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Chapter 37. Conversion Disorder

José R. Maldonado, M.D.
DOI: 10.1176/appi.books.9781585622986.260013

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Excerpt

DSM-IV-TR (American Psychiatric Association 2000) has six criteria for the diagnosis of conversion disorder. The essential diagnostic feature is "one or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition" (criterion A, p. 498). Although this criterion was used in DSM-I (American Psychiatric Association 1952) and DSM-II (American Psychiatric Association 1968), it was broadened in DSM-III (American Psychiatric Association 1980) to encompass symptoms involving "a loss of or alteration in physical functioning that suggests a physical disorder" (p. 244). Criterion B establishes that "psychological factors are judged to be associated with" (p. 498) the initiation and maintenance of symptoms or deficits. Criterion C was added to rule out the intentional (feigned) production of symptoms, as in factitious disorder or malingering. Criterion D establishes that the symptom or deficit cannot, after appropriate investigation, be fully explained by a neurological or other general medical condition or by the direct effects of a substance. It also establishes that culturally sanctioned behaviors or experiences (e.g., possession syndrome) may not be diagnosed as a conversion disorder. Criterion E establishes that the symptoms must have clinical significance as evidenced by the presence of significant distress, social or occupational impairment, or the need to pursue medical evaluation and treatment. Finally, criterion F notes that the symptom or deficit "is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder" (p. 498).

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Table Reference Number
Table 37–1. Steps in the treatment of conversion disorders
Table Reference Number
Table 37–2. Specific techniques used in the treatment of conversion disorder 

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