La belle indifférencein conversion symptoms and hysteria

Abstract

BackgroundLa belle indifférencerefers to an apparent lack of concern shown by some patients towards their symptoms. It is often regarded as typical of conversion symptoms/hysteria.AimsTo determine the frequency ofla belle indifférencein studies of patients with conversion symptoms/hysteria and to determine whether it discriminates between conversion symptoms and symptoms attributable to organic disease.MethodA systematic review of all studies published since 1965 that have reported rates ofla belle indifférencein patients with conversion symptoms and/or patients with organic disease.ResultsAtotal of 11 studies were eligible for inclusion. The median frequency ofla belle indifférencewas 21 % (range 0–54%) in 356 patients with conversion symptoms, and 29% (range 0–60%) in 157 patients with organic disease.ConclusionsThe available evidence does not support the use ofla belle indifférenceto discriminate between conversion symptoms and symptoms of organic disease. The quality of the published studies is poor, with a lack of operational definitions and masked ratings.La belle indifférenceshould be abandoned as a clinical sign until both its definition and its utility have been clarified.