FFinalistSouthampton · 2027
Psychiatry
AKT · Psychiatry/Personality & other

Conversion (functional neurological) disorder

Overview

Neurological symptoms (weakness, sensory loss, non-epileptic seizures, blindness) that are genuine and unconsciously produced — incompatible with recognised neurological disease on examination. Not feigned (unlike malingering/factitious).

Recognise

  • Motor (limb weakness, gait), sensory, or non-epileptic attack disorder
  • Positive functional signs: Hoover sign (functional leg weakness), give-way weakness, tremor entrainment
  • Symptoms are genuine and NOT consciously produced; "la belle indifférence" is unreliable

Red flags

  • Must exclude organic neurological disease; new "functional" symptoms in the elderly warrant caution

Differentials & how to tell them apart

Organic neurological diseaseexamination/imaging consistent with a lesion; no positive functional signs
Factitious disordersymptoms CONSCIOUSLY produced to assume the sick role (no external gain)
Malingeringsymptoms CONSCIOUSLY feigned for external gain (money, avoiding work)
Somatic symptom disorderexcessive distress about somatic symptoms generally, not a single neurological deficit

Investigations

Diagnosis is POSITIVE (functional signs), not just exclusion. Targeted investigation to exclude organic disease; video-EEG for non-epileptic attacks.

Management

  1. 1Give a clear, POSITIVE diagnosis (not "nothing is wrong"); physiotherapy (functional motor) / psychology / CBT.Gate: Symptoms are genuine and unconscious → distinguishing from malingering (conscious + external gain) and factitious (conscious + sick role) changes management entirely
  2. 2MDT functional-disorder rehabilitation; treat comorbid depression/anxiety.
No drug — physiotherapy, CBT, and a clear positive explanation of the diagnosis

Key points

The conscious/unconscious × internal/external grid: conversion (unconscious), factitious (conscious, sick role), malingering (conscious, external gain). Positive signs (Hoover) make the diagnosis.

Monitor & prognosis

Functional recovery; comorbid mood.

Variable; better with early positive diagnosis and rehabilitation.

Source: StatPearls; neurology / liaison psychiatry