Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Conversion disorder in adults: Clinical features, assessment, and comorbidity

Jon Stone, FRCP, PhD
Michael Sharpe, MD
Section Editor
Joel Dimsdale, MD
Deputy Editor
David Solomon, MD


Conversion disorder (functional neurologic symptom disorder) is characterized by neurologic symptoms (eg, weakness, abnormal movements, or nonepileptic seizures) that are inconsistent with a neurologic disease, but cause distress, and/or impairment [1]. The disorder is common in clinical settings and often has a poor prognosis [2-5].  

This topic reviews the clinical features, assessment, and comorbidity of conversion disorder. The terminology, diagnosis, differential diagnosis, epidemiology, pathogenesis, prognosis, and treatment are discussed separately, as are conversion disorder with attacks or seizures (functional or psychogenic nonepileptic seizures) and conversion disorder with abnormal movements (functional or psychogenic movement disorders):

(See "Conversion disorder in adults: Terminology, diagnosis, and differential diagnosis".)

(See "Conversion disorder in adults: Epidemiology, pathogenesis, and prognosis".)

(See "Conversion disorder in adults: Treatment".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 20, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  2. Stone J, Carson A, Duncan R, et al. Who is referred to neurology clinics?--the diagnoses made in 3781 new patients. Clin Neurol Neurosurg 2010; 112:747.
  3. Carson A, Stone J, Hibberd C, et al. Disability, distress and unemployment in neurology outpatients with symptoms 'unexplained by organic disease'. J Neurol Neurosurg Psychiatry 2011; 82:810.
  4. Gelauff J, Stone J, Edwards M, Carson A. The prognosis of functional (psychogenic) motor symptoms: a systematic review. J Neurol Neurosurg Psychiatry 2014; 85:220.
  5. Durrant J, Rickards H, Cavanna AE. Prognosis and outcome predictors in psychogenic nonepileptic seizures. Epilepsy Res Treat 2011; 2011:274736.
  6. Rosebush PI, Mazurek MF. Treatment of conversion disorder in the 21st century: have we moved beyond the couch? Curr Treat Options Neurol 2011; 13:255.
  7. Stone J, Vuilleumier P, Friedman JH. Conversion disorder: separating "how" from "why". Neurology 2010; 74:190.
  8. Abbey SE, Wulsin L, Levenson JL. Somatization and somatoform disorders. In: The American Psychiatric Publishing Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill, Second Edition, Levenson JL (Ed), American Psychiatric Publishing, Inc., Washington, DC 2011. p.261.
  9. Stone J, Reuber M, Carson A. Functional symptoms in neurology: mimics and chameleons. Pract Neurol 2013; 13:104.
  10. Stone J, Carson A, Duncan R, et al. Which neurological diseases are most likely to be associated with "symptoms unexplained by organic disease". J Neurol 2012; 259:33.
  11. Stonnington CM, Barry JJ, Fisher RS. Conversion disorder. Am J Psychiatry 2006; 163:1510.
  12. Stone J, Carson A, Sharpe M. Functional symptoms and signs in neurology: assessment and diagnosis. J Neurol Neurosurg Psychiatry 2005; 76 Suppl 1:i2.
  13. Stone J. The bare essentials: Functional symptoms in neurology. Pract Neurol 2009; 9:179.
  14. Crimlisk HL, Bhatia K, Cope H, et al. Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms. BMJ 1998; 316:582.
  15. Roelofs K, Spinhoven P, Sandijck P, et al. The impact of early trauma and recent life-events on symptom severity in patients with conversion disorder. J Nerv Ment Dis 2005; 193:508.
  16. Sharpe M, Walker J, Williams C, et al. Guided self-help for functional (psychogenic) symptoms: a randomized controlled efficacy trial. Neurology 2011; 77:564.
