Conversion syndromes in neurology - A psychopathological and psychodynamical differentiation into conversion disorder, somatisation disorder and factitious disorder

Conversion syndromes are frequent among medically unexplained somatic sympt oms in neurology. A careful differential diagnosis must be carried out in a psychiatric consultation service. In a prospective study lasting for over four years 169 patients with pseudoneurological signs of conversion were in cluded. From a clinical point of view the following conversion syndromes we re presented: astasia/abasia: 27.2%, paresis/plegia: 24.3%, aphonia: 1.8%, hyp-/anaesthesia: 21.9%, blindness: 5.3%, non-epileptic seizures: 19.5%. Ac cording to the diagnostic criteria of DSM-III-R three subgroups were differ entiated: conversion disorder (n = 132), somatisation disorder (n = 28), fa ctitious disorder (n = 9). Intermittent courses of illness were prevailing in conversion disorder, whereas chronic courses predominated in the other t wo subgroups. High rates of psychiatric comorbidity were typical signs of s omatisation disorder. Frequent autodestructive motives (suicidality, delibe rate and covert self-harm, chronic pain, high rate of operations) in illnes s behaviour had to be registered in somatisation and factitious disorder. B oth subgroups were characterised by frequent traumatic events during early development. Important socio-economic aspects of illness behaviour above al l in somatisation and factitious disorder were underlined. The results are discussed in terms of psychiatric differential diagnosis and psychiatric co morbidity, psychodynamic evaluation, illness behaviour and therapeutic opti ons in a C/L-service.