Lyme Disease and Conversion Disorder: Medical Dismissal in Children

Some of the most challenging cases in my Lyme disease practice involve adolescents who were initially diagnosed with conversion disorder. In many of these cases, the diagnosis reflects a broader pattern of Lyme disease medical dismissal, where real neurologic and psychiatric symptoms are attributed to psychogenic causes before infectious or inflammatory disease is fully considered.

Symptoms such as tics, tremors, OCD behaviors, rage episodes, or sudden cognitive decline are often labeled functional. But in a significant subset of patients, the underlying cause is Lyme disease or another tick-borne infection.

The overlap between Lyme disease and conversion disorder is not just clinical—it is systemic. And too often, it results in delayed diagnosis, missed treatment opportunities, and prolonged suffering.

When Conversion Disorder Becomes a Form of Medical Dismissal

Conversion disorder (also known as functional neurological symptom disorder) is a legitimate diagnosis. However, when applied prematurely, it can function as a form of medical dismissal, particularly in patients with complex, evolving symptoms.

When laboratory tests are inconclusive and MRI scans appear normal, clinicians may feel pressure to provide an explanation. But “medically unexplained” does not mean “psychiatric by default.” Symptoms may be infectious, inflammatory, immune-mediated, or neurologic in ways not captured by routine testing.

When Lyme disease is excluded too early, diagnostic curiosity often ends. This is a core mechanism of Lyme disease medical dismissal, where persistent symptoms are minimized rather than reevaluated.

Why Adolescents Are Especially Vulnerable

Adolescents with Lyme disease are particularly susceptible to dismissal. I frequently see teenagers with sudden-onset tics, intrusive thoughts, abnormal movements, or emotional dysregulation referred directly to psychiatry without a comprehensive infectious or inflammatory evaluation.

This is how Lyme disease medical dismissal unfolds in practice—not through malice, but through premature diagnostic closure. When symptoms are attributed to stress or anxiety alone, opportunities for early intervention are lost.

PANS, PANDAS, and Tick-Borne Illness

Sudden neuropsychiatric symptoms in children are often associated with PANS or PANDAS, classically linked to streptococcal infection. However, Lyme disease and other tick-borne infections can produce nearly identical symptom patterns.

Many patients I see with conversion disorder–like presentations are later found to have Lyme disease, Babesia, or Bartonella contributing to neuroinflammation and immune dysregulation.

For an overview, see:

Neuropsychiatric Symptoms in Lyme Disease

Lyme disease is frequently underdiagnosed, particularly when neurologic or psychiatric symptoms dominate the presentation. These may include panic attacks, severe anxiety, brain fog, slowed cognitive processing, emotional lability, rage episodes, dizziness, dissociation, imbalance, or abnormal movements.

These symptoms often overlap with what is labeled conversion disorder—except for one critical difference: they may be biologically driven and treatable.

When Patients Fall Between Specialties

Children with neuropsychiatric Lyme disease often fall into a diagnostic gap. Psychiatry may assume a psychogenic cause. Neurology may find no structural abnormality. Infectious disease may decline treatment without definitive testing.

This fragmentation reinforces Lyme disease medical dismissal, leaving families without answers and clinicians without a clear path forward.

The Cost of Misdiagnosis for Families

Parents frequently tell me, “We knew something was wrong, but no one would listen.”

When Lyme disease is misdiagnosed as conversion disorder, children may lose access to treatments that could meaningfully improve function and quality of life. Families, in turn, lose trust in a medical system that appears unwilling to tolerate uncertainty.

What Clinicians Can Do Differently

Avoiding dismissal requires intention. Clinicians can improve care by:

1. Including infectious and inflammatory causes in the differential diagnosis

2. Considering Lyme disease and tick-borne illness in sudden psychiatric presentations

3. Using clinical judgment even when standard tests are negative

4. Collaborating across psychiatry, neurology, immunology, and infectious disease

When we do this, we often discover that these patients were not “functional”—they were misunderstood.

Final Thought: Listen Before You Label

Lyme disease and conversion disorder share a dangerous overlap: patients who are dismissed before they are understood.

Situations where children cannot advocate for themselves are often rooted in Lyme disease medical dismissal, where cognitive and neuropsychiatric symptoms are mistaken for noncompliance instead of recognized as manifestations of illness.

Good medicine begins with listening—and continues with curiosity.

📚 Research Citations and Links

• Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases

• Neuropsychiatric Manifestations and Cognitive Decline in Patients With Long-Standing Lyme Disease: A Scoping Review

• Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS)

• PANSand PANDAS overview, Lyme Science blog, Dr. Daniel Cameron