La Belle Indifference

The term “la belle indifference” is a French term that translates to “beautiful ignorance.” La belle indifference is defined as a paradoxical absence of psychological distress despite a serious medical illness or symptoms of a health condition. This condition is most commonly associated with conversion disorder. According to the Diagnostic and Statistical Manual of Mental Disorders V (DSM 5), conversion disorder is also referred to as functional neurologic symptom disorder (FNSD). FNSD, or conversion disorder, is characterized by at least 1 neurological deficit with no medical or neurological etiology and is incompatible with any known medical or neurological disorders. Psychological distress or conflict may be manifested as a physical symptom in patients with conversion disorder. La belle indifference is not formally included in DSM 5 as a diagnosis. However, it is used in conjunction with conversion disorder. According to the DSM 5, the mere presence of la belle indifference does not confirm the diagnosis of conversion disorder. However, la belle indifference is most commonly seen in patients with conversion disorder, so this topic focuses primarily on its association with conversion disorder. For a full review of conversion disorder, please refer to the conversion disorder topic by StatPearls.  In the DSM 5, conversion disorder is classified under somatic symptom and related disorders (SSD). Other diagnoses included under SSD include somatic symptom disorder, psychological factors affecting other medical conditions, illness anxiety disorder, and factitious disorder. The most common presentation of FNSD, or conversion disorder, includes weakness or paralysis of 1 side of the body or bilaterally, abnormal movements (including tremors, myoclonus, dystonic movements, etc.), seizures (psychogenic neuroleptic seizures), swallowing problems (globus), speech problems (dysphonia or aphonia), sensory loss (vision or olfactory issues) and syncopal episodes.