unexplainable coma. Dissociative symptoms can happen in the beginning but these aren’t the part of the DSM-V diagnosis. The patient may act as if they aren’t concerned about the symptoms, even when they are debilitating. Stress usually precipitates the attack but not necessarily. Mental health issues such as anxiety, depression, and childhood sexual abuse/PTSD are common. Typical comorbidities include eating disorders, anxiety disorders, panic disorder, personality disorders, and depression. The patient may also have other somatic disorders. Not usually seen as comorbidities are substance use disorders and psychosis. Different cultures throughout the world will have different main manifestations of this disorder. The reasons for the cultural differences in conversion symptoms are not known. In all cultures, however, it does follow a stressful experience. Treatment of conversion disorder involve several different providers, including psychologists, psychiatrists, and rehabilitation specialists. Comorbidities have to be treated. The patient may resist a psychiatric diagnosis at first but must eventually accept it if they are to improve. Psychodynamic and cognitive behavioral therapy can help overcome the symptoms with psychoanalysis helpful in about 70 percent of cases. Hypnosis is controversial but can also help resolve the symptoms. Post-hypnotic suggestions can be given with an 80 percent success rate.
PSYCHOLOGICAL FACTORS AFFECTING OTHER MEDICAL CONDITIONS (316) This is the diagnosis when the patient has a preexisting medical condition and has behavioral and/or psychological factors that negatively impact the outcome of the disorder. The patient generally has an identifiable medical illness and will do things that overtly or covertly make it worse. The patient may make it worse or may stop their recovery efforts, affect adversely the treatment of the condition, exhibit unhealthy behaviors, or may not do what the doctor tells them to do. The problem is not explained by another mental disorder. The disease can be mild, moderate, severe, or extreme, depending on the risk to the patient. Mild disease will increase the medical risk by noncompliance. Moderate disease will adversely 142
