Conversion Disorder

Anthony Feinstein, MD, PhD; Behavioral Neurology and Psychiatry p. 861-872 June 2018, Vol.24, No.3 doi: 10.1212/CON.0000000000000601
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PURPOSE OF REVIEW: This article provides a broad overview of conversion disorder, encompassing diagnostic criteria, epidemiology, etiologic theories, functional neuroimaging findings, outcome data, prognostic indicators, and treatment.

RECENT FINDINGS: Two important changes have been made to the recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria: the criteria that conversion symptoms must be shown to be involuntary and occurring as the consequence of a recent stressor have been dropped. Outcome studies show that the rate of misdiagnosis has declined precipitously since the 1970s and is now around 4%. Functional neuroimaging has revealed a fairly consistent pattern of hypoactivation in brain regions linked to the specific conversion symptom, accompanied by ancillary activations in limbic, paralimbic, and basal ganglia structures. Cognitive-behavioral therapy looks promising as the psychological treatment of choice, although more definitive data are still awaited, while preliminary evidence indicates that repetitive transcranial magnetic stimulation could prove beneficial as well.

SUMMARY: Symptoms of conversion are common in neurologic and psychiatric settings, affecting up to 20% of patients. The full syndrome of conversion disorder, while less prevalent, is associated with a guarded prognosis and a troubled psychosocial outcome. Much remains uncertain with respect to etiology, although advances in neuroscience and technology are providing reproducible findings and new insights. Given the confidence with which the diagnosis can be made, treatment should not be delayed, as symptom longevity can influence outcome.

Address correspondence to Dr Anthony Feinstein, Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada, ant.feinstein@utoronto.ca.

RELATIONSHIP DISCLOSURE: Dr Feinstein serves on the editorial board of the Multiple Sclerosis Journal and receives personal compensation for speaking engagements for EMD Serono, Inc; F. Hoffman-La Roche Ltd; Novartis AG; Sanofi Genzyme; and Teva Pharmaceutical Industries Ltd. Dr Feinstein receives research/grant support from the Multiple Sclerosis Society of Canada and publishing royalties from Amadeus Press, Cambridge University Press, and Johns Hopkins University Press.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Feinstein reports no disclosure.

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© 2018 American Academy of Neurology