Difficulty is that these cannot be differentiated by self-report only; the clinician HAS to investigate other sources of information.
- Symptoms or deficits affecting voluntary motor or sensory functioning
- Actually very rare
- Commonly recurs (25% in the first year)
- Risk factors: maladaptive personality traits (borderline, histrionic traits), history of childhood abuse/neglect, stressful life events may precipitate
- Does not require that the symptoms are “intentionally produced.” Conversion symptoms are not strictly voluntary from the patient’s subjective experience.
- If there’s no true LOSS of function, consider Somatic Symptom Disorder.
- External incentives are absent. Patients are not voluntarily “faking” it. Internal motivations may include enjoyment or benefiting from the sick role.
- Also very rare.
- Usually comes on in early adulthood. Often comes on after hospitalization for a general medical or psychiatric disorder.
- Course is intermittent.
- Intentional, voluntary. This is truly “faking” for secondary gain.
- Secondary gains may include legal, occupational benefits; medications; etc.
APPROACH TO THESE DISORDERS:
- Focus on accurately identifying behaviors, verifying or refuting medical conditions.
- Does not need to focus on motivation anymore.
- Conversion vs Malingering: usually requires long-term relationship and observation of patient’s course. Collateral examination for symptom production (neuropsych testing) may be helpful.
Source: Rachel Hughes, PhD, behavioral health fellow, SMFMR.