Question 1

How do you distinguish between something like conversion disorder and a physical disorder that has yet to be diagnosed (and is affected by stress)?

Richard Kanaan · Accepted Answer

This is something that many people diagnosed with conversion disorder worry about – that the doctor may have missed the ‘real’ diagnosis, either because they haven’t thought of it or because it hasn’t been discovered yet.  The good news is that recent studies have found that when conversion disorder is diagnosed, it’s rare for that to be proved wrong.  One of the reasons why doctors can be confident they’ve got the diagnosis right is that there are often distinctive features of conversion disorder they can identify.  So, it’s not just that they can’t think of what else it could be; it’s that they have found things about the patient which make conversion disorder far more likely.  There’s a whole range of these distinctive features, but the most helpful are things about a patient’s symptoms which couldn’t be caused by other neurological diseases.

Question 2

Thanks for this topic.  Is there a particular kind of stress that prompts non-epileptic seizures?

Richard Kanaan · Accepted Answer

People with non-epileptic seizures report all different kinds of stressors, and some report no stressors at all.  A review we conducted suggested people with non-epileptic seizures had perhaps suffered more abuse than other kinds of conversion disorder, but this is an area that is difficult to study well, so it’s hard to be sure based on what’s been published.

Question 3

It seems like some patients could get upset about being diagnosed with conversion disorder (i.e. if they disagree with the diagnosis). How do you minimize the likelihood of patients getting upset and/or feeling invalidated with that diagnosis?

Richard Kanaan · Accepted Answer

In my clinics, the diagnosis is made after several hours, seeing several clinicians, and reviewing all of their clinical information.  At the end of that, we are able to explain to the patient how we reached our view, explain what the diagnosis means and answer any questions.  The process can be exhausting, but at the end of it people appreciate, I think, that they and their problems have been taken seriously and examined carefully.  Of course, they may not ultimately agree with the diagnosis, but it would be rare for someone to feel invalidated or get upset.  Not all doctors have the same resources of time, and trying to get the same outcome in a brief appointment is a challenge that colleagues in neurology have been working on.  A key advance has been the focus on showing patients the distinctive features I mentioned in my answer above.

Question 4

How, if at all, is your work related to the recent TikTok tics pediatric neurologists are studying?

Richard Kanaan · Accepted Answer

The reports I have seen of TikTok tics have been diagnosed with functional tics, which is a kind of conversion disorder.  So those cases, at least, are the very same thing – the only unusual aspect being how the disorder was acquired.

Question 5

Hi Professor, I have two questions. 1. If the disorder is a stress response can a person experience multiple biological shut downs simultaneously, e.g., blindness and paralysis. 2. What intervention does the literature support for this disorder?

Richard Kanaan · Accepted Answer

1.	Absolutely.  It’s very common for patients to have a range of symptoms of more than one type.
2.	Sadly, the evidence base for conversion disorder treatments is quite limited compared to other disorders.  There are lots of small studies, but very few studies of the size and scale that we might be inclined to consider definitive.  So, while I think there is broad agreement amongst most people who work with conversion disorder about how it should be treated, it’s hard to say that this is really supported by the literature.

Conversion Disorder