Conversion and dissociative disorders ICD F44 formerly called hysteria

Conversion disorder is the current term for syndromes in which there is loss of physical function, such as paralysis of a limb, blindness, or fits, that cannot be explained by physical disease. The condition is regarded as not intentionally produced, thereby distinguishing it from factitious disorder (see below). It tends to develop acutely in stressful circumstances. Such symptoms appear to express an emotional conflict or need, and may bear some symbolic relationship to the nature of the stress. For example, one student developed a paralysed right hand the day before a written examination. The symptoms often appear to bring advantages for the patient: a 'primary gain' of keeping psychological stress at bay, and a 'secondary gain' of attracting sympathy and support or avoiding unwelcome obligations.

Most cases seen today tend to resolve quickly, although they may recur under repeated stress. Florid cases, with severe features such as chronicity and unconcern about the symptoms ('la belle indifférence'), are rare in modern Western society. Civilian cases tend to occur in women, but male cases are encountered in military settings during wartime. Epidemic forms occur.

Dissociative disorder refers to a similar presentation; however, the loss is not of physical function but of mental, such as psychogenic amnesia. Fugue is a classic manifestation, in which the patient travels away from his home area, and turns up far away with no memory of himself or how he got there. Liaison with police, who will check missing persons alerts, is often necessary. Obvious stressors (e.g. legal, family, or financial) in the background are often discovered. Gradual recovery is usual.

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