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

Conversion disorder in adults: Epidemiology, pathogenesis, and prognosis

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 epidemiology, pathogenesis, and prognosis of conversion disorder. The terminology, diagnosis, differential diagnosis, clinical features, assessment, and treatment are discussed separately, as are specific subtypes of conversion disorder (psychogenic nonepileptic seizures and psychogenic movement disorders):

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

(See "Conversion disorder in adults: Clinical features, assessment, and comorbidity".)

(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: Oct 2017. | This topic last updated: Jun 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. Carson AJ, Brown R, David AS, et al. Functional (conversion) neurological symptoms: research since the millennium. J Neurol Neurosurg Psychiatry 2012; 83:842.
  7. Fink P, Hansen MS, Oxhøj ML. The prevalence of somatoform disorders among internal medical inpatients. J Psychosom Res 2004; 56:413.
  8. Perkin GD. An analysis of 7836 successive new outpatient referrals. J Neurol Neurosurg Psychiatry 1989; 52:447.
  9. Ewald H, Rogne T, Ewald K, Fink P. Somatization in patients newly admitted to a neurological department. Acta Psychiatr Scand 1994; 89:174.
  10. Weddington WW Jr. Conversion reaction in an 82-year-old man. J Nerv Ment Dis 1979; 167:368.
  11. Stone J, Sharpe M, Binzer M. Motor conversion symptoms and pseudoseizures: a comparison of clinical characteristics. Psychosomatics 2004; 45:492.
  12. Duncan R, Oto M, Martin E, Pelosi A. Late onset psychogenic nonepileptic attacks. Neurology 2006; 66:1644.
  13. Snijders TJ, de Leeuw FE, Klumpers UM, et al. Prevalence and predictors of unexplained neurological symptoms in an academic neurology outpatient clinic--an observational study. J Neurol 2004; 251:66.
  14. 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.
  15. Stone J, Carson A, Sharpe M. Functional symptoms in neurology: management. J Neurol Neurosurg Psychiatry 2005; 76 Suppl 1:i13.
  16. Kranick S, Ekanayake V, Martinez V, et al. Psychopathology and psychogenic movement disorders. Mov Disord 2011; 26:1844.
  17. Nicholson TR, Aybek S, Craig T, et al. Life events and escape in conversion disorder. Psychol Med 2016; 46:2617.
  18. 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.
  19. Testa SM, Krauss GL, Lesser RP, Brandt J. Stressful life event appraisal and coping in patients with psychogenic seizures and those with epilepsy. Seizure 2012; 21:282.
  20. Sharpe D, Faye C. Non-epileptic seizures and child sexual abuse: a critical review of the literature. Clin Psychol Rev 2006; 26:1020.
  21. Roelofs K, Keijsers GP, Hoogduin KA, et al. Childhood abuse in patients with conversion disorder. Am J Psychiatry 2002; 159:1908.
  22. 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.
  23. Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. Brain 2010; 133:1537.
  24. 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.
  25. 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.
  26. Pareés I, Kojovic M, Pires C, et al. Physical precipitating factors in functional movement disorders. J Neurol Sci 2014; 338:174.
  27. Bautista RE, Gonzales-Salazar W, Ochoa JG. Expanding the theory of symptom modeling in patents with psychogenic nonepileptic seizures. Epilepsy Behav 2008; 13:407.
  28. Hankey GJ, Stewart-Wynne EG. Pseudo-multiple sclerosis: a clinico-epidemiological study. Clin Exp Neurol 1987; 24:11.
  29. Barnert C. Conversion reactions and psychophysiologic disorders: a comparative study. Psychiatry Med 1971; 2:205.
  30. Chabrol H, Peresson G, Clanet M. Lack of specificity of the traditional criteria for conversion disorders. Eur Psychiatry 1995; 10:317.
  31. Nazir FS, Lees KR, Bone I. Clinical features associated with medically unexplained stroke-like symptoms presenting to an acute stroke unit. Eur J Neurol 2005; 12:81.
  32. Roy A. Hysteria. J Psychosom Res 1980; 24:53.
  33. Friedman JH, LaFrance WC Jr. Psychogenic disorders: the need to speak plainly. Arch Neurol 2010; 67:753.
  34. Crimlisk HL, Bhatia KP, Cope H, et al. Patterns of referral in patients with medically unexplained motor symptoms. J Psychosom Res 2000; 49:217.
  35. Davison P, Sharpe M, Wade D, Bass C. "Wheelchair" patients with nonorganic disease: a psychological inquiry. J Psychosom Res 1999; 47:93.
  36. Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994; 331:69.
  37. Bass C, Murphy M. Somatoform and personality disorders: syndromal comorbidity and overlapping developmental pathways. J Psychosom Res 1995; 39:403.
