Doc: Conversion disorder a complicated condition
Dear Dr. Roach: I am 69 and take medications for blood pressure and cholesterol, as well as plenty of vitamins. I have had many medical conditions (e.g., Meniere’s disease and lower back pain) that eventually were resolved. I’ve been diagnosed with conversion disorder by two doctors whose opinions I respect.
Both doctors assured me that it was not a mental problem, but my reading indicates that the only remedy is psychiatric counseling for a childhood trauma. I have no memory of any physical or sexual abuse, although my childhood was sad due to non-nurturing parents, which my siblings shared.
Dear M.M.: Conversion disorder (also called functional neurological disorder) is poorly understood. The diagnosis often is not made or not explained clearly to the patient, which makes treatment difficult. The underlying cause is not well-understood by medical science. The term “conversion” refers to a psychodynamic theory that unconscious conflicts are “converted” to physical symptoms.
According to this model, these conflicts often arise in childhood, but not exclusively. The psychodynamic theory is difficult to test, and there are other theories for the underlying cause. Evidence to support a neurological cause include an abnormal structure and function of some brain areas in people with this diagnosis.
Conversion disorder is uncommon in the general population. The symptoms in conversion disorder may include episodes that look like seizures (but which are proven not to be, by an EEG during an event); sensory symptoms like numbness; abnormal movements; and weakness and paralysis.
Accepting the diagnosis is a critical first step, and this means trusting the clinicians and trusting what they have done to rule out a different type of neurological problem. Making the diagnosis of conversion disorder before a thorough evaluation is complete is a big mistake. The fact that you trust your doctors is a sign of a good prognosis for you.
Treatment starts with education. Modalities that may be effective in people with conversion disorder include physical therapy, psychotherapy (including cognitive-behavioral therapy) and occasionally medications.
The information at fndhope.org is very helpful.
Dear Dr. Roach: Is there any reason to start taking vitamin D at age 90? I’m in good health except for osteopenia and high blood pressure. How long does it take to have an effect?
Dear P.S.: In your case, there are potentially two good reasons to start taking vitamin D — if your blood levels are low.
One is that with osteopenia (a condition of low bone mass, a precursor to osteoporosis, which increases risk for bone fractures), replacing low vitamin D can improve bone strength and reverse bone loss. This can keep people from needing other medications for osteoporosis, which are much more likely than vitamin D to have side effects.
Older people with vitamin D deficiency also often have some muscle weakness. If you can’t get out of a chair without using your hands and you have a low vitamin D level, replacing vitamin D may help with the weakness. Of course, there are many causes for weakness in a person and there is no guarantee of effectiveness, but vitamin D is very safe in moderate doses, like 1,000 to 2,000 IU daily. Vitamin D also may reduce fall risk, probably by improving strength, especially in combination with exercise.
Email questions to ToYourGoodHealth@med.cornell.edu