02/12/18 18.

24

emedicine.medscape.com

Conversion Disorder in
Emergency Medicine
Updated: Oct 26, 2017
Author: Seth Powsner, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP

Overview

Background
Conversion disorder (functional neurological symptom disorder) is classified as one of the somatic symptom and
related disorders in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association,
Fifth Edition (DSM-5);[1, 2] these were formerly known as somatoform disorders.[3] Although defined as a condition
that presents as an alteration or loss of a physical function suggestive of a physical disorder, conversion disorder is
traditionally taken to be the expression of an underlying psychological conflict or need.

Conversion symptoms are presumed to result from some unconscious process. The precipitating psychological conflict
or stressor may not be apparent initially, but may become evident in the course of obtaining a patient’s history: ideally,
it is a psychological issue related symbolically and temporally to symptom onset. Conversion symptoms are not
considered to be under voluntary control, and, should not be due to any physical disorder or known pathological
mechanism (after appropriate medical evaluation). NB: Conscious/intentional production of physical symptoms is
classified as factitious disorder or malingering.

Though classified with somatic symptom/somatoform disorders in DSM-III through DSM-5, conversion disorder is
classified as a dissociative disorder in ICD-10, keeping its long association with hysteria (Dissociative Disorders in
DSM).[4, 5] Clinical descriptions of conversion disorder date to almost 4000 years ago; the Egyptians attributed
symptoms to a "wandering uterus." In the 19th century, Paul Briquet described the disorder as a dysfunction of the
CNS.[6, 7] Freud first used the term conversion to refer to the development of a somatic symptom to help bind anxiety
around a repressed conflict.[8] In current practice, the term has made it into the popular press.[9, 10]

For related information, see Medscape's Psychiatry and Mental Health Specialty page.

Pathophysiology
Presenting symptoms can range far across the field of clinical neurology. Conversion reactions usually approximate
lesions in the nervous system’s voluntary motor or sensory pathways. Symptoms most commonly reported are
weakness, paralysis, pseudoseizures, involuntary movements (eg, tremors), and sensory disturbances. These losses
or distortions of neurologic function cannot adequately be accounted for by organic disease.

Functional MRI (fMRI) and transcranial magnetic stimulation (TMS) studies have shown different activation patterns in
patients with conversion symptoms and healthy control subjects; this is in keeping with the "involuntary" nature of
conversion symptoms.[11, 12, 13, 14, 15]

Patients whose symptoms are limited to pain or sexual functioning are not classified under conversion disorder;
likewise, patients already classified as demonstrating somatization disorder or schizophrenia are also not classified

https://emedicine.medscape.com/article/805361-print Page 1 of 11
 02/12/18 18.24

under conversion disorder.

The DSM-5 diagnostic criteria for conversion disorder are as follows:[1]

One or more symptoms of altered voluntary motor or sensory function.

Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or
medical conditions.

The symptom or deficit is not better explained by another medical or mental disorder.

The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning or warrants medical evaluation.

According to psychodynamic theory, conversion symptoms develop to defend against unacceptable impulses.[8] The
primary gain, that is to say the unconscious purpose of a conversion symptom is to bind anxiety and keep a conflict
internal. A fairly transparent example would be leg paralysis after an equestrian competitor is thrown from his or her
horse. The symptom has a symbolic value that is a representation and partial solution of a deep-seated psychological
conflict: to avoid running away like a coward, and yet to avoid being thrown again.

According to learning theory, conversion disorder symptoms are a learned maladaptive response to stress. Patients
achieve secondary gain by avoiding activities that are particularly offensive to them, thereby gaining support from
family and friends, which otherwise may not be offered.[16]

Epidemiology
Frequency

United States

True conversion reaction is rare.[17, 18] Predisposing factors include extreme psychosocial stress, and perhaps, rural
upbringing. Some psychiatrists suspect that western society has incorporated Freudian notions of unconscious
motivations and conflicts: conversion reactions have become too obvious to serve their purpose.

The incidence of individual persistent conversion symptoms is estimated to be 2-5/100,000 per year.[1]

Cultural factors may play a significant role.[19] Symptoms that might be considered a conversion disorder in
the United States may be a normal expression of anxiety in other cultures.

One study reports that conversion disorder accounts for 1.2-11.5% of psychiatric consultations for hospitalized
medical and surgical patients.

