Rosh Psychiatry Board Practice Exam

A young man presents with loss of sensation in his hands after witnessing a fatal accident. What is the most likely diagnosis?

1. Conversion disorder

2. Factitious disorder

3. Malingering

4. Somatic symptom disorder

The correct answer is: Conversion disorder

The scenario described involves a young man who experiences loss of sensation in his hands following a traumatic event, which is witnessing a fatal accident. This sudden onset of sensory loss, in the context of a psychological trigger, aligns well with conversion disorder. Conversion disorder is characterized by neurological symptoms that cannot be explained by medical conditions and often arise after psychological stress or trauma. These symptoms can include loss of sensation, paralysis, seizures, or other motor or sensory deficits. Importantly, individuals with conversion disorder are not intentionally producing or feigning their symptoms; instead, the symptoms manifest as a way for the individual to cope with emotional distress or to express psychological conflict. In contrast, factitious disorder involves intentionally producing symptoms, often to assume the sick role, which is not the case here. Malingering involves the intentional production of symptoms for the purpose of external gain, such as avoiding work or obtaining financial benefits, which does not apply in this context where the onset is directly linked to an emotional trauma. Lastly, somatic symptom disorder involves the presence of somatic symptoms that cause significant distress or impairment, but these symptoms do not have to be specifically linked to a traumatic event and are typically more persistent compared to the acute nature of conversion disorder symptoms following a clear psychological