Conversion disorder is one of the psychopathologies that best illustrates the bidirectional relationship between mental health and physical health The term ‘conversion’ refers to the transformation of a psychological discomfort into a physical alteration The physical symptoms are not caused consciously or They are not voluntary nor are they faked to avoid obligations or be the center of attention. Conversion disorder is one of the most illustrative examples of this bidirectional and complex relationship that exists between mental health and physical health, between mind and body. In line with the World Health Organization’s definition of health as “a state of physical, mental, and social well-being”, more and more experts prefer not to make this distinction between physical and mental health. Mental and physical health are related because each of them generates and influences the human being to a greater or lesser extent. Thus, a healthy mind makes the body work better, and a healthy body generates emotional well-being, which is the basis for good mental health. Seen in this way, everything seems very coherent and makes sense: but the reality is that in general, among Many people are reluctant to accept that a physical pain or a physiological symptom has a psychological rather than organic origin. Socially, physical weakness is better seen than psychological weakness: as if the physical does not depend on our will and the psychological does. This resistance makes many people spend years of their life as a specialist looking for an organic explanation for their illness before going to a psychologist or psychiatrist. The body manifests psychological discomfortIn the article A case of conversion disorder analyzed from the perspective of the hospital interconsultation Luis Javier Sanz Rodríguez and Begoña Torres López explain the case of a 62-year-old patient who, during her hospital admission for an acute coronary problem, suffered an episode of hemiparesis (weakness) on the left side of her body. After carrying out numerous tests, they ruled out any organic origin of her problem. The patient, the article explains, was very reluctant to accept that the weakness she suffered on the left side of her body had a psychological origin. However, after evaluation consultations in the hospital’s mental health unit, the patient was able to take aware of your problem. The fact of being hospitalized for a coronary issue made her feel tremendously guilty: unconsciously she, this woman, she felt that she was failing her family. That emotional discomfort, that internal conflict, in a person like her, very little given to expressing her emotions, became a physical symptom. Her body manifested through a hemiparesis that great psychological discomfort. Conversion disorder is the maximum expression of this complex and bidirectional relationship between mind and body. Another example is that of the parents of Antonio, a 14-year-old adolescent who was going through an emotionally delicate situation after the death in an accident of one of his best friends. These parents were reassured when they were told that their son’s paralysis in his right arm was not due to any neurological failure, but rather a conversion disorder. They remained very calm, but they did not understand what was happening to their son and the reason for this paralysis. They believed that Antonio was inventing that paralysis to get his attention. It took several visits to the mental health service for Antonio’s parents to understand that the fact that there was no physically detectable neurological anomaly did not mean that his son was ‘inventing’ that symptom. As the experts explain, people who suffer from this condition suffer from real anguish, they do not fake the symptoms, so it is not advisable to tell them that common phrase of “what happens to you is not real, it is only in your head”. We see, conversion disorder is the maximum expression of this complex and bidirectional relationship between mind and body. The term conversion is used to refer to the ability of a certain patient to involuntarily transform or convert a psychological disturbance into a physical disturbance or difficulty. Conversion disorder is a type of somatoform disorder, according to the international classification of diseases (ICD-10) of the WHO. Somatoform disorders should not be confused with psychosomatic disorders, in which, although they are also psychological in origin, there is detectable involvement at an organic level, as we explained in this NIUS article. What is a conversion disorder Conversion disorder refers to to a set of symptoms that have the form of a neurological condition and that interfere with the patient’s behavior but that do not correspond to any diagnosed physical alteration or can be justified by any other disease. The main characteristic of this disorder is the appearance of these symptoms or difficulties at the motor and/or sensory level involuntarily but associated with psychological factors or alterations; that is, to diagnose this conversion disorder there must be an emotionally complex episode in the patient’s life close in time. In fact, there is usually a clear temporal relationship between the stressful event the patient faced and the onset of conversion symptoms. The main symptoms of a conversion disorder are the following: Motor symptoms: Lack of coordination and balance, paralysis and localized muscle weakness, tremor, hoarseness, difficulty swallowing, sensation of a lump in the throat, urinary retention and seizures. Sensory symptoms: Sensation of anesthesia or analgesia, double vision, blindness, blurred vision, tunnel vision, deafness, loss of smell and taste, and hallucinations. In order to make the most accurate diagnosis possible, the patient must present the following diagnostic criteria included in the Diagnostic and Statistical Manual of Mental Disorders (DSM): Presence of one or more difficulties that interfere with the motor or sensory functions that suggest the presence of a neurological or medical disorder. Existence of previous events, experiences or conflicts that may be associated with the symptomatology. These symptoms are not consciously or voluntarily provoked as in factitious disorder, in which the person consciously fakes the symptoms to avoid obligations or be the center of attention. The symptoms are not justified by the presence of another alteration or medical condition, or by the consumption of substances. The symptoms cause a clinically significant, interfering in the different areas of the patient’s daily life and needing medical attention. The set of symptoms is not rest It leads to pain or deficits in sexual function, it does not appear during a somatization disorder and it is not due to the appearance of another sexual disorder. La belle indifference Another of the most characteristic and peculiar symptoms of conversion disorder is the so-called belle indifference: the little concern that the patient feels about the symptoms they are experiencing despite the fact that these can be very striking what is happening to him However, this does not usually happen in patients with conversion disorder, who are usually unaltered or indifferent to their problem. This reaction is so common that belle indifference is considered one more symptom of conversion disorder, although the reason for this reaction is still unknown. As we said, conversion disorder always appears associated with a stressful event, which is also very close in time to the onset of symptoms. The remission of these symptoms usually occurs spontaneously in a few days, when the stressful event disappears or ceases to be so present in the patient’s life; either because the stressor disappears or because the person has learned to manage it with psychotherapy. If the person faces a stressor again, but has not learned to relate to it in a less emotionally damaging way, the most normal thing is that the symptoms reappear ; so we would speak of a chronic disorder. The psychological explanation for conversion Psychology explains the existence of conversion disorder by one of these two mechanisms: primary gain or secondary gain. Primary gain means that the person suffering from this disorder obtains unconsciously some benefit in return, for example, keeping a conflict or worry out of your awareness. Primary gain is frequently associated with traumatic experiences, stress, or sexual and physical abuse. In fact, on many occasions, the symptoms that appear are related in a surprisingly direct way to the problem to which they were exposed. For example, pain can be felt in the same part of the body that another person was seriously injured in a traumatic accident that the patient witnessed. Secondary gain means that the person, also unconsciously, can obtain reinforcement with his problem, such as for example, avoiding an activity that is harmful to him or her or getting the support and attention of others, which otherwise would not be possible. This gain could be that of Antonio who, secondarily, with his paralysis would be unconsciously looking for the space and time (missing school, leaving his daily activities) necessary to be able to mourn the death of his friend. In any of the two types of gain, conversion disorder tells us about this complex and bidirectional relationship between mind and body and the need to understand ourselves as complete beings where there is no distinction between physical and mental health; where health is always one.