Why did this happen to me?

PREDISPOSING FACTORS

  • History of functional symptoms

  • Stressful life events

  • Adverse childhood events (emotional, sexual, physical or verbal abuse, violence, poor family functioning)

  • Neurological conditions (e.g. migraines)

  • Sometimes they are NOT present in patients!

COMORBID DISORDERS

  • Anxiety

  • Post-traumatic stress disorder

  • Depression

  • Dissociation

  • Sleep problems

  • Immobility

The brain does not integrate sensations well

Strong patterns or predictions of symptoms

PERPETUATING FACTORS

  • Misdiagnosis

  • Feeling that no one believes you/feeling that the movement will do harm

  • Learning by conditioning

  • Sedative drugs and/or opiates

  • Social benefits of the disease

  • Availability of legal redress

PRECIPITATING FACTORS

  • Damage

  • Operative intervention

  • Panic attack

  • Dissociative event

  • Migraine

  • Neurological conditions

  • Head injury

  • As a result of taking medication

TREATMENT

  • Understanding FND

  • Physiotherapy

  • Psychological treatment/psychotherapy

  • Occupational therapy

  • Treatment of comorbid disorders

Predisposing factors

While aetiological discussions about the causes that led to the onset and development of the disorder itself are psychologically relevant for patients, obvious proximate causes are often not possible and/or appropriate to be part of the initial consultation. Thus, in practice, clarification of the three types of factors that influence the predisposition, initiation and maintenance of a functional neurological disorder is advised, as this discusses potential risk and maintenance factors, without suggesting that these must be present in a patient in order to diagnose them with a functional neurological disorder (Gilmour et al., 2019).

Thus, the DSM-5 no longer requires the identification of risk factors related to a traumatic event in childhood and/or the past (Espay et al., 2018), as 14-77% of patients do not report prior stressful life circumstances (e.g., sexual, physical, and emotional abuse; Ludwig et al., 2018), and the aforementioned stressors are no more common in the FND population, compared to a clinically healthy control population (Gilmour et al., 2019).

  • Biological

    • 'Organic' diseases

    • Female gender

    • History of functional symptoms

    Psychological

    • Emotional disturbances

    • Personality disorders

    Sociological

    • Socio-economic deprivation

    • Life events and problems

  • Biological

    • Genetic factors influencing personality

    • Biological vulnerabilities in the central nervous system

    Psychological

    • Traumatic childhood experiences

    • Non-functional attachment style/coping strategy

    • Personality traits (neuroticism)

    Sociological

    • Childhood abuse

    • Poor family functioning

    • Imitating symptoms from others

  • Biological

    • Abnormal physiological events (side effects of medication, hyperventilation, sleep deprivation)

    • Operative intervention

    • Physical injury/pain

    Psychological

    • Perceiving life events as negative or unexpected

    • Acute dissociative seizures/panic attacks

    Sociological

    • Mourning

  • Biological

    • Plasticity in the motor and sensory pathways of the central nervous system, leading to established patterns of abnormal movement

    • Learning by conditioning

    • Neuroendocrine and immunological abnormalities similar to those in anxiety/depression

    Psychological

    • Beliefs about the disease

    • Perception of symptoms as irreversible

    • The feeling that no one believes you

    • Feeling that the movement will cause damage

    • Avoiding triggering symptoms

    • The feeling that they will fall

    • Hypochondria

    Sociological

    • Social benefits of the disease

    • Availability of legal redress

    • Continuous medical examinations and uncertainty

    • Over-reliance on sources of information or group affiliation that reinforces beliefs that symptoms are irreversible and purely physical in nature

    • Bennett, K., Diamond, C., Hoeritzauer, I., Gardiner, P., McWhirter, L., Carson, A., in Stone, J. (2021). A practical review of functional neurological disorder (FND) for the general physician. Clinical Medicine, 21(1), 28.

    • Lidstone, S. C., Nassif, W., Juncos, J., Factor, S. A., in Lang, A. E. (2021). Diagnosing functional neurological disorder: seeing the whole picture. CNS spectrums, 26(6), 593-600.

    • Perez, D. L., Aybek, S., Popkirov, S., Kozlowska, K., Stephen, C. D., Anderson, J., ... and American Neuropsychiatric Association Committee for Research. (2021). A review and expert opinion on the neuropsychiatric assessment of motor functional neurological disorders. The Journal of neuropsychiatry and clinical neurosciences, 33(1), 14-26.