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

Author:

Pick SusannahORCID,Goldstein Laura HORCID,Perez David LORCID,Nicholson Timothy R

Abstract

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.

Funder

National Institute for Health Research

National Institute of Mental Health

Publisher

BMJ

Subject

Psychiatry and Mental health,Clinical Neurology,Surgery

Reference93 articles.

1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5th edn. Washington: American Psychiatric Association, 2013.

2. Who is referred to neurology clinics?—The diagnoses made in 3781 new patients

3. Epidemiology;Carson;Handb Clin Neurol,2016

4. World Health Organisation . The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: Switzerland: World Health Organisation, 1992.

5. Psychogenic non-epileptic seizures—Definition, etiology, treatment and prognostic issues: A critical review

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