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Dissociative Neurological Symptoms — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersDissociative Neurological SymptomsMRCPsych Paper B

An 18-year-old woman reports sudden severe loss of vision in her left eye after a distressing argument. Specialist neuro-ophthalmic assessment identifies no causative ocular or neurological disease. On monocular visual-field testing, the field remains the same diameter when tested at 50 cm and 150 cm, demonstrating a tubular field incompatible with physiological visual loss. There is no evidence that she is deliberately producing the symptom or seeking an external incentive. Under ICD-11, what is the most appropriate diagnosis?

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Correct answer: C — Dissociative neurological symptom disorder with visual disturbance

The diagnosis is **dissociative neurological symptom disorder with visual disturbance** (ICD-11 6B60.0). The tubular visual field is a positive functional sign: unlike a physiological visual field, its diameter does not increase as testing distance increases. Functional symptoms are genuine and are not intentionally produced. The preceding argument may be a precipitant but is neither necessary nor sufficient for diagnosis. Malingering involves intentional production for external gain, whereas factitious disorder involves intentional production to adopt the sick role. Bodily distress disorder is characterised by persistent bodily symptoms with excessive attention or concern rather than a positively demonstrated functional neurological deficit. An acute stress reaction does not account for the specific internally inconsistent visual finding.

Reference: Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64, Table 1: ICD-11 dissociative neurological symptom disorder, visual subtype 6B60.0. https://www.nice.org.uk/guidance/qs198/chapter/Quality-statement-5-Functional-neurological-disorders-in-adults