Demystifying Conversion Disorder: A Guide for Primary Care Clinicians

Table 1

DSM-5 Diagnostic Criteria for Functional Neurological Symptom Disorder (Conversion Disorder) 

  • One or more symptoms of altered voluntary motor or sensory function.
  • Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
  • The symptom or deficit is not better explained by another medical or mental disorder.
  • The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth ed. Arlington: American Psychiatric Association; 2013.

Table 2

Symptoms, Presentation, and Distinguishing Features of CD

Symptom Presentation and Distinguishing Features
  • Sudden onset
  • No injury sustained while maneuvering around the office
  • No bruises/scrapes
  • Pupillary reflex present
  • Blink reflex to loud unexpected sound present
Psychogenic nonepileptic seizures
  • Lack response or paradoxical increase in seizures with antiepileptic drug treatment
  • Negative history of injury or loss of bladder/bowel control during seizure episode
  • When weights are added to the affected limb, greater tremor amplitude vs diminished tremor amplitude in those with organic tremor
  • Inverted foot or “clenched fist”
  • Adult onset
  • Fixed posture apparently present during sleep
  • Severe pain
  • Loss of use of half of the body or of a single limb
  • Paralysis does not follow anatomical patterns
  • Paralysis often inconsistent upon repeat examination
  • Patient may report feeling faint or syncope, but no autonomic changes identified (eg, pallor)
  • No associated injury
  • Fainting spells have “swooning” character
  • Normal/full cough during auscultation of the lungs
  • Most common in extremities
  • “Glove and stocking” distribution common
  • Unlike “glove and stocking” distribution that may occur in polyneuropathy, areas of conversion anesthesia have precise, sharp boundary, often located at a joint
  • Normal rather than increased deep tendon reflexes
  • Absence of Babinski sign
  • Normal motor evoked potentials

Ali et al. Innov Clin Neurosci. 2015 May-Jun;12(5-6):27-33.6