Conversion Disorder and Autonomic Nervous System Dysfunction

Q: Conversion Disorder and Autonomic Nervous System Dysfunction

Hello： Conversion disorder often involves deep-seated psychological trauma or stress, which may originate from childhood, and typically presents with more dramatic neurological symptoms such as hemiplegia or inability to speak, rather than pain. <br>Autonomic dysregulation can ma

What is conversion disorder? Is it considered a type of autonomic nervous system dysfunction?

Hello, doctor.
I have been experiencing chronic pain for nearly two years, and the pain intensity is quite high.
I have consulted various specialties and undergone numerous tests, but most results have been normal.
There was one instance where I was hospitalized due to severe discomfort accompanied by some neurological symptoms, and the physician suspected a rare disease.
However, after discharge, I still had no clear diagnosis.
Some neurological examinations revealed slight muscle weakness, but the physician deemed it not significant.
Consequently, a neurologist suggested that I might have conversion disorder.
I later consulted a psychiatrist, who prescribed some sedatives and anticonvulsants for chronic pain management, but the effects were minimal, and my pain has not improved.
Currently, I am gradually needing higher doses of pain medication due to tolerance issues, which has raised concerns about potential addiction.
I would like to ask if autonomic nervous system dysregulation or conversion disorder could lead to this situation.
Note: I am currently using tramadol for pain relief, and during severe episodes, I even resort to morphine.

Wei Ni, 10~19 year old female. Ask Date: 2022/05/23

Dr. Cai Qijin reply Psychiatry

Hello: Conversion disorder often involves deep-seated psychological trauma or stress, which may originate from childhood, and typically presents with more dramatic neurological symptoms such as hemiplegia or inability to speak, rather than pain.
Autonomic dysregulation can manifest with various autonomic symptoms, such as palpitations, chest tightness, tremors, and sweating, and may be accompanied by pain.
Based on the situation you described, fibromyalgia syndrome should be considered.
You may want to seek evaluation from a psychiatrist or neurologist.

Reply Date: 2022/05/23

More Info

Understanding Conversion Disorder and Autonomic Nervous System Dysfunction
Conversion disorder, also known as functional neurological symptom disorder, is a condition where psychological distress manifests as physical symptoms that cannot be explained by medical or neurological conditions. It often occurs in response to stress or trauma and can present with a variety of symptoms, including paralysis, tremors, or chronic pain, as seen in your case. The symptoms are real and can significantly impact a person's quality of life, but they do not have a clear organic cause.

In your situation, the chronic pain you've experienced for nearly two years, despite numerous medical evaluations yielding normal results, raises the possibility of conversion disorder. This condition can sometimes be misdiagnosed, especially when the symptoms are primarily physical, as in your case with high levels of pain. The muscle weakness noted during neurological examinations, while not deemed significant by your doctors, could also be a manifestation of this disorder.

Autonomic nervous system dysfunction, on the other hand, refers to a malfunction of the autonomic nervous system, which controls involuntary bodily functions such as heart rate, blood pressure, and digestion. Symptoms can include palpitations, dizziness, and gastrointestinal issues, and it can coexist with conversion disorder. The stress and anxiety associated with chronic pain can exacerbate autonomic dysfunction, leading to a cycle of worsening symptoms.

The medications you've been prescribed, including sedatives and anticonvulsants for pain management, may not have provided the relief you hoped for. This lack of efficacy can be frustrating and may lead to increased dosages, raising concerns about tolerance and potential addiction, especially with opioids like tramadol and morphine. It's crucial to approach pain management holistically, considering both physical and psychological aspects.

Chronic pain can lead to changes in the brain's pain pathways, making it more challenging to treat. Psychological therapies, such as cognitive-behavioral therapy (CBT), can be beneficial in addressing the underlying stressors contributing to your pain and improving coping strategies. Additionally, physical therapy may help in managing symptoms and improving function.

It's essential to have open communication with your healthcare providers about your concerns regarding medication dependency and the effectiveness of your current treatment plan. A multidisciplinary approach involving neurologists, psychiatrists, and pain specialists may provide a more comprehensive strategy for managing your symptoms.

In summary, both conversion disorder and autonomic nervous system dysfunction can contribute to the chronic pain and other symptoms you are experiencing. Addressing these conditions requires a multifaceted approach that includes medical treatment, psychological support, and lifestyle modifications. If you feel your current treatment is not addressing your needs, consider seeking a second opinion or discussing alternative therapies with your healthcare team.

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