Conversion disorder Hysterical neurosis Conversion disorder is a condition in which a person has blindness, paralysis, or other nervous system

(neurologic) symptoms that cannot be explained by medical evaluation. Causes, incidence, and risk factors Conversion disorder symptoms may occur because of a psychological conflict. Symptoms usually begin suddenly after a stressful experience. People are more at risk for a conversion disorder if they also have a medical illness, dissociative disorder, or a personality disorder. It is important to understand that patients are not making up their symptoms (malingering). Some doctors falsely believe that conversion disorder is not a real condition, and may tell patients the problem is all in their head. However, these conditions are real. They cause distress and cannot be turned on and off at will. The physical symptoms are thought to be an attempt to resolve the conflict the person feels inside. For example, a woman who believes it is not acceptable to have violent feelings may suddenly feel numbness in her arms after becoming so angry that she wanted to hit someone. Instead of allowing herself to have violent thoughts about hitting someone, she may experience the physical symptom of numbness in her arms. Symptoms Symptoms of a conversion disorder include the loss of one or more bodily functions, such as: Blindness Inability to speak Numbness Paralysis

Diagnostic testing does not find any physical cause for the symptoms. Signs and tests Common signs of conversion disorder include: Treatment Talk therapy (psychotherapy) and stress management training may help reduce symptoms. The affected body part or physical function will need physical or occupational therapy until the symptoms disappear. For example, paralyzed limbs must be exercised to prevent muscle wasting. A debilitating symptom that begins suddenly A history of a psychological problem that gets better after the symptom appears A lack of concern that usually occurs with a severe symptom

Expectations (prognosis) Symptoms usually last for days to weeks and may suddenly go away. Usually the symptom itself is not life threatening, but complications can be debilitating.

Dissociative disorders Dissociative disorders are defined as conditions that involve disruptions or breakdowns of memory, awareness, identity and/or perception. The five dissociative disorders listed in the DSM IV are as follows: Depersonalization disorder (DSM-IV Codes 300.6[2]) - periods of detachment from self or surrounding which may be experienced as "unreal" (lacking in control of or "outside of" self) while retaining awareness that this is only a feeling and not a reality. Dissociative amnesia (DSM-IV Codes 300.12[3]) (formerly Psychogenic Amnesia) - noticeable impairment of recall resulting from emotional trauma Dissociative fugue (DSM-IV Codes 300.13[4]) (formerly Psychogenic Fugue) - physical desertion of familiar surroundings and experience of impaired recall of the past. This may lead to confusion about actual identity and the assumption of a new identity. Dissociative identity disorder (DSM-IV Codes 300.14[5]) (formerly Multiple Personality Disorder) - the alternation of two or more distinct personality states with impaired recall, among personality states, of important information. Dissociative disorder not otherwise specified (DSM-IV Codes 300.15[6]) - which can be used for forms of pathological dissociation not covered by any of the specified dissociative disorders.

Post-traumatic stress disorder PTSD Last reviewed: February 14, 2010. Post-traumatic stress disorder is a type of anxiety disorder. It can occur after you've seen or experienced a traumatic event that involved the threat of injury or death. Causes, incidence, and risk factors Post-traumatic stress disorder (PTSD) may occur soon after a major trauma, or it can be delayed for more than 6 months after the event. When it occurs soon after the trauma, it usually gets better after 3 months. However, some people have a longer-term form of PTSD, which can last for many years. PTSD can occur at any age and can follow a natural disaster such as a flood or fire, or events such as war, a prison stay, assault, domestic abuse, or rape. The terrorist attacks of September 11, 2001, in the United States may have caused PTSD in some people who were involved, in people who saw the disaster, and in people who lost relatives and friends. These kinds of events can produce stress in anyone, but not everyone develops PTSD. The cause of PTSD is unknown, but psychological, genetic, physical, and social factors are involved. PTSD changes the bodys response to stress. It affects the stress hormones and chemicals that carry information between the nerves (neurotransmitters). Having been exposed to trauma in the past may increase the risk of PTSD. Having good social support helps to protect against PTSD. In studies of Vietnam veterans, those with strong support systems were less likely to get PTSD than those without social support. People with PTSD re-experience the event again and again in at least one of several ways. They may have frightening dreams and memories of the event, feel as though they are going through the experience again (flashbacks), or become upset during anniversaries of the event. Symptoms

People with PTSD re-experience the event again and again in at least one of several ways. They may have frightening dreams and memories of the event, feel as though they are going through the experience again (flashbacks), or become upset during anniversaries of the event. Symptoms of PTSD fall into three main categories: 1. Repeated "reliving" of the event, which disturbs day-to-day activity Flashback episodes, where the event seems to be happening again and again Recurrent distressing memories of the event Repeated dreams of the event Physical reactions to situations that remind you of the traumatic event 2. Avoidance Emotional "numbing," or feeling as though you dont care about anything Feelings of detachment Inability to remember important aspects of the trauma Lack of interest in normal activities Less expression of moods Staying away from places, people, or objects that remind you of the event Sense of having no future 3. Arousal Difficulty concentrating Exaggerated response to things that startle you Excess awareness (hypervigilance) Irritability or outbursts of anger Sleeping difficulties

You also might feel a sense of guilt about the event (including "survivor guilt"), and the following symptoms, which are typical of anxiety, stress, and tension: Agitation, or excitability Dizziness Fainting

Feeling your heart beat in your chest (palpitations) Fever Headache Paleness

Signs and tests There are no tests that can be done to diagnose PTSD. The diagnosis is made based on a certain set of symptoms that continue after you've had extreme trauma. Your doctor will do psychiatric and physical exams to rule out other illnesses. Treatment

Treatment aims to reduce symptoms by encouraging you to recall the event, express your feelings, and gain some sense of control over the experience. In some cases, expressing grief helps to complete the necessary mourning process. Support groups, where people who have had similar experiences can share their feelings, are helpful. People with PTSD may need to treat depression, alcohol or substance abuse, or related medical conditions before addressing symptoms of PTSD. Behavioral therapy is used to treat avoidance symptoms. This can include being exposed to the object that triggers your symptoms until you become used to it and no longer avoid it (called graded exposure and flooding). Medicines that act on the nervous system can help reduce anxiety and other symptoms of PTSD. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), can be effective in treating PTSD. A number of other medicines used for mental health disorders may be prescribed. A doctor should monitor you if you take these drugs, because they can have side effects. Sedatives can help with sleep disturbance. Anti-anxiety medicines may be useful, but some types, such as benzodiazepines, can be addictive. Support Groups You can find more information about post-traumatic stress disorder and coping with a national tragedy from the American Psychiatric Association -- www.psych.org. Expectations (prognosis) The best outcome, or prognosis, depends on how soon the symptoms develop after the trauma, and on how quickly you get diagnosed and treated. Complications Alcohol abuse Depression, anxiety, and fear of things that are not usually frightening to other people (phobia), may be part of this disorder Drug abuse