Key Takeaways
- Lifetime prevalence of conversion disorder is approximately 5 per 100,000
- Annual incidence rate is 4-5 cases per 100,000 population
- Female-to-male ratio is 2:1 in adults
- Paralysis is the most common symptom (40% of cases)
- Sensory loss reported in 30% of patients
- Non-epileptic seizures in 25% of presentations
- Childhood sexual abuse history in 30-50% of cases
- Stressful life events precede 70% of onsets
- Trauma association in 40%
- Diagnosis requires exclusion of neurological disease (95% accuracy)
- DSM-5 criteria met in 85% via clinical interview
- Hoover's sign positive in 60% motor cases
- CBT effective in 70% of treated cases
- Physiotherapy resolves motor symptoms in 60%
- Antidepressants help 50% with comorbid depression
Conversion disorder affects 50 in 100,000 globally, is often triggered by stress, and has a high recovery rate in children.
Diagnosis
- Diagnosis requires exclusion of neurological disease (95% accuracy)
- DSM-5 criteria met in 85% via clinical interview
- Hoover's sign positive in 60% motor cases
- EEG normal in 98% of non-epileptic seizures
- MRI brain normal in 90%
- Video-EEG telemetry confirms 92% PNES
- Sensitivity of clinical diagnosis 75%, specificity 90%
- fMRI shows voluntary control in 70%
- MMPI-2 detects inconsistency in 80%
- Positive distraction tests in 65%
- Interrater reliability kappa 0.78 for diagnosis
- Rule out MS/SLE first (missed in 5%)
- Symptom validity testing accurate 85%
- DSM-IV to DSM-5 change improves specificity by 15%
- Pediatric diagnosis challenges in 40% due to suggestibility
Diagnosis Interpretation
Epidemiology
- Lifetime prevalence of conversion disorder is approximately 5 per 100,000
- Annual incidence rate is 4-5 cases per 100,000 population
- Female-to-male ratio is 2:1 in adults
- Peak age of onset is between 20-40 years
- Prevalence in children is 2-10 per 100,000
- Higher rates in rural populations (up to 20% increase)
- 25% of neurology outpatients have conversion symptoms
- Global prevalence estimated at 50 per 100,000
- Increased incidence post-trauma (15% of cases)
- 30% comorbidity with anxiety disorders
- Mean duration of symptoms is 6 months
- 40% of cases remit within 1 year
- Prevalence in military personnel is 10 per 10,000
- Urban vs rural: 1.5 times higher in urban areas
- Lifetime risk in women: 0.1-0.5%
- 15% of cases in adolescents aged 10-19
- Incidence doubled during COVID-19 (from 4 to 8/100k)
- 5% of general neurology referrals
- Ethnic minorities show 20% higher rates
- Seasonal variation: peak in winter (25% more cases)
Epidemiology Interpretation
Etiology
- Childhood sexual abuse history in 30-50% of cases
- Stressful life events precede 70% of onsets
- Trauma association in 40%
- Depression comorbidity in 50%
- Genetic factors contribute 10-20% heritability
- Dissociative disorders overlap in 25%
- Childhood physical abuse in 25%
- Personality disorders in 30% of patients
- Socioeconomic stress factor in 60%
- Hysteria model linked to 80% psychological triggers
- Brain imaging shows altered connectivity in 40%
- Malingering ruled out in 90%, but suggestion plays role in 15%
- Autoimmune links in 5-10%
- Cultural factors influence symptom choice (e.g., trance in 20% Asia)
- Family history of mental illness in 35%
- Perfectionism trait in 45% of cases
Etiology Interpretation
Prognosis
- 70% spontaneous remission without treatment
- Chronicity in 20-30% after 5 years
- Relapse rate 25% within 2 years
- Full recovery in 90% children vs 60% adults
- Mortality risk 2% from complications
- Disability persists in 15%
- Comorbid anxiety worsens prognosis (40% chronic)
- Early intervention improves outcome by 50%
- 5-year follow-up: 50% symptom-free
- PNES prognosis better with therapy (80% control)
- Socioeconomic status predicts recovery (high SES 70%)
- Multiple episodes reduce recovery to 40%
- La Belle indifference correlates with good prognosis (75%)
- Trauma-resolved cases 85% remit
- Long-term SSRI halves chronic risk
- Pediatric cases 95% resolve by adulthood
Prognosis Interpretation
Symptoms
- Paralysis is the most common symptom (40% of cases)
- Sensory loss reported in 30% of patients
- Non-epileptic seizures in 25% of presentations
- Gait abnormalities in 20% of cases
- Visual disturbances (blindness) in 15%
- Speech disorders (aphonia) in 10%
- Tremor as presenting symptom in 18%
- Weakness or paralysis affects limbs in 50%
- Symptoms often unilateral (60%)
- Sudden onset in 80% of cases
- Associated pain in 35% of patients
- Cognitive symptoms like amnesia in 12%
- Motor symptoms predominate (70%) over sensory (30%)
- Swallowing difficulties (globus) in 8%
- Positive signs (e.g., Hoover's sign) in 65%
- Symptoms inconsistent with anatomy (75%)
- La Belle indifference in 20-30%
- Multiple symptoms simultaneous in 40%
Symptoms Interpretation
Treatment
- CBT effective in 70% of treated cases
- Physiotherapy resolves motor symptoms in 60%
- Antidepressants help 50% with comorbid depression
- Hypnotherapy success rate 75% short-term
- Multidisciplinary approach best (80% improvement)
- SSRIs remit symptoms in 45%
- Psychoeducation reduces relapse by 40%
- PT with behavioral reinforcement 65% success
- Family therapy aids 55% pediatric cases
- Mindfulness reduces symptoms 50%
- Placebo response in 30%
- Inpatient rehab 70% discharge improved
- Biofeedback effective 60%
- No benefit from antipsychotics (10% response)
- Internet-based CBT 65% efficacy
Treatment Interpretation
Sources & References
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