International

At the National Hospital in London, the diagnosis was made in 1% of inpatients.[20] Iceland's incidence of conversion
disorder is reported to be 15 cases per 100,000 persons.

Mortality/Morbidity
Patients diagnosed with conversion disorder may go on to demonstrate serious, traditional medical illness. This has
been happening less and less often over the years (29% in 1950s down to 4% in 1990s). Unfortunately, emergency
physicians may find themselves sorting out new neurologic symptoms in settings of terrible time pressure: populations
statistics may be of little reassurance for any specific individual.

Sex- and age-related demographics

Sex ratio is not known although it has been estimated that women patients outnumber men by 6:1. According to DSM-
5, conversion disorder is two to three times more common in females.[1]

Conversion disorder may present at any age but is rare in children younger than 10 years or in persons older than 35

https://emedicine.medscape.com/article/805361-print Page 2 of 11
 02/12/18 18.24

years.[21]

In a University of Iowa study of 32 patients with conversion disorder, however, the mean age was 41 years with a
range of 23-58 years.[22]

An Australian study estimated a pediatric incidence of 2.3/100,000 based on 194 cases of conversion disorder found
among those reported to the Australian Pediatric Surveilance Unit from 2002–2003. Family loss (death/separation),
followed by family violence, were the most commonly identified stressors (precipitants).[23] Prior opinion has been that
incidence of conversion is increased after physical or sexual abuse, and that incidence also increases in those children
whose parents are either seriously ill or have chronic pain.[24]

Presentation

History
Degree of impairment usually is marked and interferes with daily life activities. Prolonged loss of function may produce
organic complications such as disuse atrophy or contractures.

Weakness, paralysis, pseudoseizures, involuntary movements (eg, tremors), and sensory disturbances (eg, aphonia,
deafness, blindness) are the most frequent complaints. Symptoms often enable patients to avoid an unpleasant
situation at home or work, attract attention, or gain support from others. This may become evident through careful
questioning.

The symptom must not be under voluntary control. Determining whether or not a symptom is really under voluntary
control may be difficult. Features suggestive of voluntary control consist of variability, inconsistency, obvious and
immediate benefit, as well as a personality that may suggest dishonesty and opportunism. Symptoms, if they are
voluntary, tend to be self-limited and of brief duration.

La belle indifférence was considered a classic feature of conversion disorder. It is characterized by the inappropriate
and paradoxical absence of distress despite the presence of an unpleasant symptom. Patients often deny emotional
difficulty. Unfortunately, la belle indifférence, histrionic personality, and secondary gain are clinical features that appear
to have no diagnostic significance. They can easily be absent in patients with conversion disorder; they can be easily
be present in patients with traditional neurologic disorder.

One study reported 5 patients with hysterical conversion reactions after injury or infarction to the left cerebral
hemisphere.[25]

Physical
Absence of a physical disorder is an important diagnostic feature. Individuals with conversion disorder often have
physical signs but lack objective neurological signs to substantiate their symptoms.

Weakness
Weakness usually involves whole movements rather than muscle groups. Weakness affects the extremities more often
than ocular, facial, or cervical movements.

With the use of various clinical techniques, weakness of one limb can be demonstrated to cause contraction of
opposing muscle groups. Discontinuous resistance during testing of power or give-way weakness may exist.[26]
Muscle wasting is absent, and reflexes are normal.

Sensory symptoms

Sensory loss or distortion often is inconsistent when tested on more than one occasion and is often incompatible with
peripheral nerve or root distribution.[27]

https://emedicine.medscape.com/article/805361-print Page 3 of 11
 02/12/18 18.24

Discrete patches of anesthesia or hemisensory loss that stop in the midline may be present.

Classic dermatomes in patients with numbness usually are not followed.

Visual symptoms

Visual symptoms include monocular diplopia, triplopia, field defects, tunnel vision, and bilateral blindness associated
with intact pupillary reflexes.

Optokinetic nystagmus may be observed in patients with apparent blindness when exposed to a rotating striped drum.

Gait disturbances
Astasia-abasia is a motor coordination disorder characterized by the inability to stand despite normal ability to move
legs when lying down or sitting.

Patients walk normally if they think they are not being observed.

Occasionally, while being observed, patients actively attempt to fall. This contrasts with those patients with organic
disease who attempt to support themselves.

