Conversion disorder involves one or more neurologic symptoms related to voluntary movement or sensory function, like sight or hearing, which is a neurological or medical condition that cannot otherwise explain. Unlike malingering or factitious disorder, where symptoms are simulated or deliberately produced to achieve some secondary gain or external goal, conversion symptoms are real and often worsened because they cannot be scientifically explained.
Symptoms of conversion disorder include involuntary motor deficits, such as weakness or paralysis (e.g., a history of dropping things, dragging the leg when walking, etc.). A critical diagnostic finding in conversion weakness is that the deficit is inconsistent at different times in the examination. For example, one may report being unable to flex their feet when lying down but can walk on tip-toes when standing. In other cases, symptoms appear only in specific settings (i.e., one might feel unable to move their legs only when they are at school but have no trouble when they are home).
Other symptoms of conversion disorder include sensory disturbances, like sensory loss or numbness; visual disturbances, such as blurred vision, double vision, or complete blindness; difficulty swallowing; and speech disturbances, such as functional dysphonia, which usually presents as whispering or hoarseness. Individuals may also experience psychogenic nonepileptic seizures, which are episodes of movement, sensation, or behaviors similar to epileptic seizures but do not have a neurologic origin.
In addition to conversion symptoms, individuals often report many current or prior physical symptoms or functional disorders, such as irritable bowel syndrome, fibromyalgia, or chronic fatigue syndrome. They may also report dissociative disorders, including depersonalization (i.e., feeling disconnected from oneself) and derealization (i.e., feeling detached from the environment), particularly at the onset of the disorder or in association with a nonepileptic seizure.
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