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

Abstract

BackgroundAs a group, individuals with functional neurological disorder (FND) report an approximately 3-fold increase in adverse life experiences (ALEs) compared to healthy controls. In patients with FND, studies have identified a positive correlation between symptom severity and the magnitude of ALEs. While not all individuals with FND report ALEs, such findings raise the possibility of a trauma-subtype of FND.ObjectiveThis study investigated if patients with FND, with or without probable post-traumatic stress disorder (PTSD) and/or significant childhood maltreatment, differed in their symptom severity and physical health.Materials and methodsSeventy-eight patients with FND were recruited (functional seizures, n = 34; functional movement disorder, n = 56). Participants completed self-report measures of symptom severity [Somatoform Dissociation Questionniare-20 (SDQ-20), Screening for Somatoform Disorders: Conversion Disorder subscale (SOMS:CD), Patient Health Questionniare-15 (PHQ-15)], physical health [Short Form Health Survey-36 (SF36-physical health)], childhood maltreatment [Childhood Trauma Questionnaire (CTQ)], and PTSD [PTSD Checklist-5 (PCL-5)]; a psychometric battery of other common predisposing vulnerabilities was also completed. To adjust for multiple comparisons, a Bonferroni correction was applied to all univariate analyses.ResultsPatients with FND and probable PTSD (n = 33) vs. those without probable PTSD (n = 43) had statistically significant increased scores on all symptom severity measures – as well as decreased physical health scores. In secondary post-hoc regression analyses, these findings remained significant adjusting for age, sex, race, college education, and: pathological dissociation; alexithymia; attachment styles; personality characteristics; resilience scores; functional seizures subtype; or moderate-to-severe childhood abuse and neglect scores; SOMS:CD and SDQ-20 findings also held adjusting for depression and anxiety scores. In a separate set of analyses, patients with FND and moderate-to-severe childhood abuse (n = 46) vs. those without moderate-to-severe childhood abuse (n = 32) showed statistically significant increased SDQ-20 and PHQ-15 scores; in post-hoc regressions, these findings held adjusting for demographic and other variables. Stratification by childhood neglect did not relate to symptom severity or physical health scores.ConclusionThis study provides support for a possible trauma-subtype of FND. Future research should investigate the neurobiological and treatment relevance of a FND trauma-subtype, as well as continuing to delineate clinical characteristics and mechanisms in individuals with FND that lack a history of ALEs.

Socioemotional self- and co-regulation in functional seizures: comparing high and low posttraumatic stress

“…In prior work we included FS participants with neurologist/epileptologist-verified diagnoses based on careful assessment including video EEG ( 41 , 42 ); here, we chose to broaden our sample to FS individuals who may not have had access to epilepsy monitoring unit evaluation. Reasonable consistency between present findings and prior work, yet with some differences [e.g., fewer significant correlations between socioemotional processes and symptoms ( 49 )—which also may be due to measure limitations (single items assessing seizure frequency and severity) and small sample size], suggests that a community sample may provide important information, alongside systematic comparisons with diagnostically-verified samples. Such an approach could facilitate understanding FS as a continuum, perhaps with subclinical presentations and normed self-report measures to capture them, akin to studies of depression and other clinical syndromes [e.g., ( 89 , 90 )].…”

Associations among stressors across the lifespan, disability, and relapses in adults with multiple sclerosis

“…Future work with a lifespan approach is needed to better understand and inform symptom management for PwMS, especially work that expands upon the few studies investigating childhood adversity and pain (MacDonald et al., 2021), fatigue (Pust et al., 2020), and psychiatric comorbidity (Wan et al., 2022). Further, ACE research has been growing in many adjacent areas of symptom severity such as functional neurological disorder (Paredes‐Echeverri et al., 2023), Tourette's syndrome (Yang et al., 2022), frequent headaches (Anto et al., 2021), and Parkinson's disease (Subramanian et al., 2023). A lifespan approach may similarly increase nuance in these areas as well as MS.…”

A Case of Functional Cognitive Disorder: Psychotherapy and Speech and Language Therapy Insights

“…18,19 While adverse life experiences, both proximal and remote, can be relevant predisposing vulnerabilities or acute precipitants in a subset of individuals with FND, such experiences are nonspecific and no longer diagnostically required. 20,21 The five main subtypes of FND include functional (psychogenic nonepileptic/dissociative) seizures, functional motor disorders (such as functional speech/ voice and functional limb weakness presentations), functional sensory deficits, persistent postural perceptual dizziness (a form of functional dizziness), and FCD. 22 For FCD, there are four diagnostic criteria: (1) one or more cognitive complaints, (2) clinical evidence of internal inconsistency, (3) symptoms or deficits lacking sufficient explanation 4) inconsistent patterns in neurocognitive testing (e.g., overt impairment in word registration yet relatively preserved delayed recall of words).…”

“…Rather than framed as a diagnosis of exclusion, FND is now a rule-in diagnosis based on examination signs and semiological features specific to the condition 18,19 . While adverse life experiences, both proximal and remote, can be relevant predisposing vulnerabilities or acute precipitants in a subset of individuals with FND, such experiences are nonspecific and no longer diagnostically required 20,21 . The five main subtypes of FND include functional (psychogenic nonepileptic/dissociative) seizures, functional motor disorders (such as functional speech/voice and functional limb weakness presentations), functional sensory deficits, persistent postural perceptual dizziness (a form of functional dizziness), and FCD 22 …”