Misdiagnosis of conversion symptoms

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7525.1145-c (Published 10 November 2005) Cite this as: BMJ 2005;331:1145

Conversion disorders still exist

  1. James Paul Pandarakalam (jpandarak{at}hotmail.com), consultant psychiatrist
  1. St Helens North Community Mental Health Trust, Peasley Cross Resource Centre, St Helens, Merseyside WA9 3DA

    EDITOR—The concept that unresolved tension from psychological conflict is either transferred to the parasympathetic system causing psychosomatic diseases or to the muscular system leading to conversion reactions still holds water. Laypeople's psychiatric vocabulary has improved: patients can better articulate their distress, and this has probably resulted in the decline of conversion disorders.1 Many potential conversion disorders now present as straightforward cases of depression.

    True cases of conversion disorder still exist. As a whole, conversion disorders are characterised by sensory, motor, or visceral symptoms; commonly missed symptoms are gait and movement disorders. Hoover's contralateral leg sign is currently less talked about in academic circles, but it is still useful in differentiating hysterical hemiplegia from true hemiplegia. This is demonstrated by placing the palm underneath the ankle of the affected leg and asking the patient to raise the unaffected leg; the examiner can feel the pressure in his or her palm in true hemiplegia.


    • Competing interests None declared.


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