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Conversion disorder is a common and debilitating condition Eric yutzy wife sexual dysfunction remains poorly understood. We present a previously undescribed form of conversion disorder to highlight the complexity of the condition and consider the interplay of factors that produce conversion symptoms.

A year-old male presented with acquired prosopagnosia and language impairment. Neuropsychological testing indicated right temporal lobe dysfunction. Extensive work-up outruled an organic aetiology.

Reactivation Eric yutzy wife sexual dysfunction childhood trauma coincided with the onset of his symptoms. Childhood trauma is known to have adverse effects on the developing brain which may affect an individual's emotional behaviour and coping style.

Functional neuroimaging techniques suggest Eric yutzy wife sexual dysfunction conversion symptoms may be linked to the disruption of higher order neural circuitry involved in the integration of emotional processing and cortical functioning.

Further interdisciplinary studies are required to further elucidate the neurobiological basis for this condition. Conversion disorder is a stigmatised and stigmatising condition that causes significant distress as well as substantial social and occupational disability. However, research is now uncovering the neurophysiological consequences of trauma on the developing brain and the advent of functional neuroimaging techniques has the potential to allow us to explore how changes in neural circuitry may explain the origin of conversion symptoms.

Though this research is in its infancy, our case report demonstrates that a formulation of Eric yutzy wife sexual dysfunction disorder now needs to draw from the fields of neurology, psychiatry, and developmental neuropsychology in order to understand its complex aetiology.

A year-old right-handed male is referred Eric yutzy wife sexual dysfunction a memory clinic with a three-year history of impaired facial recognition and language difficulties. The referring physician was concerned about a potential emerging neurodegenerative process such as Alzheimer's Disease or a temporal variant of Frontotemporal Dementia.

The patient described difficulty registering and recognising faces, including his own and those of his wife and family. The first occasion that he can recall experiencing this was after his son had a hair-cut.

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His wife likened Eric yutzy wife sexual dysfunction to the patient's brother but he was unable to picture him. Things progressed from there. He has walked past his wife repeatedly while looking for her in a supermarket.

He fails to recognise customers in the Eric yutzy wife sexual dysfunction where he Eric yutzy wife sexual dysfunction as manager despite having had significant dealings with them previously. He has difficulty identifying people in photos or recognising famous actors on TV. He uses cues such as voice recognition, tattoos, and an awareness of clothing Eric yutzy wife sexual dysfunction assist him day to day. His wife now wears a specific red coat when out together to make it easier for him to identify her.

He has no trouble recalling semantic information about people once identified. When asked to visualise and describe his wife's face, he correctly described her as having brown hair but was unable to describe any additional distinguishing detail beyond the intellectual awareness that she has two eyes, a nose, and a mouth.

In a similar manner, when looking at himself in the mirror, he describes being aware that he is looking at, and therefore must be seeing, his own face, rather than experiencing a feeling of recognition or familiarity. He also reported word finding difficulties in conversation and a tendency to use an inappropriate but related word inadvertently. There were no other cognitive complaints. Episodic memory, spatial and temporal orientation, navigational ability, and praxis skills Eric yutzy wife sexual dysfunction well preserved according to both subjective and collateral information.

He had no formal psychiatric history but reported long-standing anxiety symptoms. He was otherwise well. Eric yutzy wife sexual dysfunction

Arthur F. Schroeder, MD; Hallie...

He was a nonsmoker and nondrinker. There was no history of seizures, headaches, or head injury. He completed second-level education and subsequently undertook a two-year course in hotel management. His wife described him premorbidly as an anxious personality who was quite rigid in his thinking processes and liked structure Eric yutzy wife sexual dysfunction planning.

She described him as an introvert who always have been prone to periods of withdrawal and quietness though these seemed to be happening more frequently in recent years. A history of childhood sexual abuse was disclosed Eric yutzy wife sexual dysfunction a subsequent meeting. He had left his childhood home in his late teens and spent over 30 Eric yutzy wife sexual dysfunction abroad.

His return to his native country coincided with emerging reports of institutional sexual abuse which were receiving widespread media coverage at the time. In retrospect, this was also the period when the first cognitive symptoms were noted by the patient. Assessment at the memory Eric yutzy wife sexual dysfunction included geriatric, neurologic, psychiatric, and specialist nursing review Eric yutzy wife sexual dysfunction well as in-depth neuropsychological evaluation. Physical examination, including testing of vision, was normal.

