In a conversion disorder the patient converts an intense psychological response into a motor and/or sensory disorder such as paralysis.
Key features:
(1) presence of a clinically significant motor and/or sensory neurological disorder
(2) evidence of a psychological disorder and/or a recent stressor (this may be occult)
The possibility of a conversion disorder is usually considered when (Feinstein et, Heruti et al):
(1) neurologic signs are atypical
(2) neurologic signs do not conform anatomically
(3) neurologic findings do not match results of the clinical investigation
(4) repeated neurologic exams are inconsistent
(5) certain functions are preserved (respiration, sphincter control, etc)
Essential exclusions:
(1) neurologic or medical disorder that can explain the findings
(2) feigning of symptoms
(3) malingering
(4) occult malignancy
(5) other psychologic disorder that can explain the findings better
Additional findings:
(1) Some patients are seemingly indifferent to the findings (“la belle indifference”) but this is neither sensitive nor specific. Many patients are distressed by the findings.
(2) Positive improvement following interventions targeting a conversion disorder and psychological issue supports the diagnosis.
