A new science of emotion: implications for functional neurological disorder

Abstract

Functional neurological disorder (FND) reflects impairments in brain networks leading to distressing motor, sensory, and/or cognitive symptoms that demonstrate positive clinical signs on examination incongruent with other conditions. A central issue in historical and contemporary formulations of FND has been the mechanistic and etiological role of emotions. However, the debate has mostly omitted fundamental questions about the nature of emotions in the first place. In this perspective article, we first outline a set of relevant working principles of the brain (e.g., allostasis, predictive processing, interoception, and affect), followed by a focused review of the theory of constructed emotion to introduce a new understanding of what emotions are. Building on this theoretical framework, we formulate how altered emotion category construction can be an integral component of the pathophysiology of FND and related functional somatic symptoms. In doing so, we address several themes for the FND field including: 1) how energy regulation and the process of emotion category construction relate to symptom generation, including revisiting alexithymia, “panic attack without panic”, dissociation, insecure attachment, and the influential role of life experiences; 2) re-interpret select neurobiological research findings in FND cohorts through the lens of the theory of constructed emotion to illustrate its potential mechanistic relevance; and 3) discuss therapeutic implications. While we continue to support that FND is mechanistically and etiologically heterogenous, consideration of how the theory of constructed emotion relates to the generation and maintenance of functional neurological and functional somatic symptoms offers an integrated viewpoint that cuts across neurology, psychiatry, psychology, and cognitive-affective neuroscience.

Toward a possible trauma subtype of functional neurological disorder: impact on symptom severity and physical health

“…Some considerations include overlapping brain–trauma and brain–symptom severity relationships, as well as possible shared predictive processing influences. For example, life experiences impact the repertoire of emotion and non-emotion concepts, and differences in emotion granularity and emotion category construction warrant future research as potential bridges between ALEs and the development/severity of FND symptoms ( 68 ). Lastly, prospective longitudinal studies are needed to determine if clinical outcomes reliably differ in patients with FND with or without a history of trauma.…”

COVID-19 Vaccination in Young People with Functional Neurological Disorder: A Case-Control Study

“…Once vaccination or another stressor (physical or emotional) has triggered the FND symptoms, a number of factors may contribute to symptom maintenance (see Supplementary Text Box S8) [3,[6][7][8][9][10][11]36,42,[69][70][71][72][73][74][75]88,[93][94][95][96]. Broadly speaking, all these factors re-flect the young person's inability, including the inability of the young person's biological system, to activate restorative (calming) processes that could help the mind, body, and brain return to baseline function.…”

“…Contemporary aetiological models adopt a biopsychosocial network (systems) perspective [1,[5][6][7]. These models propose that FND involves complex interactions between biological susceptibility and lived experience, including the effect of that experience on activation of the stress system(s), on the brain as active predictor [8][9][10], on the perception of that experience, and on the biological (epigenetic) embedding of lived experience in the body and brain [2,3,8,11]. In the current study we document, for a cohort of young people with past or current treatment for FND, reports of new-onset, exacerbated, or recurrent functional neurological symptoms following vaccination for COVID-19.…”

Die interdisziplinäre – integrative – Versorgung von funktionellen neurologischen Störungen

“…abeitung einhergehen [32][33][34]. Bei all dem schließen sich biologische und psychosoziale Einflüsse nicht aus, sondern sind komplementär aufeinander bezogen, sie bedingen sich wechselseitig und können oft gar nicht scharf voneinander getrennt werden [35]. Umschriebene funktionelle Störungen der Sensomotorik sind oft eingebettet in Störungen der Wahrnehmung und des Ausdrucks von Emotionen sowie der Handlungsfähigkeit in der jeweiligen psychosozialen Lebenswirklichkeit.…”