Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies

Ludwig, Lea; Pasman, Joëlle A.; Nicholson, Timothy R; Aybek, Selma; David, Anthony S.; Tuck, Sharon; Kanaan, Richard A A; Roelofs, Karin; Carson, Alan; Stone, Jon

doi:10.1016/s2215-0366(18)30051-8

Cited by 324 publications

(250 citation statements)

References 62 publications

Supporting

Mentioning

227

Contrasting

Unclassified

Order By: Relevance

“…Contemporary explanations have moved away from psychodynamic trauma-focused models and instead emphasise dysfunction of higher-order cognitive processes 7–9. Nevertheless, the importance of psychosocial adversity in FND cannot be underestimated given that rates of early-life and proximal adverse events have been repeatedly found to be higher in FND samples relative to controls 10. Stressful life-events including abuse/neglect, ongoing relationship disturbances, occupational stress and caring responsibilities are commonly reported 6 11–13…”

Section: Introductionmentioning

confidence: 99%

Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda

Pick

Goldstein

Perez

et al. 2018

J Neurol Neurosurg Psychiatry

210

167

View full text Add to dashboard Cite

Functional neurological disorder (FND) is a common and highly disabling disorder, but its aetiology remains enigmatic. Conceptually, there has been reduced emphasis on the role of psychosocial stressors in recent years, with a corresponding increase in neurobiological explanations. However, a wealth of evidence supports the role of psychosocial adversities (eg, stressful life events, interpersonal difficulties) as important risk factors for FND. Therefore, there is a need to integrate psychosocial (environmental) and neurobiological factors (eg, sensorimotor and cognitive functions) in contemporary models of FND. Altered emotional processing may represent a key link between psychosocial risk factors and core features of FND. Here, we summarise and critically appraise experimental studies of emotional processing in FND using behavioural, psychophysiological and/or neuroimaging measures in conjunction with affective processing tasks. We propose that enhanced preconscious (implicit) processing of emotionally salient stimuli, associated with elevated limbic reactivity (eg, amygdala), may contribute to the initiation of basic affective/defensive responses via hypothalamic and brainstem pathways (eg, periaqueductal grey). In parallel, affect-related brain areas may simultaneously exert a disruptive influence on neurocircuits involved in voluntary motor control, awareness and emotional regulation (eg, sensorimotor, salience, central executive networks). Limbic-paralimbic disturbances in patients with FND may represent one of several neurobiological adaptations linked to early, severe and/or prolonged psychosocial adversity. This perspective integrates neurobiological and psychosocial factors in FND and proposes a research agenda, highlighting the need for replication of existing findings, multimodal sampling across emotional response domains and further examination of emotional influences on sensorimotor and cognitive functions in FND populations.

show abstract

Section: Introductionmentioning

confidence: 99%

Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda

Pick

Goldstein

Perez

et al. 2018

J Neurol Neurosurg Psychiatry

210

167

View full text Add to dashboard Cite

show abstract

“…A recent review found that stressful life events were significantly more common in people with FMDs and may be relevant to the aetiology of the condition for some patients. 7 Despite the similarities outlined above, there are differences between these two cases. The progression of their FTs were highly different: the patient in case 1 has had deterioration in his symptoms over time, yet in case 2 there was steady improvement.…”

Section: Discussionmentioning

confidence: 99%

Functional tremors in older people: an individualised approach is required

Chalkley¹,

Ruhi²

2018

Prog Neurol Psychiatry

View full text Add to dashboard Cite

There is debate as to the most appropriate and accurate description of functional movement disorders (FMDs). In this article, Dr Chalkley and Dr Ruhi discuss the characteristics of FMDs and specifically look at two patients' tremors that were entirely distractible and variable in direction, amplitude and frequency. They describe similar onset and development of their symptoms: hand tremors starting after a traumatic event, which then progressed to the whole body. Despite this, there were multiple differences between the cases; of note, the effect of emotion, exercise and relaxation were completely opposing. They conclude that a traumatic life event may trigger a cascade of somatic symptoms, how personalised approaches to psychological therapy are of importance and crucially that more high‐quality research is needed to make evidence‐based decisions on the management of FMDs.

show abstract

“…A recent meta-analysis of case-control studies found higher frequency of both childhood and adulthood stressors in people with FND than controls 1. It reported OR=2.8–4.3 for stressful life events preceding FND symptom onset, with higher ratios in studies using better-quality interview methods.…”

Section: Stress and Healthmentioning

confidence: 99%

“…Growing research focus on sensitive periods of brain development at which maltreatment may exert greater harm, predisposing to psychopathology,9 will inform our understanding of how traumatic stressors interact with biological susceptibility in FND. However, the quality of research which recognises the key role played by stress, is often limited by methodological issues such as self-report questionnaires and recall bias 1. Detailed interview techniques, which blind-rate a range of experiences, contextualised to the person’s life, remain the gold standard, but require considerable time and training, and cannot fully objectify (at least partially) subjective stress experiences.…”

Section: Implications For Fndmentioning

confidence: 99%

Stress and functional neurological disorders: mechanistic insights

Keynejad

Frodl

Kanaan

et al. 2018

J Neurol Neurosurg Psychiatry

100

View full text Add to dashboard Cite

At the interface between mind and body, psychiatry and neurology, functional neurological disorder (FND) remains poorly understood. Formerly dominant stress-related aetiological models have been increasingly challenged, in part due to cases without any history of past or recent trauma. In this perspective article, we review current evidence for such models, and how research into the role of traumatic stress in other disorders and the neurobiology of the stress response can inform our mechanistic understanding of FND. First, we discuss the association between stress and the onset or exacerbation of a variety of physical and mental health problems. Second, we review the role of hypothalamic-pituitary-adrenal axis dysfunction in the neurobiology of ill-health, alongside evidence for similar mechanisms in FND. Third, we advocate a stress-diathesis model, in which biological susceptibility interacts with early life adversity, where FND can be precipitated by traumatic events later in life and maintained by psychological responses. We hypothesise that greater biological susceptibility to FND is associated with less severe remote and recent stress, and that FND precipitated by more severe stress is associated with lower biological vulnerability. This would explain clinical experience of variable exposure to historical and recent traumatic stress among people with FND and requires empirical investigation. A testable, evidence-based stress-diathesis model can inform nuanced understanding of how biological and psychological factors interact at the individual level, with potential to inform personalised treatment pathways. Much-needed research to establish the aetiology of FND will enhance clinical care and communication, facilitate effective treatment and inform prevention strategies.

show abstract

Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies

Abstract: None.

Cited by 324 publications

References 62 publications

Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda

Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda

Functional tremors in older people: an individualised approach is required

Stress and functional neurological disorders: mechanistic insights

Contact Info

Product

Resources

About