Factitious disorder and malingering. The diagnosis of conversion disorder does not re- quire the judgment that the symptoms are not intentionally produced (i.e., not feigned), because assessment of conscious intention is unreliable. However definite evidence of feigning (e.g., clear evidence that loss of function is present during the examination but not at home) would suggest a diagnosis of factitious disorder if the individual’s apparent aim is to assume the sick role or malingering if the aim is to obtain an incentive such as money.
Dissociative disorders. Dissociative symptoms are common in individuals with con- version disorder. If both conversion disorder and a dissociative disorder are present, both diagnoses should be made.
Body dysmorphic disorder. Individuals with body dysmorphic disorder are exces- symptoms of sensory or motor functioning in the affected body part.
Depressive disorders. In depressive disorders, individuals may report general heavi- ness of their limbs, whereas the weakness of conversion disorder is more focal and prom- inent. Depressive disorders are also differentiated by the presence of core depressive symptoms.
Panic disorder. Episodic neurological symptoms (e.g., tremors and paresthesias) can occur in both conversion disorder and panic attacks. In panic attacks, the neurological symptoms are typically transient and acutely episodic with characteristic cardiorespira- tory symptoms. Loss of awareness with amnesia for the attack and violent limb move- ments occur in non-epileptic attacks, but not in panic attacks.
Anxiety disorders, especially panic disorder, and depressive disorders commonly co—occur with conversion disorder. Somatic symptom disorder may co-occur as well. Psychosis, sub- stance use disorder, and alcohol misuse are uncommon. Personality disorders are more common in individuals with conversion disorder than in the general population. Neuro- logical or other medical conditions commonly coexist with conversion disorder as well.
A. A medical symptom or condition (other than a mental disorder) is present.
B. Psychological or behavioral factors adversely affect the medical condition in one of the following ways: 1. The factors have inﬂuenced the course of the medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the medical condition.
2. The factors interfere with the treatment of the medical condition (e.g., poor adher- ence).
3. The factors constitute additional weII-established health risks for the individual.
4. The factors influence the underlying pathophysiology, precipitating or exacerbating symptoms or necessitating medical attention.
C. The psychological and behavioral factors in Criterion B are not better explained by an- other mental disorder (e.g., panic disorder, major depressive disorder, posttraumatic stress disorder).
Specify current severity:
Mild: Increases medical risk (e.g.. inconsistent adherence with antihypertension treat- ment).
Moderate: Aggravates underlying medical condition (e.g., anxiety aggravating asthma).
Severe: Results in medical hospitalization or emergency room visit.
Extreme: Results in severe, life-threatening risk (e.g., ignoring heart attack symp- toms).
The essential feature of psychological factors affecting other medical conditions is the presence of one or more clinically significant psychological or behavioral factors that ad- versely affect a medical condition by increasing the risk for suffering, death, or disability (Criterion B). These factors can adversely affect the medical condition by inﬂuencing its course or treatment, by constituting an additional well—established health risk factor, or by inﬂuencing the underlying pathophysiology to precipitate or exacerbate symptoms or to necessitate medical attention.