Presenting Complaints

• Patients exhibit unusual or dramatic physical symptoms such as seizures, amnesia, trance, loss of sensation, visual disturbances, paralysis, aphonia, identity confusion, "possession" states.

Diagnostic Features

• Physical symptoms that are:
  • unusual in presentation
  • not consistent with know disease
    
    
• Onset is often sudden and related to psychological stress or difficult personal circumstances.
  
  
• In acute cases symptoms may
  • be dramatic and unusual
  • severity may change from minute to minute
  • symptoms related to attention from others
    
    
• In more chronic cases, patient may look calm, relative to seriousness of complaint.
• Presentation may vary widely in different cultures.

Differential Diagnosis

• Carefully consider medical/physical explanations. A full history and physical (including neurological) examination are essential. Early symptoms of neurological disorders (e.g. multiple sclerosis) can resemble conversion symptoms.
• When other unexplained physical symptoms are present, see section on Unexplained Somatic Complaints.

When pronounced depressive symptoms are present, see section on Depression.