A 35-year-old woman presents with a sudden onset of inability to walk, with normal sensation. Neurological exam reveals give-way weakness, inconsistency on different examination maneuvers (Hoover sign positive), and normal MRI brain/spine. She recently had a severe interpersonal conflict. DSM-5 diagnosis is:

• A Somatic Symptom Disorder
• B Conversion Disorder (Functional Neurological Symptom Disorder) ✓
• C Factitious Disorder
• D Malingering

Explanation

Conversion Disorder (DSM-5: Functional Neurological Symptom Disorder) presents with neurological symptoms (motor, sensory, seizure-like) that are incompatible with neurological disease — demonstrated by positive clinical signs (Hoover sign: hip extension weakness resolves when involuntary effort is tested via contralateral hip flexion). DSM-5 no longer requires a preceding psychological stressor. Factitious disorder involves deliberate feigning with internal motivation. Malingering involves deliberate feigning for external gain. Somatic Symptom Disorder has distressing somatic symptoms with excessive psychological reactions.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.