Processing of Emotion in Functional Neurological Disorder

Abstract

Emotions have traditionally been considered crucial in the development of functional neurological disorder, but the evidence underpinning this association is not clear. We aimed to summarize evidence for association between functional neurological disorder and emotions as formulated by Breuer and Freud in their conception of hysterical conversion. Based on a systematic literature search, we identified 34 controlled studies and categorized them into four groups: (i) autonomic arousal, (ii) emotion-motion interactions, (iii) social modulation of symptoms, and (iv) bodily awareness in FND. We found evidence for autonomic dysregulation in FND; convergent neuroimaging findings implicate abnormal limbic-motor interactions in response to emotional stimuli in FND. Our results do not provide enough empirical evidence for social modulation of the symptoms, but there is a clinical support for the role of suggestion and placebo in FND. Our results provide evidence for abnormal bodily awareness in FND. Based on these findings, we propose that functional neurological symptoms are forms of emotional reactions shaped into symptoms by previous experience with illness and possibly reinforced by actual social contexts. Additional research should investigate the effect of social context on the intensity of functional neurological symptoms and associated brain regions.

Processing of Emotions in Functional Movement Disorder: An Exploratory fMRI Study

“…A growing body of neuroimaging evidence supports the notion that abnormal emotional processing is a key factor in the etiology of functional neurological symptoms (1, 2). Task-based neuroimaging studies show limbic and paralimbic hyperactivation (3–5), abnormal limbic-motor circuit connectivity (4–6), and altered activation of several prefrontal regions in emotion processing tasks in various groups of patients with FND (3, 6–9).…”

Medication prescriptions in 322 motor functional neurological disorder patients in a large UK mental health service: A case control study

“…Antidepressants may have multiple actions, including possible central analgesic effects (Lynch, 2001), and reductions in affective arousal and sleep dysfunction (Clouse et al, 1994). The relationship between antidepressant treatment and mFND prognosis remains complicated by the presence of co-morbid depression and anxiety, as well as other factors such as attachment traits (Jalilianhasanpour et al, 2018), emotional regulation (Sojka et al, 2018), attentional dysregulation (Edwards et al, 2012), health anxiety and illness belief (Bakvis et al, 2009), and phobic avoidance (Stone et al, 2012). As it stands, the effectiveness or otherwise of antidepressants in this group and their mechanism of action remain poorly understood.…”

Functional Neurological Disorders as Seen by a Cohort of General Practitioners in Northern Italy: Evidence From an Online Survey

“…Our understanding of FND has made considerable advances, with implications for diagnosis and treatment. Research into the pathophysiology of FND has challenged old assumptions about the disease as a primarily psychological illness ( 5 ). It has been widely demonstrated that symptoms are more consistently explained by abnormalities in high-order cognitive functions involving attention and sense of agency (e.g., feeling of control over abnormal bodily movement) rather than by psychological difficulties ( 6 ).…”