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The diagnostic difficulty is not that conversion symptoms suggest neurological disease, but that symptoms of neurological disease are often misdiagnosed as CD; thus the differential diagnosis is very important and can be tricky.
From a strictly anatomical standpoint, conversion symptoms fail to respond to known patterns of nerve distribution or function.
This is supported by the fact that when unilateral, conversion symptoms are more frequently manifested on the left side of the body versus the right side.[2,3,10,16]
Due to findings such as these, many clinicians now feel that conversion symptoms that present as paresthesias on the left side of the body should be assumed to be neuropathologic despite paresthesias which may not correlate with normal neuroanatomical boundaries; these may be underlying neurophysiological changes in process.
This explanation stands in contrast to that offered in relation to the development of conversion symptoms, in which psychic stimulation occurring as a result of internal conflict is repressed and after being ejected from the mind is expressed as an organic symptom (Freud, 1894).
The genesis of somatic symptoms is also not linked to particular causal trauma as is the case with conversion symptoms. It is likely that this is because the origin of somatic symptoms is now understood to be a sustained, continuous set of experiences that result in arrested emotional development (Fonagy, Gergley, Jurist and Target, 2004; Mitrani, 1993).
It would thus seem that conversion symptoms demonstrate a problem in the preconscious layer of thought, or at Luquet's metaprimary or metaconscious and intuitive layers of thought (Bouchard and Lecours, 2004).
Psychic energy blocked by repressed and unfulfilled desires gains expression in various physical channels resulting in conversion symptoms. With the appearance of physical symptoms, the anxiety produced by unconscious and unacceptable wishes is expressed symbolically and is, therefore, reduced.
Conversion symptoms do not merely function as a way of relieving anxiety, rather, as an escape from the social consequences of being in a conflicting situation.
Eigen values and screen plot identified four meaningful factors: conversion symptoms, physical pain symptoms, hypochondriacal symptoms, and body dysmorphic symptoms.