Systematic review of misdiagnosis of conversion symptoms and "hysteria"

doi:10.1136/bmj.38628.466898.55

BMJ, doi: 10.1136/bmj.38628.466898.55, (Published 13 October 2005)

PAPERS

Systematic review of misdiagnosis of conversion symptoms and "hysteria"

Jon Stone ¹^*, Roger Smyth ¹, Alan Carson ¹, Steff Lewis ¹, Robin Prescott ¹, Charles Warlow ¹, Michael Sharpe ¹

¹ School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh EH4 2XU

^* Correspondence to: Jon.Stone{at}ed.ac.uk.

Objective Paralysis, seizures, and sensory symptoms that areunexplained by organic disease are commonly referred to as "conversion"symptoms. Some patients who receive this diagnosis subsequentlyturn out to have a disease that explains their initial presentation.We aimed to determine how frequently this misdiagnosis occurs,and whether it has become less common since the widespread availabilityof brain imaging.

Design Systematic review.

Data sources Medline,Embase, PsycINFO, Cinahl databases, and searches of referencelists.

Review methods We included studies published since 1965on the diagnostic outcome of adults with motor and sensory symptomsunexplained by disease. We critically appraised these papers,and carried out a multivariate, random effect, meta-analysisof the data.

Results Twenty seven studies including a total of1466 patients and a median duration of follow-up of five yearswere eligible for inclusion. Early studies were of poor quality.There was a significant (P<0.02) decline in the mean rateof misdiagnosis from the 1950s to the present day; 29% (95%confidence interval 23% to 36%) in the 1950s; 17% (12% to 24%)in the 1960s; 4% (2% to 7%) in the 1970s; 4% (2% to 6%) inthe 1980s; and 4% (2% to 6%) in the 1990s. This decline wasindependent of age, sex, and duration of symptom in people includedin the studies.

Conclusions A high rate of misdiagnosis of conversionsymptoms was reported in early studies but this rate has beenonly 4% on average in studies of this diagnosis since 1970.This decline is probably due to improvements in study qualityrather than improved diagnostic accuracy arising from the introductionof computed tomography of the brain.

(Accepted 16 August 2005)

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Rapid Responses:

Read all Rapid Responses

Hysteria or conversion disorder?better diagnosis because of modern technology.: AK Al-Sheikhli
bmj.com, 20 Oct 2005 [Full text]
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Diagnosis is not pervasive: Mohammed Usman
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Decline in conversion disorders and increased cases of depression: James Paul Pandarakalam
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Misdiagnosis: Neil M Davidson
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Converts to conversion?: M E Jan Wise
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Profile of Conversion disorders among children: Pravija T Manikoth
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misdiagnosis of conversion symptoms and "hysteria": Dr Pramod Koyee
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