A 38-year-old woman develops sudden inability to walk following news of her husband's death in an accident. Neurological examination reveals normal reflexes, no Babinski sign, and a positive Hoover's sign. Brain and spinal MRI are normal. What is the DSM-5 diagnosis and what has replaced the DSM-IV requirement for a psychological precipitant?
- A Somatic symptom disorder; requires excessive thoughts, feelings, and behaviours about the symptom
- B Illness anxiety disorder; reassurance-seeking must be present
- C Functional neurological symptom disorder (conversion disorder); a psychological precipitant is no longer required — diagnosis is based on positive clinical signs of internal inconsistency ✓
- D Factitious disorder; conscious simulation must be demonstrated
Explanation
DSM-5 renamed conversion disorder to 'functional neurological symptom disorder' (FNSD) and eliminated the DSM-IV requirement for an identifiable psychological stressor preceding symptoms — this requirement was dropped because it could not be reliably established and led to exclusion of genuine cases. The DSM-5 diagnosis is now based on positive clinical evidence of inconsistency between the neurological symptom and established neurological disease, exemplified by the Hoover's sign (involuntary hip extension during contralateral leg flexion, demonstrating preserved motor function), variable tremor frequency on change of attention, and other non-organic signs. Psychological stressors are still relevant but are no longer necessary for the diagnosis.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.