Conversion Disorders Differential Diagnoses

Updated: Nov 09, 2015
  • Author: Scott A Marshall, MD; Chief Editor: David Bienenfeld, MD  more...
  • Print
DDx

Diagnostic Considerations

The differential diagnosis of conversion disorders is highly dependent on the manner in which the patient presents. Organic etiologies must be excluded. Some have suggested that conversion disorder not be considered a diagnosis of exclusion, [2] although a thorough medical and neurologic clinical evaluation and appropriate diagnostic testing is warranted prior to making the diagnosis of conversion. If, for example, a diagnosis of psychogenic hemiparesis is considered, organic etiologies such as tumor, stroke, multiple sclerosis, and others should be ruled out. As in working up any disease, the clinician must weigh the risks and benefits of diagnostic testing to the patient's overall condition.

Other problems to be considered include the following:

  • Epileptic seizures including frontal lobe epilepsy

  • Syncope - Cardiogenic, hypovolemia, orthostasis

  • Syncopal convulsion

  • Movement disorders - Tics, startle attacks, tremors, myoclonus

  • Sleep disorders - Narcolepsy, night terrors, restless legs syndrome, rapid eye movement sleep behavioral disorder

  • Other psychiatric disorders - Depressive disorders, anxiety disorders, panic disorder, posttraumatic stress disorder (PTSD), dissociative disorders, psychotic disorders, other somatic disorders, intermittent explosive disorder

  • Malingering

  • Medications - Toxicity (eg, tremors from high levels of valproic acid), akathisia (from neuroleptics and possibly antidepressants), EPS from neuroleptics, withdrawal from medications such as benzodiazepines, opiates, and occasionally with antidepressants such as SSRIs or SNRIs

  • Environmental exposures to chemicals or heavy metals

  • Drugs of abuse (inhalants, hallucinogens)