Specify symptom type: (F44.4) Wlth weakness or paralysis (F44.4) With abnormal movement (e.g., tremor, dystonic movement, myoclonus, gait (F44.4) With swallowing symptoms (F44.4) With speech symptom (e.g., dysphonia, slurred speech) (F44.5) With attacks or seizures (F44.6) With anesthesia or sensory loss (F44.6) With special sensory symptom (e.g., visual, olfactory, or hearing distur- (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 it:
Many clinicians use the alternative names of "functional" (referring to abnormal central nervous system functioning) or ”psychogenic” (referring to an assumed etiology) to de- scribe the symptoms of conversion disorder (functional neurological symptom disor- der). In conversion disorder, there may be one or more symptoms of various types. Motor symptoms include weakness or paralysis; abnormal movements, such as tremor or dys- tonic movements; gait abnormalities; and abnormal limb posturing. Sensory symptoms include altered, reduced, or absent skin sensation, vision, or hearing. Episodes of abnor- mal generalized limb shaking with apparent impaired or loss of consciousness may resem- ble epileptic seizures (also called psychogenic or non-epileptic seizures). There may be episodes of unresponsiveness resembling syncope or coma. Other symptoms include re- duced or absent speech volume (dysphonia/aphonia), altered articulation (dysarthria), a sensation of a lump in the throat (globus), and diplopia.
Although the diagnosis requires that the symptom is not explained by neurological disease, it should not be made simply because results from investigations are normal or because the symptom is ”bizarre.” There must be clinical findings that show clear evidence of incompatibility with neurological disease. Internal inconsistency at examination is one way to demonstrate incompatibility (i.e., demonstrating that physical signs elicited through one examination method are no longer positive when tested a different way). Ex- amples of such examination findings include ' Hoover’s sign, in which weakness of hip extension returns to normal strength with con— tralateral hip ﬂexion against resistance.
0 Marked weakness of ankle plantar-ﬂexion when tested on the bed in an individual who is able to walk on tiptoes; 0 Positive findings on the tremor entrainment test. On this test, a unilateral tremor may be identified as functional if the tremor changes when the individual is distracted away from it. This may be observed if the individual is asked to copy the examiner in making a rhythmical movement with their unaffected hand and this causes the functional tremor to change such that it copies or “entrains” to the rhythm of the unaffected hand or the functional tremor is suppressed, or no longer makes a simple rhythmical move- ment.
0 In attacks resembling epilepsy or syncope ("psychogenic” non-epileptic attacks), the occurrence of closed eyes with resistance to opening or a normal simultaneous electro- encephalogram (although this alone does not exclude all forms of epilepsy or syncope).
0 For visual symptoms, a tubular visual field (i.e., tunnel vision).
It is important to note that the diagnosis of conversion disorder should be based on the overall clinical picture and not on a single clinical finding.
A number of associated features can support the diagnosis of conversion disorder. There may be a history of multiple similar somatic symptoms. Onset may be associated with stress or trauma, either psychological or physical in nature. The potential etiological rele- vance of this stress or trauma may be suggested by a close temporal relationship. However, while assessment for stress and trauma is important, the diagnosis should not be withheld if none is found.