Pseudoseizures

During an attack, marked involvement of the truncal muscles with opisthotonos and lateral rolling of the head or body
is present. All 4 limbs may exhibit random thrashing movements, which may increase in intensity if restraint is applied.

Cyanosis is rare unless patients deliberately hold their breath.

Reflexes (eg, pupillary, corneal) are retained but may be difficult to test due to tightly closed lids.

Tongue biting and incontinence are rare unless the patient has some degree of medical knowledge about the natural
course of the disease.

In contrast to true seizures, pseudoseizures primarily occur in the presence of other people and not when the patient is
alone or asleep.

Causes
True etiology of conversion disorder is unknown. Most clinicians presume conversion reactions are caused by previous
severe stress, emotional conflict, or an associated psychiatric disorder.

Many studies confirm high incidence of depression in patients with conversion disorder. As many as half of these
patients have personality disorders or display hysterical traits.[28]

In children, conversion disorder is sometimes observed following physical or sexual abuse.

Children who have family members with a history of conversion reactions may be more likely to suffer from conversion
disorder. In addition, if family members are seriously ill or in chronic pain, children may be more likely to be affected.

DDx

Differential Diagnoses
Acute Management of Stroke

Adrenal Crisis in Emergency Medicine

https://emedicine.medscape.com/article/805361-print Page 4 of 11
 02/12/18 18.24

Amyotrophic Lateral Sclerosis in Physical Medicine and Rehabilitation

Bell Palsy

Benign Positional Vertigo in Emergency Medicine

Brain Abscess in Emergency Medicine

CBRNE - Botulism

Cauda Equina and Conus Medullaris Syndromes

Central Vertigo

Child Abuse

Ciguatera Toxicity

Cysticercosis in Emergency Medicine

Delirium, Dementia, and Amnesia in Emergency Medicine

Emergency Treatment of Rabies

Emergent Management of Myasthenia Gravis

Encephalitis

Epidural Hematoma in Emergency Medicine

Epidural Infections (Spinal Epidural Abscess) and Subdural Infections (Subdural Empyema)

Guillain-Barré Syndrome

Herpes Simplex Encephalitis

Herpes Simplex in Emergency Medicine

Huntington Disease

Lambert-Eaton Myasthenic Syndrome (LEMS)

Lumbar (Intervertebral) Disk Disorders

Medication-Induced Dystonic Reactions

Meniere Disease (Idiopathic Endolymphatic Hydrops)

Mercury Toxicity

Multiple Sclerosis

Neuroleptic Agent Toxicity

Neuroleptic Malignant Syndrome

Panic Disorder

Spinal Cord Infections

Spinal Cord Neoplasms

Syphilis

Tick-Borne Diseases, Lyme

https://emedicine.medscape.com/article/805361-print Page 5 of 11
 02/12/18 18.24

Toxicity, Selective Serotonin Reuptake Inhibitor

Transient Ischemic Attack

Vestibular Neuronitis

Withdrawal Syndromes

Workup

Workup

Laboratory Studies
Carefully consider the possibility of an organic etiology.

Some authors have suggested that unnecessary, painful, or invasive testing can result in reinforcement and fixation of
symptoms and should be avoided when possible.

Consider laboratory testing to exclude the following clinical entities:

Electrolyte disturbances

Hypoglycemia

Hyperglycemia

Renal failure

Systemic infection

Toxins

Other drugs

Imaging Studies
A chest x-ray (CXR) may be considered to diagnose an occult neoplasm.

CT scan or MRI may be performed to exclude a stroke or a space-occupying lesion in the brain or spinal cord.

Other Tests
An electroencephalograph may help distinguish pseudoseizures from a true seizure disorder.

Procedures
Spinal fluid may be diagnostic in ruling out infectious or other causes of neurologic symptoms.

Treatment

https://emedicine.medscape.com/article/805361-print Page 6 of 11
 02/12/18 18.24

Prehospital Care
Treat patients as if their symptoms have an organic origin. Prehospital personnel most often cannot distinguish a
conversion reaction from an organic illness.

Emergency Department Care

Emergency physicians must be aware that the diagnosis of conversion disorder does not exclude the presence of
underlying disease, and diagnosis should not be made solely on the basis of negative workup results. Approach each
patient as if their symptoms had an organic basis, and treat them accordingly.

Consultations
Consultation is often necessary and should be considered during ED discharge planning for any patients without
previous histories of conversion reaction.

