Psychogenic coma is most consistent with which diagnosis?

• A. Malingering
• B. Factitious disorder
• C. Catatonia
• D. Conversion disorder

Answer: (D)

Psychogenic coma reflects a functional neurological symptom arising from conversion disorder, where psychological distress is manifested as a neurological presentation without an organic brain disease. In this scenario, a patient appears profoundly comatose, yet there are no consistent, objective signs of structural or metabolic brain injury. Exam often shows inconsistencies, non-anatomical patterns, or signs that don’t fit a true coma, and there can be abrupt improvement with time or distraction, suggesting a non-physical cause. Crucially, the symptoms are not intentional; the patient is not consciously faking it or seeking external or internal rewards. This differentiates it from malingering (deliberate deception for external gain) and factitious disorder (deliberate production of symptoms to assume the sick role). Catatonia, while also presenting with marked immobility or mutism, follows a recognizable neuropsychiatric pattern with rigidity, stupor, or posturing and typically ties to mood or psychotic disorders. Therefore, psychogenic coma is most consistent with conversion disorder.