Abnormal Psychology

Dissociative and Somatoform Disorders 361

people are present; patients don’t hurt their heads, bite their tongues, or urinate,

as during true seizures.

Anna O. had both motor conversion symptoms (paralysis of her neck, arm, and

legs) and sensory conversion symptoms (problems with vision, a lack of sensation in

her elbows). Breuer did not report any seizure-like symptoms.

In conversion disorder, muscle symptoms do not correspond to what would be

produced by the relevant nerve pathways, but rather they arise from the patients’

perception of what would happen if certain nerve pathways were disrupted. Thus,

a patient may not be able to write but can scratch an itch, which would be impos-

sible with true paralysis of the hand muscles. Similarly, when the sensory symptom

of blindness occurs in conversion disorder, medical tests reveal that all parts of the

visual system function normally. This was true for Mary, described in Case 8.6.

Figure 8.4g4

(a) (b)

8.4 • Conversion Disorder: Glove

Anesthesia Patients suffering from

conversion disorder have sensory or motor

symptoms that at fi rst may appear to be

neurological but on further investigation do

not correspond to true neurological damage.

One example is glove anesthesia, in which the

person reports that his or her hand—and only

the hand—has no sensation, as shown in (a).

However, the neural pathways that would create

such an anesthesia in the hand would also

create a lack of sensation in the arm (b); the

color-coded regions show the areas served by

different nerves. Thus, conversion disorder may

be the appropriate diagnosis when a patient

reports glove anesthesia in the absence of

anesthesia of the arm.

CASE 8.6 • FROM THE INSIDE: Conversion Disorder

On graduating from high school, Mary decided to enter a convent and by the age of twenty-

one had taken her vows of poverty, chastity, and obedience. This came as a shock to her family

who, although they were practicing Catholics, had been far from religious. “I had a great need

to help people and do something spiritual and good,” Mary recalls....

For the fi rst decade she enjoyed the sense of community and the studious aspect of convent

life.... But as time went on she became disenchanted with the church, which she felt was “out

of touch with real people.... The church required blind obedience and no disagreement.”

Mary began feeling nervous and anxious. She was rarely sick, but one day [when she was

36 years old] developed soreness in the back of her eye. Every time she moved it, she’d feel

pins and needles.... By the fourth day she couldn’t see out of one eye. A neurologist said it

was optic neuritis, a diagnosis of nerve infl ammation of unknown origin. She was hospital-

ized and given cortisone, but her sight didn’t improve.

... Mary took a leave of absence and spent the good part of a year at a less stressful con-
vent in the countryside. She began meeting regularly with a psychologist.... “I discovered
I was a perfectionist, overworking to avoid my growing doubts.”... Her eyesight gradually
came back, and shortly after that she left the church.
... “During that period in my life I was undergoing deep psychological trauma. I was so
unhappy, and I literally didn’t want to see,” she says. “I believed then, as I do today, that the
body was telling me something, and I had to listen to it.”
(Cantor, 1996, pp. 57–58)