  38. Edwards MJ, Adams RA, Brown H, et al. A Bayesian account of 'hysteria'. Brain 2012; 135:3495.
  39. Dimaro LV, Dawson DL, Roberts NA, et al. Anxiety and avoidance in psychogenic nonepileptic seizures: the role of implicit and explicit anxiety. Epilepsy Behav 2014; 33:77.
  40. Demartini B, Petrochilos P, Ricciardi L, et al. The role of alexithymia in the development of functional motor symptoms (conversion disorder). J Neurol Neurosurg Psychiatry 2014; 85:1132.
  41. Roelofs K, Spinhoven P. Trauma and medically unexplained symptoms towards an integration of cognitive and neuro-biological accounts. Clin Psychol Rev 2007; 27:798.
  42. Stone J, Warlow C, Sharpe M. Functional weakness: clues to mechanism from the nature of onset. J Neurol Neurosurg Psychiatry 2012; 83:67.
  43. Schrag A, Trimble M, Quinn N, Bhatia K. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain 2004; 127:2360.
  44. Pareés I, Saifee TA, Kojovic M, et al. Functional (psychogenic) symptoms in Parkinson's disease. Mov Disord 2013; 28:1622.
  45. Lempert T, Schmidt D. Natural history and outcome of psychogenic seizures: a clinical study in 50 patients. J Neurol 1990; 237:35.
  46. Goldstein LH, Mellers JD. Ictal symptoms of anxiety, avoidance behaviour, and dissociation in patients with dissociative seizures. J Neurol Neurosurg Psychiatry 2006; 77:616.
  47. Stone J, Carson AJ. The unbearable lightheadedness of seizing: wilful submission to dissociative (non-epileptic) seizures. J Neurol Neurosurg Psychiatry 2013; 84:822.
  48. Hendrickson R, Popescu A, Dixit R, et al. Panic attack symptoms differentiate patients with epilepsy from those with psychogenic nonepileptic spells (PNES). Epilepsy Behav 2014; 37:210.
  49. Binzer M, Eisemann M, Kullgren G. Illness behavior in the acute phase of motor disability in neurological disease and in conversion disorder: a comparative study. J Psychosom Res 1998; 44:657.
  50. Sharpe M, Stone J, Hibberd C, et al. Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome. Psychol Med 2010; 40:689.
  51. Harvey SB, Stanton BR, David AS. Conversion disorder: towards a neurobiological understanding. Neuropsychiatr Dis Treat 2006; 2:13.
  52. Voon V, Gallea C, Hattori N, et al. The involuntary nature of conversion disorder. Neurology 2010; 74:223.
  53. Maurer CW, LaFaver K, Ameli R, et al. Impaired self-agency in functional movement disorders: A resting-state fMRI study. Neurology 2016; 87:564.
  54. Baek K, Doñamayor N, Morris LS, et al. Impaired awareness of motor intention in functional neurological disorder: implications for voluntary and functional movement. Psychol Med 2017; 47:1624.
  55. Nicholson TR, Aybek S, Kempton MJ, et al. A structural MRI study of motor conversion disorder: evidence of reduction in thalamic volume. J Neurol Neurosurg Psychiatry 2014; 85:227.
  56. Aybek S, Nicholson TR, Draganski B, et al. Grey matter changes in motor conversion disorder. J Neurol Neurosurg Psychiatry 2014; 85:236.
  57. Aybek S, Nicholson TR, Zelaya F, et al. Neural correlates of recall of life events in conversion disorder. JAMA Psychiatry 2014; 71:52.
  58. Stone J, LaFrance WC Jr, Levenson JL, Sharpe M. Issues for DSM-5: Conversion disorder. Am J Psychiatry 2010; 167:626.
  59. 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.
  60. Maldonado JR. Conversion disorder. In: Gabbard's Treatments of Psychiatric Disorders, Fourth Edition, Gabbard GO (Ed), American Psychiatric Publishing, Inc., Washington, DC 2007. p.595.
  61. 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.
  62. Toth C. Hemisensory syndrome is associated with a low diagnostic yield and a nearly uniform benign prognosis. J Neurol Neurosurg Psychiatry 2003; 74:1113.
  63. Ibrahim NM, Martino D, van de Warrenburg BP, et al. The prognosis of fixed dystonia: a follow-up study. Parkinsonism Relat Disord 2009; 15:592.
  64. Duncan R, Razvi S, Mulhern S. Newly presenting psychogenic nonepileptic seizures: incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav 2011; 20:308.
  65. Jankovic J, Vuong KD, Thomas M. Psychogenic tremor: long-term outcome. CNS Spectr 2006; 11:501.
  66. Carson AJ, Best S, Postma K, et al. The outcome of neurology outpatients with medically unexplained symptoms: a prospective cohort study. J Neurol Neurosurg Psychiatry 2003; 74:897.
  67. Mace CJ, Trimble MR. Ten-year prognosis of conversion disorder. Br J Psychiatry 1996; 169:282.
  68. Couprie W, Wijdicks EF, Rooijmans HG, van Gijn J. Outcome in conversion disorder: a follow up study. J Neurol Neurosurg Psychiatry 1995; 58:750.
  69. Binzer M, Kullgren G. Motor conversion disorder. A prospective 2- to 5-year follow-up study. Psychosomatics 1998; 39:519.