Functional (psychogenic) movement disorders: merging mind and brain
Abstract
Functional (psychogenic) movement disorders (FMD) are part of the wide spectrum of functional neurological disorders, which together account for over 16% of patients referred to neurology clinics. FMD have been described as a "crisis for neurology" and cause major challenges in terms of diagnosis and treatment. As with other functional disorders, a key issue is the absence of pathophysiological understanding. There has been an influential historical emphasis on causation by emotional trauma, which is not supported by epidemiological studies. The similarity between physical signs in functional disorders and those that occur in feigned illness has also raised important challenges for pathophysiological understanding and has challenged health professionals' attitudes toward patients with these disorders. However, physical signs and selected investigations can help clinicians to reach a positive diagnosis, and modern pathophysiological research is showing an appreciation of the importance of both physical and psychological factors in FMD.
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The relation between attention and tic generation in Tourette syndrome.
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“These peculiar circumstances are difficult to explain without reference to culture and context and we therefore assert RS to be culture-bound.”
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“For better outcome, diagnostic delay should be avoided and treatment is best offered in a multidisciplinary approach, including symptom-focused cognitive–behavioral therapy approaches and physical interventions [140, 141].”
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“, schizophrenia [4], alien hand syndrome [6], or functional neurological disorders [7]).”
BackgroundHallucinations, somatic‐functional disorders of PD‐DLB as expressions of thalamic dysfunction
ONOFRJ, M. C., Espay, A. J., Bonanni, L., Pizzi, S. D., & Sensi, S. L. (2019) · Movement Disorders · doi:10.1002/mds.27781 · Cited by 79 · see citing works
“These false perceptions may (in the case of conversion-functional disorders) or may not (in the case of somatic symptoms) be followed by induction of compensatory motor outputs, thereby generating subcortical patterns of motor activity or motor suppression that range from conversion paresis to catatonia.(8,10) Althoug…”
BackgroundBrain Stimulation for Torsion Dystonia
Fox, M., & Alterman, R. L. (2015) · JAMA Neurology · doi:10.1001/jamaneurol.2015.51 · Cited by 78 · see citing works
Treatment of Functional (Psychogenic) Movement Disorders
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“However, we prefer to define this disorder by its clinical appearance, rather than by any causative speculation, as a movement disorder that is significantly altered by distraction or non-physiological manoeuvres (including dramatic placebo response) and that is clinically incongruent with movement disorders known to…”
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Psychogenic palatal tremor may be underrecognized: Reappraisal of a large series of cases
Stamelou, M., Saifee, T. A., Edwards, M. J., & Bhatia, K. P. (2012) · Movement Disorders · doi:10.1002/mds.24948 · Cited by 72 · see citing works
Self-citationPsychogenic nonepileptic seizures and movement disorders
Erro, R., Brigo, F., Trinka, E., Turri, G., Edwards, M. J., & Tinazzi, M. (2016) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000000235 · Cited by 67 · see citing works
Self-citationPsychogenic Movement Disorders
Morgante, F., Edwards, M. J., & Espay, A. J. (2013) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/01.con.0000436160.41071.79 · Cited by 66 · see citing works
“Diagnosis of psychogenic movement disorders is a multistep process (Figure 9-1) that should be based on specific aspects of history and examination rather than on excluding organic disorders.(6) Throughout this process, it is important to be aware of the historical and phenomenologic features common to all psychogenic…”
BackgroundInfluentialSelf-citationde Gusmão, C. M., Guerriero, R. M., Bernson‐Leung, M. E., Pier, D. B., Ibeziako, P. I., Bujoreanu, S. I., Maski, K. P., Urion, D. K., & Waugh, J. L. (2014) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2014.04.009 · Cited by 65 · see citing works
Functional neurological disorders: The neurological assessment as treatment
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Persistent Postural-Perceptual Dizziness
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Myoclonus and other jerky movement disorders
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Psychogenic Movement Disorders
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“The reported prevalence of PMDs at movement disorders clinic varies from 2% to 20%.(9) These disorders are associated with marked disability and distress, reported to be similar to or greater than those reported by patients with neurodegenerative disease, such as Parkinson disease.”
