Lea Ludwig1, Joëlle A Pasman2, Timothy Nicholson3, Selma Aybek4, Anthony S David3, Sharon Tuck5, Richard A Kanaan6, Karin Roelofs7, Alan Carson8, Jon Stone9. 1. Department of Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. 2. Developmental Psychopathology, Radboud University, Nijmegen, Netherlands. 3. Section of Cognitive Neuropsychiatry, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK. 4. Section of Cognitive Neuropsychiatry, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK; Laboratory for Behavioral Neurology and Imaging of Cognition, Fundamental Neurosciences Department, Geneva University, Geneva, Switzerland. 5. Epidemiology and Statistics Core, Edinburgh Clinical Research Facility, Edinburgh, UK. 6. Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, VIC, Australia; Florey Institute for Neuroscience and Mental Health, Heidelberg, VIC, Australia. 7. Behavioural Science Institute, Radboud University, Nijmegen, Netherlands; Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, Netherlands. 8. Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK; Department of Rehabilitation Medicine, NHS Lothian, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. Electronic address: a.carson@ed.ac.uk. 9. Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Abstract
BACKGROUND: Stressful life events and maltreatment have traditionally been considered crucial in the development of conversion (functional neurological) disorder, but the evidence underpinning this association is not clear. We aimed to assess the association between stressors and functional neurological disorder. METHODS: We systematically reviewed controlled studies reporting stressors occurring in childhood or adulthood, such as stressful life events and maltreatment (including sexual, physical abuse, and emotional neglect) and functional neurological disorder. We did a meta-analysis, with assessments of methodology, sources of bias, and sensitivity analyses. FINDINGS: 34 case-control studies, with 1405 patients, were eligible. Studies were of moderate-to-low quality. The frequency of childhood and adulthood stressors was increased in cases compared with controls. Odds ratios (OR) were higher for emotional neglect in childhood (49% for cases vs 20% for controls; OR 5·6, 95% CI 2·4-13·1) compared with sexual abuse (24% vs 10%; 3·3, 2·2-4·8) or physical abuse (30% vs 12%; 3·9, 2·2-7·2). An association with stressful life events preceding onset (OR 2·8, 95% CI 1·4-6·0) was stronger in studies with better methods (interviews; 4·3, 1·4-13·2). Heterogeneity was significant between studies (I2 21·1-90·7%). 13 studies that specifically ascertained that the participants had not had either severe life events or any subtype of maltreatment all found a proportion of patients with functional neurological disorder reporting no stressor. INTERPRETATION: Stressful life events and maltreatment are substantially more common in people with functional neurological disorder than in healthy controls and patient controls. Emotional neglect had a higher risk than traditionally emphasised sexual and physical abuse, but many cases report no stressors. This outcome supports changes to diagnostic criteria in DSM-5; stressors, although relevant to the cause in many patients, are not a core diagnostic feature. This result has implications for ICD-11. FUNDING: None.
BACKGROUND: Stressful life events and maltreatment have traditionally been considered crucial in the development of conversion (functional neurological) disorder, but the evidence underpinning this association is not clear. We aimed to assess the association between stressors and functional neurological disorder. METHODS: We systematically reviewed controlled studies reporting stressors occurring in childhood or adulthood, such as stressful life events and maltreatment (including sexual, physical abuse, and emotional neglect) and functional neurological disorder. We did a meta-analysis, with assessments of methodology, sources of bias, and sensitivity analyses. FINDINGS: 34 case-control studies, with 1405 patients, were eligible. Studies were of moderate-to-low quality. The frequency of childhood and adulthood stressors was increased in cases compared with controls. Odds ratios (OR) were higher for emotional neglect in childhood (49% for cases vs 20% for controls; OR 5·6, 95% CI 2·4-13·1) compared with sexual abuse (24% vs 10%; 3·3, 2·2-4·8) or physical abuse (30% vs 12%; 3·9, 2·2-7·2). An association with stressful life events preceding onset (OR 2·8, 95% CI 1·4-6·0) was stronger in studies with better methods (interviews; 4·3, 1·4-13·2). Heterogeneity was significant between studies (I2 21·1-90·7%). 13 studies that specifically ascertained that the participants had not had either severe life events or any subtype of maltreatment all found a proportion of patients with functional neurological disorder reporting no stressor. INTERPRETATION: Stressful life events and maltreatment are substantially more common in people with functional neurological disorder than in healthy controls and patient controls. Emotional neglect had a higher risk than traditionally emphasised sexual and physical abuse, but many cases report no stressors. This outcome supports changes to diagnostic criteria in DSM-5; stressors, although relevant to the cause in many patients, are not a core diagnostic feature. This result has implications for ICD-11. FUNDING: None.
Authors: Karina Bennett; Clare Diamond; Ingrid Hoeritzauer; Paula Gardiner; Laura McWhirter; Alan Carson; Jon Stone Journal: Clin Med (Lond) Date: 2021-01 Impact factor: 2.659
Authors: Isaiah Kletenik; Stefan H Sillau; Sanaz Attaripour Isfahani; Kathrin LaFaver; Mark Hallett; Brian D Berman Journal: Mov Disord Clin Pract Date: 2019-12-13
Authors: Laura H Goldstein; Emily J Robinson; Izabela Pilecka; Iain Perdue; Iris Mosweu; Julie Read; Harriet Jordan; Matthew Wilkinson; Gregg Rawlings; Sarah J Feehan; Hannah Callaghan; Elana Day; James Purnell; Maria Baldellou Lopez; Alice Brockington; Christine Burness; Norman A Poole; Carole Eastwood; Michele Moore; John Dc Mellers; Jon Stone; Alan Carson; Nick Medford; Markus Reuber; Paul McCrone; Joanna Murray; Mark P Richardson; Sabine Landau; Trudie Chalder Journal: Health Technol Assess Date: 2021-06 Impact factor: 4.014
Authors: Lotta-Katrin Pries; Jim van Os; Margreet Ten Have; Ron de Graaf; Saskia van Dorsselaer; Maarten Bak; Bochao D Lin; Kristel R van Eijk; Gunter Kenis; Alexander Richards; Michael C O'Donovan; Jurjen J Luykx; Bart P F Rutten; Sinan Guloksuz Journal: JAMA Psychiatry Date: 2020-12-01 Impact factor: 21.596