Merck Manual

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Functional Neurological Symptom Disorder

(Conversion Disorder)

By

Joel E. Dimsdale

, MD, University of California, San Diego

Reviewed/Revised Aug 2022 | Modified Sep 2022
VIEW PROFESSIONAL VERSION

In functional neurological symptom disorder, physical symptoms that resemble those of a nervous system (neurologic) disorder develop. The symptoms can follow mental factors such as conflicts or other stresses.

Functional neurological symptom disorder sometimes follows stress and conflict, which people with this disorder experience as (convert into) physical symptoms. People do not do this intentionally and are not aware they are doing it. They experience their symptoms just as though they were caused by a physical disorder.

Although functional neurological symptom disorder tends to develop during late childhood to early adulthood, it may appear at any age. The disorder appears to be more common among women.

Symptoms

The symptoms of functional neurological symptom disorder—such as paralysis of an arm or leg or loss of sensation in a part of the body—suggest nervous system dysfunction. Other symptoms may resemble a seizure or involve problems with thinking, difficulty swallowing, or loss of one of the special senses, such as vision or hearing.

Often, symptoms begin after some distressing social or psychologic event. Symptoms are not consciously produced. That is, people are not faking their symptoms. Symptoms are severe enough to cause substantial distress and to interfere with functioning.

People may have only one episode in their lifetime or episodes that occur sporadically. Usually, the episodes are brief.

Diagnosis

  • A doctor's evaluation

Doctors first check for physical, particularly neurologic, disorders that can account for the symptoms by taking a thorough medical history, doing a thorough physical examination, and doing tests.

The key to the diagnosis is that symptoms do not match those caused by any neurologic disorder. For example, the person may tremble and think that the trembling is caused by a seizure disorder. But when the person is distracted, the trembling disappears. If people are having a seizure, distractions do not stop the trembling.

Also, for doctors to diagnose functional neurological symptom disorder, the symptoms must cause substantial distress and interfere with functioning.

Once doctors determine that the symptoms do not match those caused by any neurologic disorder, doctors consider the diagnosis of functional neurological symptom disorder. The diagnosis is made based on all the information from the evaluation.

Treatment

  • Support from a doctor

  • Hypnosis

  • Psychotherapy

A supportive, trustful doctor-patient relationship is essential. The most helpful approach may involve collaboration of a primary care doctor with a psychiatrist and a doctor from another field, such as a neurologist.

After the doctor rules out a possible physical disorder and reassures the person that the symptoms do not indicate a serious underlying disorder, the person may begin to feel better, and the symptoms may fade.

The following treatments may help:

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
VIEW PROFESSIONAL VERSION
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