Consultation may be a cost-effective method to eliminate unnecessary hospitalization by streamlining these

patients to appropriate outpatient psychiatric follow-up.[17]

Neurologic consultation may help if the neurological examination is equivocal.

Psychiatric consultation may be necessary if an organic cause is virtually excluded. Thoughtful questioning may
elicit the underlying stressor.

Another treatment technique is suggestive therapy: an authoritative, not confrontative, pronouncement that "this
problem usually resolves in a few hours" is often successful, especially with children. Appropriate attention, for
example, repeated vital signs plus adjunctive antianxiety medication, can increase odds of success with adults.
[20, 29] Other suggestive therapies for symptom removal include hypnosis and amobarbital interviews.[17]

Behavior-oriented treatment strategies may be helpful.[30, 31] The goals are to unlearn maladaptive responses
and to learn more appropriate responses. Attempt to eliminate the patient's belief that the extremity is paralyzed
by telling the patient (1) that all tests indicate the muscles and nerves are functioning normally, (2) the brain is
communicating with the nerves and muscles, and (3) this apparent lost ability is recoverable. Although
confronting the patient with the fact that the symptoms are not organic is counterproductive, a
strategic/paradoxical behavioral intervention around the possibility of psychiatric diagnosis may help.[32]

Medication

Medication Summary
Drug therapy has not proven reliable. However, a number of psychiatrists recommend a sedative or antianxiety agent.
It is usually easiest to give a benzodiazepine, eg, lorazepam 0.5-1 mg (along with a suggestion that symptoms are
likely to remit in an hour or so). Amobarbital is falling out of favor as a sedative, or for an Amytal interview, but has
been a traditional medication.[17]

Follow-up

Further Outpatient Care

https://emedicine.medscape.com/article/805361-print Page 7 of 11
 02/12/18 18.24

Any patient diagnosed with a conversion reaction in the ED should be encouraged to pursue psychiatric follow-up. This
can be suggested as a way to reduce and manage stress and mitigate exacerbation of physical symptoms (side-
stepping arguments about etiology of symptoms). Psychiatric follow-up is especially helpful for rare cases of more
serious psychiatric syndromes presenting to an emergency department with physical symptoms.

Many patients have spontaneous remission after outpatient psychotherapy or suggestive therapy.

As of yet, there are no well-established treatment regimens for conversion disorder. There has been more success
with the other somatoform disorders.[33]

Transfer
All transfers must comply with Consolidated Omnibus Budget Reconciliation Act (COBRA)/Emergency Medical
Transfer and Active Labor Act (EMTALA) regulations (see COBRA Laws and EMTALA).

Complications
Errors in diagnosis of conversion disorder are not uncommon. With newer diagnostic testing, instances of false-
positive diagnoses of conversion disorder in which a neurological disease is later identified are around 4%.

Authors have reported various organic diseases in patients who were initially diagnosed with conversion disorder. In
one case report, a woman reporting leg weakness and back pain was subsequently diagnosed with sporadic
Creutzfeldt-Jakob disease.[34] Other patients with underlying psychiatric illnesses were found to have disk herniations,
epidural abscesses, or cerebral hemorrhages.[35, 36] In another case series, 5 patients were identified as having
sarcoma-induced osteomalacia, cerebellar medulloblastoma, Huntington chorea, transverse myelitis, and lower
extremity dystonia.[37] Although these case reports were rare, the initial diagnosis of conversion disorder without a
complete neurologic examination, appropriate imaging, and other diagnostic testing should be discouraged.[38]

Prognosis
Prognostic studies differ in outcome, with recovery rates ranging from 15-74%. Factors associated with favorable
outcomes are male gender, acute onset of symptoms, precipitation by a stressful event, good premorbid health, and an
absence of organic or psychiatric disorder.[39]

Many patients with conversion reactions have spontaneous remission or demonstrate marked or complete recovery
after brief psychotherapy.

