The frequency and identification of false positive conversion reactions

Area of Science:

• Psychiatry and Neurology
• Medical Diagnosis Accuracy

Background:

• Conversion disorder is a diagnosis of exclusion, often challenging to differentiate from organic conditions.
• Previous literature suggests a potential for misdiagnosis, but precise rates are not well-established.

Purpose of the Study:

• To estimate the frequency of inappropriate conversion reaction diagnoses in patients with actual physical diseases.
• To identify characteristic symptoms and psychological factors associated with misdiagnosed conversion reactions.

Main Methods:

• Retrospective chart review of medical hospital patients initially diagnosed with hysteria (conversion disorder).
• Diagnostic accuracy was assessed using initial records and a 10-year follow-up.
• Patients' conversion symptoms were tracked for subsequent diagnoses of physical illnesses.

Main Results:

• An estimated 25% of conversion disorder diagnoses were false positives.
• Common false positives involved neurological and musculoskeletal conditions, including spinal cord, nerve, bone, and connective tissue disorders.
• Psychological assessments (behavioral symptoms, MMPI scores) did not effectively distinguish true from false positive cases.

Conclusions:

• A significant proportion of conversion disorder diagnoses may be incorrect, masking underlying physical pathologies.
• Neurological and structural physical diseases are frequently misdiagnosed as conversion reactions.
• Current psychological assessment tools are insufficient for differentiating true conversion disorder from physical illness misdiagnoses.