  17. Binzer M, Andersen PM, Kullgren G. Clinical characteristics of patients with motor disability due to conversion disorder: a prospective control group study. J Neurol Neurosurg Psychiatry 1997; 63:83.
  18. Stone J, Carson A, Sharpe M. Functional symptoms in neurology: management. J Neurol Neurosurg Psychiatry 2005; 76 Suppl 1:i13.
  19. Stone J, Sharpe M, Rothwell PM, Warlow CP. The 12 year prognosis of unilateral functional weakness and sensory disturbance. J Neurol Neurosurg Psychiatry 2003; 74:591.
  20. Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. Brain 2010; 133:1537.
  21. Stone J, Carson A, Aditya H, et al. The role of physical injury in motor and sensory conversion symptoms: a systematic and narrative review. J Psychosom Res 2009; 66:383.
  22. van Rooijen DE, Geraedts EJ, Marinus J, et al. Peripheral trauma and movement disorders: a systematic review of reported cases. J Neurol Neurosurg Psychiatry 2011; 82:892.
  23. Stone J, Warlow C, Sharpe M. Functional weakness: clues to mechanism from the nature of onset. J Neurol Neurosurg Psychiatry 2012; 83:67.
  24. Reuber M, Enright SM, Goulding PJ. Postoperative pseudostatus: not everything that shakes is epilepsy. Anaesthesia 2000; 55:74.
  25. Brown RJ, Cardeña E, Nijenhuis E, et al. Should conversion disorder be reclassified as a dissociative disorder in DSM V? Psychosomatics 2007; 48:369.
  26. Stone J, Binzer M, Sharpe M. Illness beliefs and locus of control: a comparison of patients with pseudoseizures and epilepsy. J Psychosom Res 2004; 57:541.
  27. Stamelou M, Cossu G, Edwards MJ, et al. Familial psychogenic movement disorders. Mov Disord 2013; 28:1295.
  28. Carson AJ, Zeman A, Stone J, Sharpe MC. Neurology and neurosurgery. In: The American Psychiatric Publishing Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill, Second Edition, Levenson JL (Ed), American Psychiatric Publishing, Inc., Washington, DC 2011. p.759.
  29. Nicholson TR, Aybek S, Craig T, et al. Life events and escape in conversion disorder. Psychol Med 2016; 46:2617.
  30. Kranick S, Ekanayake V, Martinez V, et al. Psychopathology and psychogenic movement disorders. Mov Disord 2011; 26:1844.
  31. Carson AJ, Brown R, David AS, et al. Functional (conversion) neurological symptoms: research since the millennium. J Neurol Neurosurg Psychiatry 2012; 83:842.
  32. Stone J, Sharpe M, Carson A, et al. Are functional motor and sensory symptoms really more frequent on the left? A systematic review. J Neurol Neurosurg Psychiatry 2002; 73:578.
  33. Stone J, Smyth R, Carson A, et al. La belle indifférence in conversion symptoms and hysteria: systematic review. Br J Psychiatry 2006; 188:204.
  34. Daum C, Hubschmid M, Aybek S. The value of 'positive' clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review. J Neurol Neurosurg Psychiatry 2014; 85:180.
  35. Ziv I, Djaldetti R, Zoldan Y, et al. Diagnosis of "non-organic" limb paresis by a novel objective motor assessment: the quantitative Hoover's test. J Neurol 1998; 245:797.
  36. Diukova GM, Ljachovetckaja NI, Begljarova MA, Gavrileyko GI. Simple quantitative analysis of Hoover's test in patients with psychogenic and organic limb pareses. J Psychosom Res 2013; 74:361.
  37. McWhirter L, Stone J, Sandercock P, Whiteley W. Hoover's sign for the diagnosis of functional weakness: a prospective unblinded cohort study in patients with suspected stroke. J Psychosom Res 2011; 71:384.
  38. Sonoo M. Abductor sign: a reliable new sign to detect unilateral non-organic paresis of the lower limb. J Neurol Neurosurg Psychiatry 2004; 75:121.
