A 22-year-old woman presents with left arm paralysis and inability to feel her left hand after witnessing her boyfriend's accident. Neurological examination shows inconsistent 'give-way' weakness and splitting of midline vibration sense. All neuroimaging and electrophysiology are normal. The DSM-5 diagnosis is:

• A Factitious disorder
• B Malingering
• C Somatic symptom disorder
• D Functional neurological symptom disorder (conversion disorder) ✓

Explanation

Functional neurological symptom disorder (FNSD, formerly conversion disorder) involves neurological symptoms incompatible with recognised neurological disease, demonstrated by positive clinical signs (Hoover's sign, give-way weakness, midline splitting of vibration sense, variability on examination). DSM-5 requires positive clinical findings inconsistent with neurological disease — it no longer requires identification of a stressor or psychological aetiology. Factitious disorder involves intentional symptom production for the sick role; malingering involves intentional production for external gain (both require intent). FNSD is not intentional and is a functional disorder of neurological system processing.

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

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Written and medically reviewed by the StethoPrep medical team.