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Conversion Disorders (functional neurological symptom disorders):

The Diagnosis of Conversion Disorder and the Rejection of other Somatic Symptoms Disorder

Tabe Ekureh Tarkang Bessem

Presentation College

August 2, 2019
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Conversion Disorders (functional neurological symptom disorders):

After reading the case study about Ms. Paulina Davis, the 32years old African American

woman diagnosed with epilepsy, I have come to realized that she was suffering from conversion

disorder. This disorder is mostly diagnosed in late childhood and young adulthood and affects

twice as much women than men (Comer, 2015). People with this disorder, especially Paulina are

often presented with physical symptoms that normally affects their sensory and motor functioning,

but which are not consistent with a known medical disease, as she had episode of seizure activities

for which none was associated with epileptiform activities on her EEG. This make the diagnoses

hard to distinguish from genuine medical problems (Comer, 2015). A characteristic difference

between this disorder and other related disorder like factitious disorder is that with conversion, the

symptoms are not deliberately or purposely produced.

According to the DSM-5, there are four criteria that an individual need to meet in other to

be diagnosed with conversion disorder, these include;

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

B. Clinical findings provide evidence of incompatibility between the symptom and
recognized neurological or medical conditions.
C. The symptom or deficit is not better explained by another medical or mental disorder.
D. The symptom or deficit causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning or warrants medical evaluation.

Coding note: The ICD-9-CM code for conversion disorder is 300.11, which is assigned
regardless of the symptom type. The ICD-10-CM code depends on the symptom type (see
below).

Specify symptom type:

 (F44.4) With weakness or paralysis

 (F44.4) With abnormal movement (e.g., tremor, dystonic movement, myoclonus, gait
disorder)
 (F44.4) With swallowing symptoms
 (F44.4) With speech symptom (e.g., dysphonia, slurred speech)
 (F44.5) With attacks or seizures
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 (F44.6) With anesthesia or sensory loss

 (F44.6) With special sensory symptom (e.g., visual, olfactory, or hearing disturbance)
 (F44.7) With mixed symptoms

Specify if:

 Acute episode: Symptoms present for less than 6 months.

 Persistent: Symptoms occurring for 6 months or more.

Specify if:

 With psychological stressor (specify stressor)

 Without psychological stressor (American Psychiatry Association, 2013)

Paulina Davis fits into criteria A because at the hospital she had an acute episode of convulsion

for which review of the EEG showed no epileptiform activities. Even when she was placed on

video EEG -monitoring she still had several episodes of convulsive motor activities that were not

related to the expected epileptiform activities that EEG would identify.

She also fits into criteria B because her symptoms are inconsistent with the findings of the

EEG, there was no normal simultaneous occurrence of tremor or dystonic movement when

compared to the EEG. Medically there should be a simultaneous activity showed on EEG, which

is in line with the convulsive activities that Ms. Davis is having. Laboratory test finding results

showed a therapeutic level of her usual antiepileptics with no further evidence of infection or

metabolic imbalance. Urinalysis was obviously negative of illicit drugs use. So clinical findings

do not confirm or relate to her medical condition.

Ms. Davis also fits into criteria C since her symptoms can not be explained by other

medical conditions, she was referred to a psychiatrist. She refused being depressed, having suicidal

thought and denies any signs or symptoms associated with mania of psychosis. She was well

groomed and have no history of substance abuse or psychiatric illness, and engages in conversation

with good eye contact, with no cognitive deficits revealed from cognitive testing.
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She also fit into the last criteria because these symptoms are causing her impairment in

social functioning and significant distress. She was worried that the long-term impact that the

seizure might have on her and being hospitalized. She was worried about the cost of hospitalization

since she is running on a budget. She was also worried about missing the first day of class.

The specific symptoms type for Ms. Davis diagnosis would be conversion disorder

(F44.5) with attacks or seizures, Acute episode with symptoms present for less than 6 months

without any psychological stressors (American Psychiatry Association, 2013).

Rejection of other Disorders

The possible disorders that looks like conversion disorder that can be rejected from these

diagnoses are somatic symptoms disorder and factitious disorder.

Ms. Davis is not worried about her symptoms but worries about the future, which makes

this disorder different from other disorders like somatic symptom disorder. People with somatic

symptoms disorder are excessively worried or concerned about their bodily symptoms that they

are experiencing, which causes a significant impairment in their social functioning. Their symptom

normally last longer and are less dramatic than that of conversion disorder (Comer, 2015). People

with somatic symptoms disorder spend excessive time and energy towards their health problems,

which give them anxiety lasting for more than six months (American Psychiatry Association,

2013).

Ms. Davis cannot be deliberately producing her symptoms by going into seizure episodes

all the time (convulsing at home and at the hospital), this rule out the fact that she might be

suffering from factitious disorder rather than conversion disorder. People with factitious disorder

will fake or induce physical symptoms purposely to seek medical attention.

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Other disorder such as dissociative disorder, body dysmorphic disorder, depressive and

panic disorder can also be ruled out since she denies depression, have no cognitive impairment or

anxiety and she is not overly concerned about her medical condition or any body parts. She went

home against medical advice and with no medication, because she was mad about what “people

think”.

Conclusion

Conclusively I can clearly state that Ms. Davis is suffering from conversion disorder.

According to the diagnostic and statistical manual of mental disorder (DSM-5) coding

300.11(regardless of symptoms) and (F44.5) with attack or seizure, person with this disorder

have diagnostic feature that include; one or more episodes of voluntary motor or sensory function

alterations, clinical incompatibility between experienced symptoms and recognized medical

condition, symptoms cannot be explained by another medical or mental disorder and it causes

severe impairment in social or occupational functioning. This disorder commonly affects women

than do men.
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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Arlington, VA: Author.

Comer, R. J. (2015). Abnormal Psychology (9th ed). New York, NY: Worth Publishers.