People who are on the narcissistic spectrum (all those suffering from cluster B personality disorders, for example) have received what is referred to as “the narcissistic wound” during childhood. The narcissistic wound refers to a trauma or series of traumas that were inflicted on the child which caused severe damage to the child’s psyche, rendering them unable to regulate or experience their feelings normally. In the pathological narcissist, the wound has occurred when the ability to regulate emotions was just starting to develop, rendering them unable to feel empathy normally for other people and making the conscience ineffective in most situations; the narcissist’s own feelings simply scream over it.
Both systems define the condition similarly and share four key diagnostic requirements (see box 1).Box 1 The four key diagnostic features of conversion disorderNeurological symptoms involving motor or sensory symptoms or loss of consciousnessNo evidence of organic (neurological) disease that can explain the symptomsAssociated psychological stressors (relevant to onset of symptoms)Conscious simulation (feigning) is excludedThe current formal criteria therefore commit to a model that assumes conversion disorder is distinguishable from (organic) neurological disorders, a psychological explanation always being identifiable (and therefore that a positive psychological diagnosis can be made) and that it is different to and distinguishable from feigning. However, there are significant problems with these assumptions both in theory and in practice as we shall discuss. These issues reflect deep uncertainties at the core of our current understanding of the condition.Is conversion disorder distinguishable from neurological disorder?Although history, examination and investigation may exclude other neurological disorders, there are positive signs, both neurological and psychological, which neurologists employ to make the diagnosis of conversion disorder.1 16 Positive neurological signs may be such typical features as a dragging gait in leg weakness, a clenched fist in ‘psychogenic’ dystonia or prolonged seizures with eyes shut in dissociative seizures.
Vipin also stresses the importance of being able to make quick emergency calls. “Often, in a tense situation where a user needs to call rescue services, the traditional method of searching for a contact and dialling can be cumbersome. So we have included a tab in Callzapp that features large, easily accessible buttons with visual cues that can be mapped to services such as police, ambulance etc.