Contributor Information and Disclosures

Author

Seth Powsner, MD Professor of Psychiatry and Emergency Medicine, Yale University School of Medicine; Medical
Medical Director, Crisis Intervention Unit, Emergency Department, Yale-New Haven Hospital

Seth Powsner, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, American
Association for Emergency Psychiatry, American Association for Technology in Psychiatry, American Medical
Association, American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

https://emedicine.medscape.com/article/805361-print Page 8 of 11
 02/12/18 18.24

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of
Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert Harwood, MD, MPH, FACEP, FAAEM Senior Physcian, Department of Emergency Medicine, Advocate Christ
Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of
Medicine

Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: American Academy of
Emergency Medicine, Council of Emergency Medicine Residency Directors, American College of Emergency
Physicians, American Medical Association, Phi Beta Kappa, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program
Director for Emergency Medicine, Sanz Laniado Medical Center, Netanya, Israel

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American
Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency
Physicians, American College of Physicians, American Heart Association, American Thoracic Society, New York
Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Jeffrey Glenn Bowman, MD, MS Consulting Staff, Highfield MRI

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of Susan E Dufel, MD,
FACEP, to the original writing and development of this article.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC:
American Psychiatric Association; 2013.

2. Kupfer DJ. Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care. Huffington Post. Available at
http://www.huffingtonpost.com/david-j-kupfer-md/dsm-5_b_2648990.html. Accessed: April 14, 2013.

3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revisions.
Washington DC: American Psychiatric Association; 2000.

4. Kanaan RA, Carson A, Wessely SC, Nicholson TR, Aybek S, David AS. What's so special about conversion disorder? A
problem and a proposal for diagnostic classification. Br J Psychiatry. 2010 Jun. 196(6):427-8. [Medline].

5. Brown RJ, Cardena E, Nijenhuis E, et al. Should conversion disorder be reclassified as a dissociative disorder in DSM V?.
Psychosomatics. 2007 Sep-Oct. 48(5):369-78. [Medline].

6. Ford CV, Folks DG. Conversion disorders: an overview. Psychosomatics. 1985 May. 26(5):371-4, 380-3. [Medline].

7. Crommelinck M. Neurophysiology of conversion disorders: a historical perspective. Neurophysiol Clin. 2014 Oct. 44(4):315-
21. [Medline].

8. Breuer J, Freud S. Studies on hysteria. Translated from the German and edited by James Strachey, in collaboration with
Anna Freud, assisted by Alix Strachey and Alan Tyson. Case I Fräulein Anna O. (Breuer). New York: Basic Books; 1957. 21.

9. Wilson J. Taking the Mystery Out of Conversion Disorder. CNN Health. Available at

https://emedicine.medscape.com/article/805361-print Page 9 of 11
 02/12/18 18.24

http://thechart.blogs.cnn.com/2012/02/04/taking-the-mystery-out-of-conversion-disorder/. Accessed: October 23, 2017.

10. Casie Forbes. Becoming Ironman: A journey from conversion disorder to triathlete. USA Today. Available at
https://www.usatoday.com/story/life/life-columnists/2015/06/15/becoming-ironman-conversion-disorder/71246346/. June 15,
2015; Accessed: October 23, 2017.

11. Stone J, Zeman A, Simonotto E, et al. FMRI in patients with motor conversion symptoms and controls with simulated
weakness. Psychosom Med. 2007 Dec. 69(9):961-9. [Medline].

12. Liepert J, Hassa T, Tuscher O, et al. Electrophysiological correlates of motor conversion disorder. Mov Disord. 2008 Sep 10.
[Medline].

13. Edwards MJ, Bhatia KP. Functional (psychogenic) movement disorders: merging mind and brain. Lancet Neurol. 2012 Mar.
11(3):250-60. [Medline].

14. Feinstein A. Conversion disorder: advances in our understanding. CMAJ. 2011 May 17. 183(8):915-20. [Medline]. [Full Text].

15. Vuilleumier P. Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis. Neurophysiol Clin.
2014 October. 44(4):323-37. [Medline].

16. Mai FM. "Hysteria" in clinical neurology. Can J Neurol Sci. 1995 May. 22(2):101-10. [Medline].

17. Dula DJ, DeNaples L. Emergency department presentation of patients with conversion disorder. Acad Emerg Med. 1995
Feb. 2(2):120-3. [Medline].

18. Shorter E. The borderland between neurology and history. Conversion reactions. Neurol Clin. 1995 May. 13(2):229-39.
[Medline].

19. Brown RJ, Lewis-Fernández R. Culture and conversion disorder: implications for DSM-5. Psychiatry. 2011 Fall. 74(3):187-
206. [Medline].

20. Lloyd GG. Acute behaviour disturbances. J Neurol Neurosurg Psychiatry. 1993 Nov. 56(11):1149-56. [Medline].

21. Schwingenschuh P, Pont-Sunyer C, Surtees R, et al. Psychogenic movement disorders in children: A report of 15 cases and
a review of the literature. Mov Disord. 2008 Aug 29. [Medline].

