Objective: The review of a case diagnosed as Conversion Disorder (CD) in a University Movement Disorders clinic is presented here.  As this patient eventually recovered fully after 3 years of treatment, critical review of the psychiatrist’s initial evaluation and impression is informative in retrospect.

Background: An 18 year old girl developed left hand dystonic clenching that progressed to a generalized and severe dystonic/choreiform movement disorder over the course of several months.  The patient was seen at a University Movement Disorder clinic where she was diagnosed with conversion disorder.  Several months later, with approximately one year of symptoms, the patient presented to our clinic with a severe ballistic/dystonic/choreiform movement disorder which included self injury and disability to the the point of starvation.

Method: Retrospective review of our psychiatry specialist’s initial evaluation of the patient at one year into her condition is reviewed with seven indicative factors that led to his impression of a very low index of suspicion for CD.

Results: 1.  There was not a significant element of distractability including with hypnosis.  2.  There was the ability to address the childhood trauma with the patient who did not use dissociation and conversion as defenses.  3.  Time regression in trance to before the onset of her movements did not relieve it.  4.  The fact that the patient was harming herself with the uncontrolled movements, banging her head, biting her tongue, was not what conversion patients typically do.  5.  The fact she was willing to consider this psychological where most psychogenic patients are very upset and resistant to such suggestions and insist it is organic.  6.  The abnormal movements occurred as much when she knew she was being observed as when she was not aware of being observed.  7.  There was no symbolic meaning to the movements.

Conclusion: Distinguishing organic from psychogenic etiology can be challenging, with specialists in neurology and psychiatry honing expertise over many years.  We present here a patient who ultimately had a remarkable outcome from a severe and disabling movement disorder and whose initial evaluation by our psychiatry colleagues supported our impression that this was not Conversion Disorder and eventually led to complete recovery.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/severe-movement-disorder-initially-suspected-of-being-conversion-key-insights-from-the-psychiatrist/