Although residents appreciate the significance of intimate partner violence assessment, in this particular institution few consistently perform or feel comfortable screening. Development of comprehensive intimate partner violence curricula is therefore critical.
This review discusses the complex path to the current definition of conversion disorder (CD), from ancient Egypt to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and the way that our understanding of the disorder’s etiology and pathophysiology shaped both its name and its diagnostic criteria. We describe emergence of a comprehensive theory of CD’s pathophysiology, in which an overly sensitive limbic system, shaped by traumatic experiences, changes neural networks responsible for perceptual experiences and movement plans, ultimately producing CD symptoms. We also discuss the importance of early diagnosis of CD as a delayed diagnosis is associated with worse outcomes and precludes appropriate treatment. A variety of diagnostic techniques exist to help distinguish between functional neurologic symptoms and organic disease. Among treatments, we highly recommend therapeutic disclosure of the diagnosis and cognitive-behavioral therapy, which has a small but high-quality evidence base to support its use in the treatment of CD. Collaboration between psychiatrists and neurologists may ensure appropriate diagnosis and treatment of this challenging condition. Prognosis of CD is generally poor, with comorbid personality disorder and delayed diagnosis correlating with worse outcomes.
This review contains 4 figures, 6 tables, and 86 references.
Key words: conversion disorder, functional neurologic disorder, hysteria, medically unexplained symptoms, psychogenic movement disorder, psychogenic nonepileptic seizures
Pearls
Intimate partner violence (IPV) includes "physical violence, sexual violence, stalking, and psychological aggression (including coercive tactics) by a current or former intimate 1 Intimate partner violence was a widespread problem even before COVID-19, with lifetime rates of nearly 35% among White women, 28% among White men, and highest amongst those who identify as people of color, lesbian, or bisexual. 1 The COVID-19 pandemic has magnified risk factors for IPV such as unemployment and social isolation-particularly in marginalized communities-while decreasing access to resources such as childcare and shelters. 2 Because most individuals do not voluntarily disclose or seek treatment for IPV, it is critical we use the following recommendations to complete safe, trauma-informed, recoveryoriented assessment in patients presenting for care, whether in person or via telehealth.
Provide options instead of instructions, which will empower patients to choose what is best for them
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