I am a 51-year-old woman with no family history of epilepsy. Nine months ago, I started experiencing seizure activity. Test results (EEG, MRI, CT scan, etc.) were normal. The day of my first seizure, I was hospitalized (three days) and placed on anticonvulsants. I am still experiencing seizure activity. I am also on antidepressants since being diagnosed with major depression about six years ago. Because my test results were normal, my neurologist basically threw his arms up in the air and referred me to my psychiatrist! Now I have the diagnosis of "conversion disorder." Is this a psychiatric or medical diagnosis? I am asking for two reasons: 1) If it's psychiatric, it is not covered by my insurance and, on a personal level, (2) am I that mentally ill?

M.N.

Conversion disorder is indeed a psychiatric diagnosis and is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (or "DSM-IV"), the bible of psychiatric diagnosis, under the category of "Somatoform Disorders." Somatoform disorders are conditions in which a person has significantly disturbing physical symptoms that suggest a medical condition ("soma" refers to the body), but those symptoms are not fully explained by a medical condition, the effects of chemical substances such as drugs or alcohol, or by another psychiatric disorder.

Conversion disorder is characterized by symptoms or problems affecting voluntary motor or sensory functions that suggest a neurological or other medical disorder. The "conversion" in the name refers to the hypothesis that the person's physical symptom (paralysis, weakness, seizures, blindness, or the like) represents a symbolic resolution of an unconscious psychological conflict -- that is, a psychological conflict is converted into a somatic, or physical, symptom. The nature of the conflict and the resulting anxiety are dissociated from awareness. The person is NOT thought to be intentionally faking the physical symptoms.

Of course, to definitively diagnose conversion disorder one must be absolutely certain that there is no neurological or medical condition that has escaped detection. However, further complicating the issue is that some individuals can have both a true neurological or medical condition AND a conversion disorder.

Conversion disorder is best treated by psychotherapy. I don't know why your insurance company might not cover such treatment, unless it provides little or no mental health coverage, or emphasizes drug treatment over psychological treatment. I'm also curious why you were apparently unable to discuss your questions with your psychiatrist. If he or she provides only medication management rather than true psychotherapy (which is often the case these days), I'd recommend that you see a psychologist or other therapist with whom you can fully discuss your situation, the possible diagnoses and treatment, and your options.

I'd also consider getting a referral from your neurologist or psychiatrist for a full neuropsychological and personality testing battery if one hasn't been done already. Such evaluations can be done by many psychologists and might help in determining whether you truly have a conversion disorder or any other psychiatric condition, or a perhaps as yet undiagnosed neurological condition.