A full panel of blood showed elevated cholesterol only. Neuropsychological Eric yutzy wife sexual dysfunction demonstrated objective evidence of a relatively isolated prosopagnosia. Only four were correctly identified by our patient. A qualitative interpretation of this test provides additional helpful information. For example, our patient was able to appreciate that there were differences between Eric yutzy wife sexual dysfunction faces but he seemed to struggle to link those differences to a memory of having seen those faces before.

Another interesting observation was his use of nonfacial details to assist him. Similarly, a photo of Humphrey Bogart with his hat tilted at a jaunty angle was tentatively proposed to be a member of the Rat Pack.

1. Introduction

By contrast, Muhammad Ali triggered a feeling of recognition in our patient but it took a significant length of time during which three Eric yutzy wife sexual dysfunction photos were discussed before he was correctly identified. In addition to poor performance on face recognition tests, his performance on Eric yutzy wife sexual dysfunction Trail Making Test and F-A-S test was also impaired.

General memory functioning was preserved and there was no evidence of a general object agnosia as shown by perfect scores on the Word Picture Match and Pyramids and Palm Trees tests. The patient was noted to engage well and apply effort throughout and was aware of and frustrated by his failures. Though his answers were short, he was articulate with no evidence of agrammatism or hesitancy in conversation. Results of neuropsychological evaluation at memory clinic assessments 1 and 2 month interval between visits.

Lumbar puncture for cerebrospinal fluid CSF biomarker analysis was negative for an Alzheimer's signature. On the basis of these results, we concluded that there was no evidence of a structural or neurodegenerative cause for his symptoms.

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The patient was open to considering a potential psychological basis for his complaints and agreed to a referral for psychotherapeutic evaluation. When seen at the memory clinic for follow-up 18 months later, the patient reported no change in his symptoms, with persisting difficulty with face recognition and word finding problems. He continues to greet his wife as a customer when she visits him at work.

The nonspecific muscular pain and anxiety symptoms had improved, however, on low dose amitriptyline. He had begun a programme of trauma-focussed counselling under the care of his community psychiatric Eric yutzy wife sexual dysfunction. As their work progressed, it emerged that he can recollect in clear and vivid detail the face of his abuser.

We hypothesise that this case represents an unusual form of conversion disorder. Conversion disorder commonly presents with a loss of motor or sensory function, for example, limb paralysis or blindness. However, our patient's symptoms of prosopagnosia and a specific language impairment are more unusual in that Eric yutzy wife sexual dysfunction are relatively discreet deficits which indicate dysfunction of two apparently distinct systems: At the neurobiological level, however, both are localisable to dysfunction of the right temporal lobe, suggesting a plausible Eric yutzy wife sexual dysfunction for a causative insult.

As far as we can determine, an organic pathology has been outruled and we propose, therefore, a psychological basis for these symptoms which we believe have arisen as a result Eric yutzy wife sexual dysfunction a conversion-type reaction. To the best of our knowledge, this is the first such reported case of a conversion disorder presenting in this way.

We suggest that it serves to highlight the degree to which abnormal emotional processing can influence and disrupt the functioning of precise brain networks.

Conversion disorder is a syndrome of neurological symptoms of nonorganic origin often arising in the context of emotional Eric yutzy wife sexual dysfunction. The aetiology is poorly understood. The association of conversion disorder with trauma has long been recognised, though it is notable that reference to a psychological basis for symptoms has been removed from the criteria for conversion disorder in Diagnostic and Statistical Manual, Fifth Edition DSM-5 [ 2 ].

The substantial overlap in symptomatology between the three conditions, however, is now a source of renewed interest. Our patient, too, described somatic symptoms in the form of vague aches and pains which were under investigation for a possible diagnosis of fibromyalgia. Unfortunately, we did not consider applying scales such as the Somatoform Dissociation Questionnaire SDQ [ Eric yutzy wife sexual dysfunction ] and the Dissociative Experiences Scale DES [ 13 ] which have been developed to objectively measure somatoform and psychoform dissociation.

When applied to groups with conversion disorder, dissociative disorder, and somatisation disorder, they demonstrate the interplay of symptoms among the three conditions. Conversion disorder emerges as particularly closely affiliated with Eric yutzy wife sexual dysfunction disorder, providing support for the ICD classification of conversion disorder among the dissociative disorders [ 314 ].

Systematic assessment of psychiatric patients for dissociative disorders has shown that these conditions are far more prevalent Eric yutzy wife sexual dysfunction is routinely identified with significantly higher rates of childhood trauma seen than among those who do not endorse dissociative symptoms [ 1516 ]. A precise neurobiological explanation for conversion disorder remains elusive though Eric yutzy wife sexual dysfunction is known that early life stress can result in maladaptive alterations to brain circuitry and neurochemistry.

