Posttraumatic Personality Disorders
Rolland S. Parker in Concussive Brain Trauma, 2016
Conversion disorder is defined by the presence of symptoms or deficits that suggest a neurological or other general condition. Conversion symptoms do not conform to known anatomical patterns or physiological mechanisms, but may be shaped by the individual’s conceptualization of some function. Misdiagnosis may occur with later identification of definite medical symptoms; the examiner should be cautious about overcertainty concerning current diagnostic techniques. While one cannot be certain, and secondary gain occurs, conversion disorder is differentiated from malingering or factitious disorder by the assumption that symptoms are not intentionally produced to gain benefits (American Psychiatric Association, 2000, pp. 492–498, DSM-TR 300.11). Motor symptoms include impaired coordination or balance, paralysis or localized weakness, aphonia, difficulty swallowing or the sensation of a lump in the throat, urinary detention, and seizures or convulsions. Sensory symptoms include loss of touch, anesthesia, pain, double vision, blindness, and hallucinations.
Malingering
Alan R. Hirsch in Neurological Malingering, 2018
In contrast, somatic symptom disorder presents in a psychologically unwell patient who unconsciously feigns symptoms with no physical cause; complaints are often multiple, vague, and span multiple organ systems. Conversion disorder may be thought of as an extreme of somatic symptom disorder in which a stressor often precipitates a significant sensory or neurological symptom, which cannot be explained by a neurological disease or another medical condition. Factitious disorders are similar to malingering in that patients are pursuing a goal, particularly attention or sympathy from doctors, friends, or family rather than financial secondary gain. Patients having psychiatric involvement and behavior is deliberate. However, unlike malingering, these individuals are often willing to undergo painful/dangerous tests or treatments. Lastly, illness anxiety disorder can be observed in patients who are psychologically unwell, where they genuinely believe they may be affected by a condition but seek no intrinsic or extrinsic gain. Malingerers, compared to the aforementioned disorders, consciously seek extrinsic gain.
Questions and Answers
David Browne, Brenda Wright, Guy Molyneux, Mohamed Ahmed, Ijaz Hussain, Bangaru Raju, Michael Reilly in MRCPsych Paper I One-Best-Item MCQs, 2017
Answer: D. In somatisation disorder the patient experiences persistent recurrent multiple physical symptoms starting in early adult life or earlier. There is usually a long history of inconclusive medical and/or surgical investigations and procedures, and high rates of social and occupational impairment. The DSM-IV criteria require four pain symptoms, two gastro-intestinal symptoms, one sexual symptom, and one pseudoneurological symptom for the diagnosis. Conversion disorder involves symptoms or deficits affecting voluntary motor or sensory function, which cannot be fully explained by a general medical condition. Hypochondriasis is distinguished from somatisation disorder by the patient’s preoccupation with the underlying cause rather than symptom relief. Somatoform pain disorder is characterised by persistent severe and distressing pain, at one or more anatomical sites, which is not fully explained by a physical disorder. Patients with major depressive disorder may present with non-specific physical complaints, although these are not predominant in the clinical picture. In all of the above disorders the symptoms are not intentionally produced or feigned, distinguishing them from factitious disorder or malingering. [AH. pp. 229–36]
Psychogenic blepharospasm associated with Meige’s syndrome: a case report
Published in Psychiatry and Clinical Psychopharmacology, 2018
Cagdas Oyku Memis, Mustafa Kurt, Gulgez Kerimova, Bilge Dogan, Doga Sevincok, Levent Sevincok
This case demonstrates that the differential diagnosis of functional neurological symptom disorders per DSM-5 is a process of integrating neurological and psychosocial findings. Associated psychological stress and conflicts were related to conversion disorder, but Meige’s syndrome also provided an opportunity for model learning in coexistence of both disorders [7]. We also suggest that such an association might develop in cases who are suffering from several long-term medical illnesses. Our case indicates the necessity of a close clinical collaboration of neurologists and psychiatrists in a comprehensive and ongoing psychosomatic and neurological diagnostic assessment of a neurological symptom. The absence of obvious evidences of biological dysfunction underlying neurological symptoms should not lead directly to the diagnosis of a conversion disorder. We also recommend that the clinicians should take into account the co-occurrence of Meige’s syndrome and pseudo-blepharospasm in their patients.
A qualitative study of the experiences and perceptions of patients with functional motor disorder
Published in Disability and Rehabilitation, 2020
Glenn Nielsen, Marta Buszewicz, Mark J. Edwards, Fiona Stevenson
Prior to their consultation with the study neurologist, most participants had received a psychological explanation for their problem. For example, some were told that they had conversion disorder, which was caused by recent or past stressful events. Participants generally expressed dissatisfaction with these types of psychological explanations for their symptoms. Several acknowledged having been affected by psychological problems or psychological trauma (which included anxiety, depression, bipolar disorder, and an abusive relationship); however they felt these issues were not directly related to their movement problem.
Malingering, conversion and factitious disorders. The emotional and monetary costs to the healthcare delivery system
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
We would like to describe the case of a 30 year old otherwise healthy but obese Caucasian lady who was admitted to our hospital on two occasions separated by about four months. The admitting diagnosis was low back pain. The patient did give an underlying history of depression and anxiety and was on treatment for this. An MRI of the lumbosacral spine was performed prior to the first hospitalization revealed mild left-sided L5 S1 foraminal stenosis. The patient’s hospitalization was remarkable for a physical examination that lacked consistency. The patient required high doses of narcotic analgesics. She was subsequently discharged and evaluated by physiatry. Electrophysiological studies performed on an outpatient basis did not reveal any evidence of a radiculopathy. The patient was then readmitted to this facility for excruciating low back pain. An MRI of the lumbosacral spine performed with and without contrast did not reveal any new abnormality. The patient again required high-dose narcotic analgesics and was scheduled for discharge after the weekend. Immediately prior to discharge, the patient developed acute onset flaccid paralysis of the right lower extremity. The exam, however, was non-physiologic and reflexes were preserved. Lumbosacral MRI was repeated and, additionally, that of the thoracic spine was performed with and without contrast to rule out a disc herniation, osteomyelitis-disciitis, an epidural abscess, malignancy or demyelination. This was done on a stat basis and routinely scheduled patients were moved around at great inconvenience. This was negative. Neurology was consulted and further MR imaging of the brain and the cervical spine was ordered. The former was negative. The latter revealed an acquired superimposed on congenital cervical spinal stenosis with a left paracentral C4-5 disc herniation indenting the left side of the spinal cord. However, a cerebrospinal fluid stripe could be seen dorsal to the spinal cord on sagittal T2-weighted imaging. The MRI of the cervical spine did not explain the patient’s clinical condition. She was subsequently evaluated by our physical/occupational therapists and psychiatrists. A diagnosis of a conversion disorder was offered.
Related Knowledge Centers
- Dissociative Disorder
- Hypoesthesia
- Visual Impairment
- Paralysis
- Depression
- Neurology
- Psychogenic NON-Epileptic Seizure
- Trauma Trigger
- Functional Neurologic Disorder
- Stressor