Manual for Management of Mass Conversion Disorder

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The International Classification of Diseases (ICD 10, WHO) defines conversion disorder as the partial or complete loss of the normal integration between memories of the past, awareness of identity, immediate sensations and the control of bodily movements. It is often understood as psychogenic non epileptic seizure (PNES). Despite the ascribed psychological causes, physical symptoms are a common manifestation in conversion disorder. These include fainting (non-epileptic seizures), dramatic movements of the limbs, breathing difficulties, possession spells (trance like state) and reduced sensations in body parts (paralysis) as well as headaches and pains in abdomen, chest and limbs. The condition is observed in individuals and groups. Its manifestation in more than one person at a time is called mass conversion disorder. This is mostly observed in adolescent and young adult females with fewer male cases. The interactions of biological, psychological and social factors are often considered as the causes of conversion disorder. Fear of taking examinations, study stress, interpersonal difficulties with friends and family members and traumatic incidents (e.g. physical or sexual abuse) are common precipitating factors.

Health workers should rule out other physical disorders and acknowledge possible underlying mental health problems such as anxiety or depression before diagnosing conversion disorder and the treatment of other physical or mental health problems should be prioritised.

Incidents of mass conversion are being increasingly reported in schools in different parts of Nepal. Psycho-education, group and individual counselling of affected persons and supportive counselling for parents and other relatives and other non-affected people are common treatment approaches. The care and cure of index cases will often settle the symptoms of associated cases. Psychosocial and interpersonal factors should be explored and managed accordingly. Stress reduction techniques such as deep breathing and problem solving exercises also often help.

In Nepal traditional cultural beliefs regarding symptoms and causation often leads people to seek treatment from traditional healers. It is, however, important to respect cultural beliefs and indigenous healing practices although unnecessary and expensive rituals should be discouraged. There is widespread stigma against conversion disorder, and mass conversion symptoms are often erroneously understood as contagious. There is thus the need to raise the awareness of communities about the condition and how to deal with it to reduce misconceptions, superstitious beliefs and improve treatment.

A two days training content on management of mass conversion disorder has been proposed in the annex to help in the design and conduct of training for health workers and school teachers with the help of psychiatrists, clinical psychologists, experienced general psychologists and counsellors.

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