Conversion Disorder

Background

• Conversion disorder (also called functional neurological symptom disorder) is characterized by at least 1 symptom of altered voluntary motor or sensory function for at least 6 months with clinical findings that are incompatible with recognized neurological or medical conditions.
• The exact prevalence of conversion disorder is unknown but it is estimated to be 2-22 per 100,000 persons annually in United States and affects up to 20% of patients in neurological and psychiatric settings. Estimates vary based on the population under study, differences in reporting, and how the diagnosis was established.
• Risk factors, such as, psychiatric conditions, psychological stressors, and traumatic life events may predispose, precipitate, or perpetuate conversion symptoms.
• Conversion disorder may result in substantial disability and poor quality of life, as functional motor symptoms often remain unchanged or worsen over time.

Evaluation

• Suspect conversion disorder in patients with functional neurological symptoms (such as, weakness, paralysis, difficulty swallowing, unusual speech, numbness, or sensory problems) that are unexplained and incompatible with recognized neurological or medical conditions.
• Diagnosis is based on clinical presentation, history (including identification of risk factors), and neurological exam.
• Use Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) criteria.
• Other testing may be needed to identify or rule out psychiatric or medical conditions that may be causing functional neurological symptoms.
• In patients with clinical seizure patterns associated with psychogenic nonepileptic seizures, see Psychogenic Nonepileptic Seizures for additional information.
• Standardized psychiatric and psychometric assessments may be useful to evaluate for potentially perpetuating factors.

Management

• There is no well-established management for conversion disorder. Reported approaches include inpatient multidisciplinary treatment, cognitive behavioral therapy (CBT), hypnotherapy, or combination of CBT, hypnotherapy, and physical therapy.
• Treatment should not be delayed, as a longer duration of symptoms can negatively affect outcomes.
• Patient engagement in the therapeutic relationship may be challenging for those who do not recognize the potential link between psychological factors and neurofunctional symptoms, especially if a patient believes that the clinician does not view their symptoms as real. See strategies for presenting the diagnosis.
• For patients with symptoms of psychogenic nonepileptic seizure, see Psychogenic Nonepileptic Seizures.
• Treatment of comorbid psychiatric conditions (such as, anxiety, depression, posttraumatic stress disorder, somatic symptom disorder [hypochondriasis], and others) may assist patient recovery. Use clinical judgment to determine appropriate use of medications, such as, antidepressants and anxiolytics.