Preliminary evidence indicates that basal cortisol levels are elevated among individuals who experience psychogenic nonepileptic seizures PNES and this seems to correlate with levels of childhood abuse [ 17 ].

The prefrontal cortex, an area important for self-regulatory and goal-directed behaviours, appears particularly vulnerable to the effects of Eric yutzy wife sexual dysfunction changes of the hypothalamic-pituitary-adrenal HPA axis [ 18 ].

Certain aspects of our patient's personality and coping style would certainly fit with this hypothesis, though it fails to explain the late onset of distinct cognitive symptoms. A recent review describes the outcomes of studies using functional neuroimaging to characterise the brain areas considered pertinent Eric yutzy wife sexual dysfunction the generation of conversion symptoms [ 19 ].

Importantly, results differed between those with conversion disorder, those feigning symptoms, and healthy controls. Disruption to the regulating processes of the Eric yutzy wife sexual dysfunction order frontal networks was a common finding in those with conversion symptoms. The small number of studies which considered nonmotor conversion disorder showed that, in general, functional MRI activity was reduced in primary sensory areas but increased in other areas such as the frontal cortices and subcortical nuclei, areas which are important for emotional processing, regulation, and response as well as the integration of information across brain domains.

Our patient is notable in Eric yutzy wife sexual dysfunction his two presenting complaints—impairment of face recognition and language—point to dysfunction of a relatively precise neuroanatomical area. Though face recognition and identification requires the integration of information from an extended network that includes the orbitofrontal cortex, inferior frontal gyrus, posterior cingulate, and inferior occipital gyri, acquired prosopagnosia may be localised to disruption of the fusiform face area temporal lobe and the superior temporal sulcus [ 20 ].

The temporal lobes are central, also, to language, though the neuroanatomical area responsible for language generation and comprehension is also diffuse. Impairment of the F-A-S test indicates a more anterior, executive-type deficit as does impaired performance Eric yutzy wife sexual dysfunction the Trail Making Test.

While face processing is Eric yutzy wife sexual dysfunction active in the right hemisphere and word processing more so in the left, both show bilateral networks that overlap and there are some small studies to suggest that prosopagnosics may have impairments of word processing, though results are inconsistent and difficult to interpret [ 21 ]. Given the intimacy of neural connectivity in this region, however, it is not implausible to consider that a relatively subtle insult may impact on multiple cognitive functions.

We propose that the degree of repressed trauma that surfaced resulted in dysregulation of his Eric yutzy wife sexual dysfunction order frontal and subcortical emotional processing systems and their integration with the functioning of his right temporal lobe. The Structural Theory of Dissociation conceptualises this elegantly from a developmental psychology perspective.

It sets out how childhood trauma compromises the successful integration of the varying parts of the developing self with consequences for adult behaviours and psychosocial interactions [ Eric yutzy wife sexual dysfunction23 ]. Dissociation in this context may be simultaneously regarded as both a defence mechanism, in that it allows attention to the matters of everyday life, and a deficit, in that these disparate parts fail to integrate into a cohesively functioning personality.

In the case of our patient, who fled childhood institutional abuse and disrupted attachments, the apparently normal part permitted successful Eric yutzy wife sexual dysfunction attainment, occupational functioning, and a happy marital and family life while the emotional part was the source of the memory of the perpetrator, guilt, shame, stress, and defence against threat. Factors that are thought to indicate a better prognosis in conversion disorder are an acceptance of a psychological aetiology, sudden onset and short duration of symptoms, an identifiable emotional stressor, no ongoing litigation, good premorbid functioning, and no comorbid psychiatric illness [ 26 ].

Women abused only as children did not differ from women who reported undercurrent, but not infancy, abuse in calculate of physical symptoms, emotional distress, gravamen abuse, or suicide attempts.

Patients who reported both boyhood and adult pervert had higher levels of psychological quandarys and physical symptoms than those who reported childhood or adult abuse unescorted.

Schroeder, MD ; Hallie K. Derogatis, PhD ; Eric B. Sign in to access your subscriptions Sign in to your in person account. Create a free personal tab to download not busy article PDFs, dispose of up for alerts, and more.

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Conversion disorder is a overused and debilitating condition that remains poorly understood. We present a previously undescribed form of conversion upheaval to highlight the complication of the condition and consider the interplay of factors that produce conversion symptoms.

A year-old masculine presented with acquired prosopagnosia and language impairment. Neuropsychological testing indicated right worldly lobe dysfunction. Extensive work-up outruled an organic aetiology. Reactivation of childhood trauma coincided with the strike of his symptoms.

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