Case report: Dissociative neurological symptom disorder with gait disturbance: taking after the father?

TL;DR

A teenage girl with unexplained gait issues was diagnosed with a psychiatric condition after ruling out physical causes, and her symptoms improved with therapy and family support.

Contribution

This case highlights the importance of interdisciplinary care and psychosocial factors in diagnosing and treating dissociative neurological symptom disorder.

Findings

DNSD diagnosis was confirmed after ruling out organic causes through neuroimaging.

Combination of therapy and family intervention led to symptom remission.

Depressive episode suggested undiagnosed psychosocial stressors.

Abstract

Dissociative neurological symptoms disorder (DNSD), or conversion disorder, frequently manifests with unexplained neurological symptoms, necessitating referral to psychiatry following preliminary diagnosis in neurology. We present a case of an adolescent female patient with gait disturbance as the predominant clinical presentation, and delve into the diagnosis and interdisciplinary intervention process. Given neuroimaging deviations detected and familial similar presentations, the organic etiology was confirmed. However, the aberrant gait remained unexplained ultimately prompting psychiatric consultation resulting in the diagnosis of DNSD. Interventions consisting of health education, suggestive therapy, and physiotherapy notably improved gait disturbance. However, at follow-up, the patient presented with a depressive episode. It was deduced that undiagnosed psychosocial factors, notably familial dynamics, likely contributed to this decline. Eventually, transformed relation patterns among family members as well as antidepressant treatment were instrumental in attaining symptom remission.

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