The nurse is caring for a client with a conversion disorder. Which of the following assessments will the nurse expect to see?

Somatic symptom disorderpresents with recurrent physical complaints that are distressing and often medically unexplained. These symptoms are real, persistent, and emotionally charged. Nursing care must balance validationwith structured boundaries to avoid reinforcing symptom preoccupation. Therapeutic communication should acknowledge the symptom while maintaining routine and promoting functional engagement.

Rationale for correct answers

3.This response acknowledges the symptom and ensures continuityof care by reporting it, while maintaining structureby encouraging group therapy attendance.

Rationale for incorrect answers

1.Dismissing the complaint as “in your head” reflects invalidatinglanguage and undermines therapeutic rapport, increasing emotional distress.

2.Skipping group therapy reinforces avoidance, which may worsen functional impairment and reduce engagement in therapeutic activities.

4.Offering new medication without assessment promotes reinforcementof somatic focus and may lead to unnecessary pharmacologic interventions.

Take Home Points

• Nursing responses should validate symptoms while maintaining therapeutic boundaries and routine.
• Avoid reinforcing symptom preoccupation through excessive attention or unnecessary interventions.
• Encourage participation in structured activities to promote functional improvement.
• Balance empathy with clinical judgment to support emotional and physical well-being.

Conversion disorderpresents with neurological symptoms such as paralysis, blindness, or seizuresthat are inconsistent with medical findings. A classic feature is la belle indifférence, an apparent lack of concern about the symptoms. This paradoxical indifference, despite potentially disabling symptoms, reflects the unconscious nature of the disorder and helps differentiate it from malingering or factitious disorder. The symptoms are real to the patient and not intentionally produced.

Rationale for correct answers

2.Indifference to symptoms, known as la belle indifférence, is a hallmark of conversion disorder and reflects unconscious defensemechanisms.

Rationale for incorrect answers

1.Extreme distress is more typical of somatic symptom disorder, where patients are highly preoccupied with their symptoms.

3.Labile mood is associated with affective disorders, not a defining feature of conversion disorder.

4.Multiple complaints suggest somatic symptom disorder, not conversion disorder which typically presents with one dramatic neurological symptom.

Take Home Points

• Conversion disorder features neurological symptoms without medical explanation and often includes la belle indifférence.
• Indifference to symptoms helps differentiate conversion disorder from other somatic-related disorders.
• Somatic symptom disorder involves multiple complaints and high emotional distress about symptoms.
• Accurate assessment of symptom presentation and emotional response is key to differential diagnosis.