in hypnosis.

Medication can be used if there is a coexisting mental illness alongside the conversion disorder like depression or anxiety. In these cases, working with professional psychological intervention can provide a correct diagnosis and subsequent mood stabilizers, anxiolytics, or antidepressants.

TMS can be useful to help modulate symptoms, but research remains limited.

-Treatment Approaches for Somatic Symptom Disorder

Very similar treatment approaches are used for somatic symptom disorder, helping individuals to control their symptoms and perform daily tasks without any interference. This usually involves a visit to a trusted healthcare professional with whom they can develop an alliance and gain reassurance and support.

Talk therapy is also an essential way to address the way in which someone thinks and behaves while also learning how to cope with their symptoms, stress, or pain.

-The Role of Psychological Intervention

With conversion vs somatic symptom disorder, there is an opportunity for psychological intervention. Psychological intervention is essential when it comes to building a strong therapeutic relationship with the individual and discussing the symptoms and how they make the individual patient feel.

With proper psychological intervention, the right treatment can focus on getting the patient to understand and accept their diagnosis, particularly the psychological element of the illness.

Summing Up

With conversion vs somatic symptom disorder, the importance lies in differentiating between the two disorders for proper treatment. By embracing understanding, individuals with conversion disorder vs somatic symptom disorder can enjoy better care and treatment.