Conversion disorder in adults: Terminology, diagnosis, and differential diagnosis
- Jon Stone, FRCP, PhD
Jon Stone, FRCP, PhD
- Honorary Reader in Neurology
- University of Edinburgh
- Michael Sharpe, MD
Michael Sharpe, MD
- Professor of Psychological Medicine
- University of Oxford
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 nevertheless are genuine, cause distress and/or psychosocial impairment . The disorder is common in clinical settings and often has a poor prognosis [2-5].
This topic reviews the terminology, diagnosis, and differential diagnosis of conversion disorder. The epidemiology, pathogenesis, prognosis, clinical features, assessment, and treatment are discussed separately, as are specific subtypes of conversion disorder (psychogenic nonepileptic seizures and psychogenic movement disorders):
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Jun 11, 2017.References
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
- 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.
- 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.
- 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.
- Durrant J, Rickards H, Cavanna AE. Prognosis and outcome predictors in psychogenic nonepileptic seizures. Epilepsy Res Treat 2011; 2011:274736.
- Stone J, Carson A, Sharpe M. Functional symptoms in neurology: management. J Neurol Neurosurg Psychiatry 2005; 76 Suppl 1:i13.
- Stone J. The bare essentials: Functional symptoms in neurology. Pract Neurol 2009; 9:179.
- 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.
- Mayou R, Kirmayer LJ, Simon G, et al. Somatoform disorders: time for a new approach in DSM-V. Am J Psychiatry 2005; 162:847.
- Stone J, LaFrance WC Jr, Levenson JL, Sharpe M. Issues for DSM-5: Conversion disorder. Am J Psychiatry 2010; 167:626.
- Stone J. We must tell our patients what is wrong with them even if we don't know why they have symptoms. Pract Neurol 2011; 11:98.
- The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. http://www.who.int/classifications/icd/en/bluebook.pdf (Accessed on June 08, 2012).
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), Fourth edition, Text revision, American Psychiatric Association, Washington, DC 2000.
- Stone J, Carson A, Duncan R, et al. Symptoms 'unexplained by organic disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain 2009; 132:2878.
- Kanaan RA, Carson A, Wessely SC, et al. What's so special about conversion disorder? A problem and a proposal for diagnostic classification. Br J Psychiatry 2010; 196:427.
- Carson AJ, Brown R, David AS, et al. Functional (conversion) neurological symptoms: research since the millennium. J Neurol Neurosurg Psychiatry 2012; 83:842.
- Kanaan R, Armstrong D, Barnes P, Wessely S. In the psychiatrist's chair: how neurologists understand conversion disorder. Brain 2009; 132:2889.
- Mink JW. Conversion disorder and mass psychogenic illness in child neurology. Ann N Y Acad Sci 2013; 1304:40.
- Roach ES. Mass hysteria and the media: Folie à Troupeau? Pediatr Neurol 2013; 49:6.
- Balaratnasingam S, Janca A. Mass hysteria revisited. Curr Opin Psychiatry 2006; 19:171.
- Stone J, Reuber M, Carson A. Functional symptoms in neurology: mimics and chameleons. Pract Neurol 2013; 13:104.
- Yutzy SH, Parish BS. Somatoform disorders. In: The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition, Hales RE, Yudofsky SC, Gabbard GO. (Eds), American Psychiatric Publishing, Washington, DC 2008. p.609.
- Stone J, Smyth R, Carson A, et al. Systematic review of misdiagnosis of conversion symptoms and "hysteria". BMJ 2005; 331:989.
- Hankey GJ, Stewart-Wynne EG. Pseudo-multiple sclerosis: a clinico-epidemiological study. Clin Exp Neurol 1987; 24:11.
- Johnstone EC, Macmillan JF, Crow TJ. The occurrence of organic disease of possible or probable aetiological significance in a population of 268 cases of first episode schizophrenia. Psychol Med 1987; 17:371.
- Scheepers B, Clough P, Pickles C. The misdiagnosis of epilepsy: findings of a population study. Seizure 1998; 7:403.
- 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.
- Diagnostic and Statistical Manual, Fifth Edition (DSM-5)
- International Classification of Diseases - 10th Revision (ICD-10)
- DIFFERENTIAL DIAGNOSIS
- Neurologic and general medical disorders
- - Multiple sclerosis
- - Myasthenia gravis
- - Movement disorders
- - Stroke
- - Spinal disorders
- - Epilepsy
- - Autoimmune limbic encephalitis
- - Stiff person syndrome
- - Laryngeal dystonia
- Psychiatric disorders
- - Somatic symptom disorder
- - Depersonalization/derealization disorder
- - Factitious disorder