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Chapter V
Dissociative [conversion] disorders - F44
The common themes that are shared by dissociative or conversion disorders are a partial or complete loss of the normal integration between memories of the past, awareness of identity and immediate sensations, and control of bodily movements. All types of dissociative disorders tend to remit after a few weeks or months, particularly if their onset is associated with a traumatic life event. More chronic disorders, particularly paralyses and anaesthesias, may develop if the onset is associated with insoluble problems or interpersonal difficulties. These disorders have previously been classified as various types of "conversion hysteria". They are presumed to be psychogenic in origin, being associated closely in time with traumatic events, insoluble and intolerable problems, or disturbed relationships. The symptoms often represent the patient's concept of how a physical illness would be manifest. Medical examination and investigation do not reveal the presence of any known physical or neurological disorder. In addition, there is evidence that the loss of function is an expression of emotional conflicts or needs. The symptoms may develop in close relationship to psychological stress, and often appear suddenly. Only disorders of physical functions normally under voluntary control and loss of sensations are included here. Disorders involving pain and other complex physical sensations mediated by the autonomic nervous system are classified under somatization disorder (F45.0). The possibility of the later appearance of serious physical or psychiatric disorders should always be kept in mind.
Includes:
-
conversion:
- hysteria
- reaction
- hysteria
- hysterical psychosis
Excludes:
- malingering [conscious simulation] ( Z76.5 )
| F44.0 |
Dissociative amnesia
The main feature is loss of memory, usually of important recent events, that is not due to organic mental disorder, and is too great to be explained by ordinary forgetfulness or fatigue. The amnesia is usually centred on traumatic events, such as accidents or unexpected bereavements, and is usually partial and selective. Complete and generalized amnesia is rare, and is usually part of a fugue (F44.1). If this is the case, the disorder should be classified as such. The diagnosis should not be made in the presence of organic brain disorders, intoxication, or excessive fatigue.
Excludes:
- alcohol- or other psychoactive substance-induced amnesic disorder ( F10-F19 with common fourth character .6)
- amnesia:
- NOS ( R41.3 )
- anterograde ( R41.1 )
- retrograde ( R41.2 )
- nonalcoholic organic amnesic syndrome ( F04 )
- postictal amnesia in epilepsy ( G40.- )
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| F44.1 |
Dissociative fugue
Dissociative fugue has all the features of dissociative amnesia, plus purposeful travel beyond the usual everyday range. Although there is amnesia for the period of the fugue, the patient's behaviour during this time may appear completely normal to independent observers.
Excludes:
- postictal fugue in epilepsy ( G40.- )
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| F44.2 |
Dissociative stupor
Dissociative stupor is diagnosed on the basis of a profound diminution or absence of voluntary movement and normal responsiveness to external stimuli such as light, noise, and touch, but examination and investigation reveal no evidence of a physical cause. In addition, there is positive evidence of psychogenic causation in the form of recent stressful events or problems.
Excludes:
- organic catatonic disorder ( F06.1 )
- stupor:
- NOS ( R40.1 )
- catatonic ( F20.2 )
- depressive ( F31-F33 )
- manic ( F30.2 )
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| F44.3 |
Trance and possession disorders
Disorders in which there is a temporary loss of the sense of personal identity and full awareness of the surroundings. Include here only trance states that are involuntary or unwanted, occurring outside religious or culturally accepted situations.
Excludes:
- states associated with:
- acute and transient psychotic disorders ( F23.- )
- organic personality disorder ( F07.0 )
- postconcussional syndrome ( F07.2 )
- psychoactive substance intoxication ( F10-F19 with common fourth character .0)
- schizophrenia ( F20.- )
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| F44.4 |
Dissociative motor disorders
In the commonest varieties there is loss of ability to move the whole or a part of a limb or limbs. There may be close resemblance to almost any variety of ataxia, apraxia, akinesia, aphonia, dysarthria, dyskinesia, seizures, or paralysis.
Psychogenic:
aphonia
dysphonia
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| F44.5 |
Dissociative convulsions
Dissociative convulsions may mimic epileptic seizures very closely in terms of movements, but tongue-biting, bruising due to falling, and incontinence of urine are rare, and consciousness is maintained or replaced by a state of stupor or trance.
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| F44.6 |
Dissociative anaesthesia and sensory loss
Anaesthetic areas of skin often have boundaries that make it clear that they are associated with the patient's ideas about bodily functions, rather than medical knowledge. There may be differential loss between the sensory modalities which cannot be due to a neurological lesion. Sensory loss may be accompanied by complaints of paraesthesia. Loss of vision and hearing are rarely total in dissociative disorders.
Psychogenic deafness
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| F44.7 |
Mixed dissociative [conversion] disorders
Combination of disorders specified in F44.0-F44.6
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| F44.8 |
Other dissociative [conversion] disorders
Ganser's syndrome
Multiple personality
Psychogenic:
confusion
twilight state
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| F44.9 |
Dissociative [conversion] disorder, unspecified
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Related drugs:
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