Conversion disorder

Patients with neurologic symptoms inconsistent or incongruous with structural disease are frequently encountered in neurologic practice and present diagnostic and therapeutic dilemmas. Also known as conversion or dissociative disorders, and “psychogenic,” “functional,” or “non-organic” symptoms, these symptoms may be debilitating and bewildering, and are often refractory to treatment. Patient with such problems should attract attention from neurologists for practical and theoretical reasons.

Since the late 19th century, psychoanalytic theory has dominated medical thinking about these symptoms. As patients with a presumed psychiatric disorder diagnosed by neurologists, they often end up with a bad deal from both neurologists and psychiatrists, who have difficulty knowing how to understand or treat the problem.^1,2 Unfortunately, neither specialty has successfully tackled the challenge posed by Freud a century ago of making the “mysterious leap from mind to body.”

In this issue of Neurology®, Voon et al.³ report one of only a handful of physiologic studies attempting to make this “mysterious leap” and the first for a conversion movement disorder (rather than weakness or sensory disturbance). Studying 8 subjects with “clinically definite” conversion tremor, they compared functional MRI (fMRI) during conversion tremor to fMRI obtained while they were consciously …