A 30 year old female presents with an acute blindness in her right eye after having a major argument with her boyfriend. In the ED she is found to deny physical trauma to the eye but she insists she cannot see anything out of her right eye. In spite of this, she is not particularly concerned about her monocular blindness but notes that it has happened before after fighting with her boyfriend. The ED physician notes that her right eye is normal looking and reacts to light normally. What is the most likely diagnosis?
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- conversion disorder
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- factitious disorder
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- malingering
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- somatization disorder
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- dissociative fugue
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Conversion disorder is the most likely answer. Here is why: this is a young, female with an acute neurological deficit after a stressor. The fact that she is not concerned about the deficit points to “la belle indifferente” - which is almost always seen in this disorder. Contrary to popular beleif, these people are not “faking it.” There is no reported secondary gain in conversion, and no gain is made evident in this stem. Thus malingering is wrong. Factitious disorder implies creating symptoms or making oneself sick consciously but for the pleasure of “playing the sick role.” Fugue is an amnestic state when there is recent travel and loss of ones identity. Somatization disorder will ALWAYS present with multiple physical prolems in a female patient (stomach pain, Headache, menstrual complaints, etc.)