BackgroundExpert recommendations for diagnosing cervical, oromandibular, and limb dystonia
Defazio, G., Albanese, A., Pellicciari, R., Scaglione, C. L. M., Esposito, M., Morgante, F., Abbruzzese, G., Bentivoglio, A. R., Bono, F., Moja, M. C., et al. (2018) · Neurological Sciences · doi:10.1007/s10072-018-3586-9 · Cited by 57 · see citing works
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“Diagnosis of FND is often considered a challenge but it should not be one of exclusion [8].”
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“The most common form is tremor, followed by dystonia and myoclonus (Factor et al., 1995; Bhatia and Shneider, 2007; Edwards and Bhatia, 2012).”
BackgroundTaïb, S., Ory‐Magne, F., Brefel‐Courbon, C., Moreau, Y., Thalamas, C., Arbus, C., & Simonetta‐Moreau, M. (2019) · Movement Disorders · doi:10.1002/mds.27727 · Cited by 54 · see citing works
“38 Duration of symptoms, months (range) 45 (4-126) 72 (4-203) .”
Functional movement disorders are not uncommon in the elderly
Batla, A., Stamelou, M., Edwards, M. J., Pareés, I., Saifee, T. A., Fox, Z. V., & Bhatia, K. P. (2013) · Movement Disorders · doi:10.1002/mds.25350 · Cited by 54 · see citing works
“There are internationally accepted diagnostic criteria for FMD,(2) highlighting the importance of positive clinical signs in making a diagnosis.(1) FMDs often are not suspected in the elderly, and previous studies have confirmed that most patients are young.”
BackgroundSelf-citationThe Phenomenology of Functional (Psychogenic) Dystonia
Ganos, C., Edwards, M. J., & Bhatia, K. P. (2014) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.12013 · Cited by 53 · see citing works
“Finally, FD may coexist with organic movement disorders or other neurological illness (functional overlay).(27,30,42) In these cases, they usually affect the same or adjacent body parts.”
BackgroundSelf-citationFunctional neurological disorder and placebo and nocebo effects: shared mechanisms
Fiorio, M., Braga, M., Marotta, A., Villa‐Sánchez, B., Edwards, M. J., Tinazzi, M., & Barbiani, D. (2022) · Nature Reviews Neurology · doi:10.1038/s41582-022-00711-z · Cited by 56 · see citing works
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Integrated Therapy for Functional Movement Disorders: Time for a Change
Lidstone, S. C., MacGillivray, L., & Lang, A. E. (2019) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.12888 · Cited by 46 · see citing works
“Imaging studies point to an abnormal motor– limbic interface(7) and deficits in sensorimotor integration and agency.(8,9) Abnormal symptom-related beliefs and expectations, heightened self-directed attention,(10) maladaptive conditioning,(11) and autonomic and neuroendocrine changes(12) are also relevant”
BackgroundMyoclonus subtypes in tertiary referral center. Cortical myoclonus and functional jerks are common
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“The activation of these regions generates motor schemes that can cause a variety of symptoms ranging from “ functional ” paresis to catatonia [37, 194].”
BackgroundNeuroinflammation, Neuroautoimmunity, and the Co-Morbidities of Complex Regional Pain Syndrome
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“How specific symptoms are viewed and labeled can dramatically influence the course of medical inquiry, patient-practitioner (biosocial) relationships, as well as the patient acceptance of treatment plans (Stone and Edwards 2011; Edwards and Bhatia 2012).”
BackgroundPsychogenic axial myoclonus: Clinical features and long-term outcome
Erro, R., Edwards, M. J., Bhatia, K. P., Esposito, M., Farmer, S. F., & Cordivari, C. (2014) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2014.02.026 · Cited by 41 · see citing works
“Moreover, this view seems to be not anymore supported by current evidence [14].”
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Functional movement disorder comorbidity in Parkinson's disease: Unraveling the web
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How to use the entrainment test in the diagnosis of functional tremor
Roper, L. S., Saifee, T. A., Pareés, I., Rickards, H. E., & Edwards, M. J. (2013) · Practical Neurology · doi:10.1136/practneurol-2013-000549 · Cited by 40 · see citing works
Self-citationFamilial psychogenic movement disorders
Stamelou, M., Cossu, G., Edwards, M. J., Murgia, D., Pareés, I., Melis, M., & Bhatia, K. P. (2013) · Movement Disorders · doi:10.1002/mds.25463 · Cited by 39 · see citing works
Self-citationA biological measure of stress levels in patients with functional movement disorders
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“The presence of coexisting stressors continues to be used as supportive criteria in the diagnosis of functional movement disorders (FMD)[1].”