  39. Stone J, Zeman A, Sharpe M. Functional weakness and sensory disturbance. J Neurol Neurosurg Psychiatry 2002; 73:241.
  40. Fasano A, Valadas A, Bhatia KP, et al. Psychogenic facial movement disorders: clinical features and associated conditions. Mov Disord 2012; 27:1544.
  41. Daum C, Aybek S. Validity of the "Drift without pronation" sign in conversion disorder. BMC Neurol 2013; 13:31.
  42. Daum C, Gheorghita F, Spatola M, et al. Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study. J Neurol Neurosurg Psychiatry 2015; 86:425.
  43. Horn D, Galli S, Berney A, et al. Testing head rotation and flexion Is useful in functional limb weakness. Mov Disord Clin Pract 2017; 4:597.
  44. Binder LM, Spector J, Youngjohn JR. Psychogenic stuttering and other acquired nonorganic speech and language abnormalities. Arch Clin Neuropsychol 2012; 27:557.
  45. Baizabal-Carvallo JF, Jankovic J. Speech and voice disorders in patients with psychogenic movement disorders. J Neurol 2015; 262:2420.
  46. Duffy JR. Functional speech disorders: clinical manifestations, diagnosis, and management. Handb Clin Neurol 2016; 139:379.
  47. Lee O, Ludwig L, Davenport R, Stone J. Functional foreign accent syndrome. Pract Neurol 2016; 16:409.
  48. Rolak LA. Psychogenic sensory loss. J Nerv Ment Dis 1988; 176:686.
  49. Chen CS, Lee AW, Karagiannis A, et al. Practical clinical approaches to functional visual loss. J Clin Neurosci 2007; 14:1.
  50. Fekete R, Baizabal-Carvallo JF, Ha AD, et al. Convergence spasm in conversion disorders: prevalence in psychogenic and other movement disorders compared with controls. J Neurol Neurosurg Psychiatry 2012; 83:202.
  51. Delis DC, Wetter SR. Cogniform Disorder and Cogniform Condition: proposed diagnoses for excessive cognitive symptoms. Arch Clin Neuropsychol 2007; 22:589.
  52. Pennington C, Newson M, Hayre A, Coulthard E. Functional cognitive disorder: what is it and what to do about it? Pract Neurol 2015; 15:436.
  53. Stone J, Pal S, Blackburn D, et al. Functional (Psychogenic) Cognitive Disorders: A Perspective from the Neurology Clinic. J Alzheimers Dis 2015; 48 Suppl 1:S5.
  54. Jones D, Drew P, Elsey C, et al. Conversational assessment in memory clinic encounters: interactional profiling for differentiating dementia from functional memory disorders. Aging Ment Health 2016; 20:500.
  55. Harrison NA, Johnston K, Corno F, et al. Psychogenic amnesia: syndromes, outcome, and patterns of retrograde amnesia. Brain 2017; 140:2498.
  56. Staniloiu A, Markowitsch HJ. Dissociative amnesia. Lancet Psychiatry 2014; 1:226.
  57. Morris Z, Whiteley WN, Longstreth WT Jr, et al. Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2009; 339:b3016.
  58. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol 2015; 36:811.
  59. Lempert T, Schmidt D. Natural history and outcome of psychogenic seizures: a clinical study in 50 patients. J Neurol 1990; 237:35.
  60. Fiszman A, Kanner AM. Comorbidities in psychogenic nonepileptic seizures: Depressive, anxiety, and personality disorders. In: Gates and Rowan's Nonepileptic Seizures, 3rd ed., Schacter S, LaFrance Jr WC (Eds), Cambridge University Press, Cambridge 2010. p.225.
  61. Sar V, Akyüz G, Kundakçi T, et al. Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. Am J Psychiatry 2004; 161:2271.
  62. Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain 2004; 127:2360.
  63. Stone J, Sharpe M, Binzer M. Motor conversion symptoms and pseudoseizures: a comparison of clinical characteristics. Psychosomatics 2004; 45:492.