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La belle indifférence in conversion symptoms and hysteria

Systematic review

Division of Clinical Neurosciences, School of Molecular and Clinical Medicine, University of Edinburgh, Western General Hospital, Edinburgh

ROGER SMYTH, MB ChB, MPhil

Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh

ALAN CARSON, MB ChB, MPhil, MD and CHARLES WARLOW, MD

Division of Clinical Neurosciences, School of Molecular and Clinical Medicine, University of Edinburgh, Western General Hospital, Edinburgh

MICHAEL SHARPE, MD

Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK

Correspondence: Dr Jon Stone, Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK. Tel: +44 (0)131 537 2911; fax: +44 (0)131 537 1132; e-mail: jstone{at}skull.dcn.ed.ac.uk

Declaration of interest None.

Background La belle indifférence refers to an apparent lack of concern shown by some patients towards their symptoms. It is often regarded as typical of conversion symptoms/hysteria.

Aims To determine the frequency of la belle indifférence in studies of patients with conversion symptoms/hysteria and to determine whether it discriminates between conversion symptoms and symptoms attributable to organic disease.

Method A systematic review of all studies published since 1965 that have reported rates of la belle indifférence in patients with conversion symptoms and/or patients with organic disease.

Results A total of 11 studies were eligible for inclusion. The median frequency of la belle indifférence was 21% (range 0–54%) in 356 patients with conversion symptoms, and 29% (range 0–60%) in 157 patients with organic disease.

Conclusions The available evidence does not support the use of la belle indifférence to discriminate between conversion symptoms and symptoms of organic disease. The quality of the published studies is poor, with a lackof operational definitions and masked ratings. La belle indifférence should be abandoned as a clinical sign until both its definition and its utility have been clarified.

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