Clinical Features

Conversion disorders usually present as a single symptom with a sudden onset related to a severe stress. Precise history taking is imperative for making the diagnosis, focusing both on how the problem affects the patient and the surrounding events at time of onset. It may be necessary to interview the patient and family separately to confirm diagnostic suspicions. The most reliable diagnostic criterion for conversion disorder is either a previous history of it or a somatization disorder (each found in one-third of cases). Symptoms may vary in cases of recurrence.23 and 4

Motor complaints, usually involving voluntary muscles, are more common than sensory complaints.23 and 4

Rarely, the autonomic and endocrine systems are involved. Vomiting can be a psychogenic manifestation of disgust, and pseudocyesis (false pregnancy) can represent either a wish for or fear of pregnancy.

Classic symptoms of conversion disorders include paralysis, aphonia, seizures, coordination disturbances, akinesia, dyskinesia, blindness, tunnel vision, anosmia, anesthesia, and paresthesia. Pseudoseizures represent 10 to 40 percent of conversion disorders referred to psychiatrists. Patients may describe their condition with surprising lack of concern, considering the severity of the symptom (la belle indiffeerence). This was previously thought to be a hallmark of the disorder, but it is absent in about half of the cases and is found just as often in patients with organic disease. It is no longer considered diagnostic. 25

Diagnosis is made first and foremost by ruling out organic pathology. Absence of a medical condition does not solely support the diagnosis of conversion disorder because the appropriate psychological criteria must also be met. Suspicion for the disorder should arise when no physical findings related to the symptom are found or the examination is not consistent with known anatomic or pathophysiologic states. Several techniques that can be used in the physical examination are helpful in testing for true neurologic deficits (T§bl§...2.8.5.-1). Appropriate laboratory and ancillary studies should be ordered to confirm suspected organic disease. It is important to remember, however, that organic disease may be present concurrently with conversion disorder.6

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