Functional Neurological Disorder

Functional Neurological Disorder, also known as Conversion Disorder, is an infrequent psychodynamic phenomenon characterized by the unconscious manifestation of a person’s unresolved conflict or stressors in physical expressions. This physical expression involves recent psychological stressors converting into physical signs and symptoms that defy explanation through known anatomy or physiology.

Individuals with this disorder do not intentionally simulate symptoms but genuinely experience them. Symptom presentation deviates from typical patterns, such as dermatome, myotome, and sclerotome changes, making careful documentation essential for recognizing discrepancies.

Conversion disorder, labeled as “hysterical neurosis,” “conversion type,” or “functional neurological symptom disorder,” falls under the category of ‘somatic symptom disorder’ in the DSM-V. Different presentations are coded under ICD-10-CM, with prevalence estimates ranging from 0.01% to 0.5% of the general population.

The onset of conversion symptoms typically occurs abruptly during adolescence or early adulthood, often following a stressful life event. Symptoms, which may affect motor or sensory functions, lack a consistent or expected pattern. Common manifestations include impaired coordination, paralysis, altered touch sensation, visual changes, and seizures.

Prognosis is favorable for patients with acute symptom onset or those experiencing symptoms immediately after stressors. Younger individuals tend to have better outcomes, with symptoms like tremors or seizures being more persistent compared to aphonia, blindness, or paralysis, which often improve.

Conversion disorder is frequently associated with psychiatric conditions and emotional distress. Co-morbidities may include undifferentiated somatoform disorder, generalized anxiety disorder, dysthymia, and major depression, among others.

Diagnosis relies on clinical presentation, with DSM-V criteria emphasizing the incompatibility between symptoms and recognized medical conditions, the absence of intentional symptom production, and the resulting distress or impairment.

While the etiology of conversion disorder is linked to psychological conflicts and stressors, the pathophysiology remains unclear. Structural imaging and functional MRI studies show altered brain circuits, but these findings are still experimental.

Treatment involves psychoeducation, psychotherapy, and pharmacotherapy, with physical therapy playing a role in preventing secondary complications. Physical therapists should adopt a patient-centered approach, addressing impairments while incorporating behavioral modification and graded exposure to stressors.

Differential diagnosis is crucial, considering organic conditions like myasthenia gravis and psychological conditions such as factitious disorder and malingering. Involuntary psychological conditions like anxiety and depression may also coexist with conversion disorder.