Conversion disorder: Not a malingering matter

A 12-year-old girl was seen by her family physician with a chief complaint of seizures. Over the past several weeks, she has suffered from attacks of bilateral arm jerking, followed by bilateral leg jerking. Often, her head shakes violently from side to side and her eyes are seen to roll back in her head. These spells are not accompanied by bladder or bowel incontinence, but often the patient bites her tongue and kicks over tables or strikes family members during an episode. These incidents typically follow episodes of emotional outburst and can wax and wane for 20 min to 30 min with varying intensity. She has no significant medical history and takes no medications. Her school performance is excellent. She is a competitive gymnast who spends 15 h per week training. On examination, her vitals signs are normal, without orthostatic hypotension, and her neurological evaluation is unremarkable. Medical investigations including glucose, electrolytes, a urine toxin screen and an EEG are all within normal limits.