BackgroundDissociated motor learning and de-adaptation in patients with functional gait disorders
Lin, D., Castro, P., Edwards, A., Sekar, A., Edwards, M. J., Coebergh, J., Bronstein, A. M., & Kaski, D. (2020) · Brain · doi:10.1093/brain/awaa190 · Cited by 38 · see citing works
Self-citationThe neuroimaging evidence of brain abnormalities in functional movement disorders
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“While terminology plays a key role in distinguishing from malingering or feigning symptoms, an accurate term has been challenging because of a limited understanding of the underlying physiology of functional disorders.(4) Invoking a psychogenic cause in the absence of identifiable risk factors falsely labels individua…”
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Psychogenic Tremor: A Video Guide to Its Distinguishing Features
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“The reported prevalence of PMDs varies between 2% and 20% based on the definition and clinical setting.(1) While PMDs are most common in young individuals, particularly women, the gender difference is less evident in children.”
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“It makes up 50% of all PMDs.[37] PT is characterized by the presence of rest, postural, or kinetic tremor, but most often all three types are seen in unison.”
Tinazzi, M., Gandolfi, M., Landi, S., & Leardini, C. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.786126 · Cited by 35 · see citing works
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Variability of Movement Disorders: The Influence of Sensation, Action, Cognition, and Emotions
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“Patients may report marked variability in the body part affected or in symptom severity, including complete remissions and sudden recurrences.(113) It can be difficult to separate between functional and organic causes based on variability alone.”
BackgroundSelf-citationFunctional (psychogenic) movement disorders
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Diagnostic and statistical manual of mental disorders and pain management
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“Functional tremors are perceived by patients as involuntary and beyond their control, even if the motor pathways are similar to those of voluntary movements [14].”
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“With the new DSM-5 classification, diagnosis of FMD can be made without an identified psychological triggering factor [60,61].”
BackgroundMethodTen myths about functional neurological disorder
Lidstone, S. C., Araújo, R., Stone, J., & Bloem, B. R. (2020) · European Journal of Neurology · doi:10.1111/ene.14310 · Cited by 31 · see citing works
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“The terminological heterogeneity not only mirrors the fact that such conditions often fall between specialities [8], but also reflects the lack of agreement about the conceptual basis of this phenomenon [9]-[11].”
BackgroundPsychodynamic Psychotherapy for Functional (Psychogenic) Movement Disorders
Sharma, V. D., Jones, R., & Factor, S. A. (2016) · Journal of Movement Disorders · doi:10.14802/jmd.16038 · Cited by 31 · see citing works
Dosanjh, M., Alty, J., Martin, C., Latchford, G. J., & Graham, C. D. (2020) · British Journal of Health Psychology · doi:10.1111/bjhp.12478 · Cited by 32 · see citing works
“Functional movement disorders (FMD) are a sub-category, involving tremor, dystonia, paresis, tics, and gait disorders (Edwards & Bhatia, 2012).”
BackgroundHebert, C. L., Behel, J. M., Pal, G. D., Kasi, R. E., & Kompoliti, K. (2020) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2020.11.018 · Cited by 31 · see citing works
Gender and Age Determinants of Psychogenic Movement Disorders: A Clinical Profile of 73 Patients
Kamble, N., Prashantha, D., Jha, M., Netravathi, M., Reddy, Y. J. J., & Pal, P. (2016) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/cjn.2015.365 · Cited by 26 · see citing works
“Clinically PMD can present as hyperkinetic disorders and uncommonly hypokinetic disorders.(6,7) Early diagnosis and appropriate management is essential because it is associated with significant health care cost, poor quality of life, inadvertent medication use with their side effects, and burden to the caregiver.”
BackgroundFunctional jerks, tics, and paroxysmal movement disorders.
Dreissen, Y. E., Cath, D., & Tijssen, M. (2016) · Handbook of Clinical Neurology · doi:10.1016/b978-0-12-801772-2.00021-7 · Cited by 21 · see citing works
Neural activity in functional movement disorders after inpatient rehabilitation
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Inpatient Treatment of Functional Neurological Disorder: A Scoping Review
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“Functional neurological disorder (FND) is a common cause for disabling neurological symptoms, including altered awareness, motor, and sensory changes.(1) Many terms are used to describe this disorder: psychogenic, conversion, somatization, nonorganic, hysteria, shell shock, and medically unexplained.”
