Misdiagnosis analysis of dissociative conversion disorder presenting with bilateral blindness as the initial symptom

YAN Yingge; WANG Dejun; ZU Shengzhou; HAN Minna; WANG Li

doi:10.3969/j.issn.1002-3429.2025.24.004

Abstract：Objective To investigate the clinical characteristics,and key points in diagnosis and treatment of dissociative conversion disorder(DCD)presenting with bilateral blindness as the initial symptom,and to analyzing the causes of misdiagnosis and prevention strategies.Methods A retrospective analysis was conducted on the clinical data of a young male patient with post-traumatic acute bilateral blindness as the primary symptom,who was initially misdiagnosed but ultimately found to have DCD,followed by further discussion based on literature review.Results The patient developed sudden bilateral blindness after a fall.Comprehensive physical examination and auxiliary tests(including brain MRI,visual evoked potentials)revealed no organic lesions,The patient was initially diagnosed with post-concussion visual impairment.Symptomatic management and observation were administered,with further workup to rule out other etiologies.The diagnosis of DCD was subsequently confirmed through a multidisciplinary team consultation,in accordance with the DSM-5(F44.5)and ICD-11(6B60)diagnostic criteria.The duration of misdiagnosis was approximately 42 h.Hypnotic suggestion therapy was initiated immediately after diagnosis,resulting in restored vision.Conclusion Sudden functional blindness in young adults in stressful environments warrants vigilance for DCD.Diagnosis requires actively ruling out organic diseases while paying attention to psychosocial factors and characteristic"soft signs."Early identification and targeted psychological intervention(e.g.,hypnotic suggestion)are highly effective.Establishing a"dual psychosomatic screening"mechanism and standardized assessment procedures can help reduce misdiagnosis rates.