Psychiatric Comorbidities in Functional Neurological Disorders and Psychogenic Non-Epileptic Seizures: A Systematic Review and Policy Recommendations for Improving Assessment and Treatment

Abstract

Background Psychogenic Non-Epileptic Seizures (PNES) and Functional Neurological Disorders (FND) are progressively attracting the attention of healthcare professionals both in the medical or surgical specialties and in psychiatric ones. Methods Due to FND and PNES complex presentation, often comorbid with other neurological, medical, and psychiatric conditions, starting from our experience with patients presenting with both conditions, we conducted a systematic review of articles that address the comorbidity of PNES and FND with other psychiatric conditions. Results Our review supports the point that PNES and FND are not autonomous conditions but develop on the grounds of other psychiatric comorbidities including autism, borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), and alexithymia. Persons with PNES and FND have often a history of child abuse, neglect, and trauma, and these conditions can also trigger the two conditions if appearing later in life. We also propose policies to endorse the comorbidity theory and improve assessment and treatment. Conclusion The scrutinized studies confirm that PNES and FND might be comorbid or represent manifestations of what we hypothesize as an integrated biopsychosocial model where early trauma, abuse, and neglect lead to a progressive neuro sensitivity that can present in the same person, usually young female patients, as a combination of dysthymia, alexithymia, autism, PTSD, BPD, FND, and PNES.