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BACKGROUND: La belle indifference 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 indifference 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 indifference 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 indifference 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 indifference to discriminate between conversion symptoms and symptoms of organic disease. The quality of the published studies is poor, with a lack off operational definitions and masked ratings. La belle indifference should be abandoned as a clinical sign until both its definition and its utility have been clarified


Journal article


Br J Psychiatry

Publication Date





204 - 209


Attitude to Health, CLINICAL, Conversion Disorder, definition, diagnosis, Diagnosis,Differential, disease, general hospital, hospital, Humans, hysteria, Nervous System Diseases, neuroscience, organic, patient, Patients, Psychophysiologic Disorders, rating, research, Research Support, review, symptom, symptoms, terminology, uk, utility