BackgroundThe illness-disease dichotomy and the biological-clinical splitting of medicine
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Recognizing Uncommon Presentations of Psychogenic (Functional) Movement Disorders
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EMDR to Treat Functional Neurological Disorder: A Review
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“…some patients, but there are many patients who present in neurology clinics without identifiable trauma in their background (Brown & Reuber, 2016; Edwards & Bhatia, 2012), and alternative theories such as attention to and expectations regarding symptoms may be a more fitting explanation in those…”
BackgroundGalli, S., Béreau, M., Magnin, É., Moulin, T., & Aybek, S. (2019) · Revue Neurologique · doi:10.1016/j.neurol.2019.08.007 · Cited by 26 · see citing works
“Classically, onset of FMD is sudden and often with a precipitating trigger [28].”
BackgroundSense of agency disturbances in movement disorders: A comprehensive review
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Medically Unexplained Neurologic Symptoms: A Primer for Physicians Who Make the Initial Encounter
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“An additional part of successful treatment is the removal of unnecessary medications and avoidance of unnecessary tests and surgical treatments.(32) If a patient believes that he or she is taken seriously, many will eventually become less defensive and open up about emotional symptoms and possible stressors.”
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Diagnosis and management of functional neurological symptoms: The Dutch experience
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“Communicating the diagnosis of FNS to patients is challenging for neurologists [23,24].”
BackgroundSchmidt, T., Ebersbach, G., Oelsner, H., Sprock, A., König, I. R., Bäumer, T., Münchau, A. M., & Weißbach, A. (2021) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13268 · Cited by 26 · see citing works
“Yet, the accumulated empirical knowledge allows for formulating testable hypotheses for the treatment of FMD. Prospective controlled protocols are warranted to compare the efficacy and cost-effectiveness of different treatment concepts, e.g., single profession versus multi-disciplinary treatment and to better understa…”
BackgroundInfluentialTroubleshooting Gait Disturbances in Parkinson’s Disease With Deep Brain Stimulation
Pozzi, N. G., Palmisano, C., Reich, M. M., Capetian, P., Pacchetti, C., Volkmann, J., & Isaias, I. U. (2022) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2022.806513 · Cited by 24 · see citing works
Functional neurological symptoms
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“This is mainly due to those aspects that imply a presumed causal relation between psychological factors and generation of disease [2,3].”
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Speech, language and swallowing impairments in functional neurological disorder: a scoping review
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Functional Movement Disorders: Updates and Clinical Overview
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“2 For example, probing for the time course of the disorder and change in the nature of symptoms over time is important, as patients with FMD may often note a sudden onset of symptoms that follow a stressful incident (e.g., a car accident) that can serve as a trigger, incongruent with an organic…”
BackgroundTinazzi, M., Fiorio, M., Berardelli, A., Bonetti, B., Bonifati, D. M., Burlina, A. P., Cagnin, A., Calabria, F., Corbetta, M., Cortelli, P., et al. (2021) · Journal of Neurology · doi:10.1007/s00415-021-10840-y · Cited by 24 · see citing works
Tactile and Proprioceptive Temporal Discrimination Are Impaired in Functional Tremor
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“Patients with functional movement disorders may have a range of movement abnormalities including tremor.[1,2] Although the clinical features in patients with functional movement disorders are well described, the pathophysiology of these conditions is largely”
- Authors
- Edwards, M. J., & Bhatia, K. P.
- Affiliations
- UCL Queen Square Institute of Neurology (GB)
- Corresponding author
- Bhatia, Kailash P
- Venue
- The Lancet Neurology
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 11
- Issue
- 3
- Pages
- 250-260
- ISSN
- 1474-4422 (ISSN-L)
- OpenAlex
- W2103595952
- Cited by
- 314
- References
- 74
- Citations by year
- 2026: 16 · 2025: 26 · 2024: 12 · 2023: 23 · 2022: 36 · 2021: 19 · 2020: 30 · 2019: 21 · 2018: 19 · 2017: 19 · 2016: 24 · 2015: 17 · 2014: 24 · 2013: 19 · 2012: 8
- FWCI
- 2.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Neurology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- functional movement disorders, psychogenic movement disorders, conversion disorder, pathophysiology, feigned illness, psychological trauma, diagnosis, treatment, mind-brain relationship, psychological factors
- MeSH terms
- Brain, Humans, Movement Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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