A 22-year-old woman presents with sudden inability to move her right arm after witnessing domestic violence. Neurological examination, MRI brain, and nerve conduction studies are all normal. She appears remarkably unconcerned about her disability ('la belle indifférence'). The most likely DSM-5 diagnosis is:
- A Somatic Symptom Disorder
- B Functional Neurological Symptom Disorder (Conversion Disorder) ✓
- C Factitious Disorder Imposed on Self
- D Malingering
Explanation
Functional Neurological Symptom Disorder (FNSD), previously Conversion Disorder, is characterised by one or more symptoms of altered voluntary motor or sensory function, with clinical findings incompatible with known neurological or medical conditions, not better explained by another diagnosis. DSM-5 emphasises positive neurological signs of inconsistency (e.g., Hoover sign, tremor entrainment) rather than requiring psychological stressor identification. La belle indifférence (relative lack of concern) is an associated feature, though not pathognomonic. Factitious Disorder and Malingering both involve intentional symptom production; FNSD symptoms are not consciously produced.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.