22. Kent DA, Tomasson K, Coryell W. Course and outcome of conversion and somatization disorders. A four-year follow-up.
Psychosomatics. 1995 Mar-Apr. 36(2):138-44. [Medline].

23. Kozlowska K, Nunn KP, Rose D, Morris A, Ouvrier RA, Varghese J. Conversion disorder in Australian pediatric practice. J
Am Acad Child Adolesc Psychiatry. 2007 Jan. 46 (1):68-75. [Medline].

24. Hodgman CH. Conversion and somatization in pediatrics. Pediatr Rev. 1995 Jan. 16(1):29-34. [Medline].

25. Drake ME Jr. Conversion hysteria and dominant hemisphere lesions. Psychosomatics. 1993 Nov-Dec. 34(6):524-30.
[Medline].

26. Daum C, Hubschmid M, Aybek S. The value of 'positive' clinical signs for weakness, sensory and gait disorders in conversion
disorder: a systematic and narrative review. J Neurol Neurosurg Psychiatry. 2014 Feb. 85 (2):180-90. [Medline].

27. Stone J, Mutch J, Giannokous D, Hoeritzauer I, Carson A. Hurst revisited: Are symptoms and signs of functional motor and
sensory disorders "dependent on idea"?. J Neurol Sci. 2017 Oct 15. 381:188-191. [Medline].

28. Binzer M, Andersen PM, Kullgren G. Clinical characteristics of patients with motor disability due to conversion disorder: a
prospective control group study. J Neurol Neurosurg Psychiatry. 1997 Jul. 63(1):83-8. [Medline].

29. McCahill ME. Somatoform and related disorders: delivery of diagnosis as first step. Am Fam Physician. 1995 Jul. 52(1):193-
204. [Medline].

30. Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. 2007
Dec. 69(9):881-8. [Medline].

31. Speed J. Behavioral management of conversion disorder: retrospective study. Arch Phys Med Rehabil. 1996 Feb. 77(2):147-
54. [Medline].

32. Shapiro AP, Teasell RW. Behavioural interventions in the rehabilitation of acute v. chronic non-organic (conversion/factitious)
motor disorders. Br J Psychiatry. 2004 Aug. 185:140-6. [Medline].

33. Cottencin O. Conversion disorders: psychiatric and psychotherapeutic aspects. Neurophysiol Clin. 2014 Oct. 44 (4):405-10.

https://emedicine.medscape.com/article/805361-print Page 10 of 11
 02/12/18 18.24

[Medline].

34. Solvason HB, Harris B, Zeifert P, et al. Psychological versus biological clinical interpretation: a patient with prion disease. Am
J Psychiatry. 2002 Apr. 159(4):528-37. [Medline].

35. Lok U, Yalin O, Odes R, Bozkurt S, Gulacti U. Bilateral thalamic infarct as a diagnosed conversion disorder. Am J Emerg
Med. 2013 Feb 8. [Medline].

36. Li W, Brandon O, Smith DV, Petersen E. A conversion disorder or a stroke? A proximal basilar artery thrombosis induced
'locked-in' syndrome in a young Caucasian woman. BMJ Case Rep. 2013 Mar 14. 2013:[Medline].

37. Teasell RW, Shapiro AP. Misdiagnosis of conversion disorders. Am J Phys Med Rehabil. 2002 Mar. 81(3):236-40. [Medline].

38. Glick TH, Workman TP, Gaufberg SV. Suspected conversion disorder: foreseeable risks and avoidable errors. Acad Emerg
Med. 2000 Nov. 7(11):1272-7. [Medline].

39. Binzer M, Kullgren G. Motor conversion disorder. A prospective 2- to 5-year follow-up study. Psychosomatics. 1998 Nov-Dec.
39(6):519-27. [Medline].

40. Tobiano PS, Wang HE, McCausland JB, et al. A case of conversion disorder presenting as a severe acute stroke. J Emerg
Med. 2006 Apr. 30(3):283-6. [Medline].

41. Stone J, Smyth R, Carson A, et al. Systematic review of misdiagnosis of conversion symptoms and "hysteria". BMJ. 2005
Oct 29. 331(7523):989. [Medline].

https://emedicine.medscape.com/article/805361-print Page 11 of 11