Functional neurological disorder: new subtypes and shared mechanisms
Open accessAbstract
Functional neurological disorder is common in neurological practice. A new approach to the positive diagnosis of this disorder focuses on recognisable patterns of genuinely experienced symptoms and signs that show variability within the same task and between different tasks over time. Psychological stressors are common risk factors for functional neurological disorder, but are often absent. Four entities-functional seizures, functional movement disorders, persistent perceptual postural dizziness, and functional cognitive disorder-show similarities in aetiology and pathophysiology and are variants of a disorder at the interface between neurology and psychiatry. All four entities have distinctive features and can be diagnosed with the support of clinical neurophysiological studies and other biomarkers. The pathophysiology of functional neurological disorder includes overactivity of the limbic system, the development of an internal symptom model as part of a predictive coding framework, and dysfunction of brain networks that gives movement the sense of voluntariness. Evidence supports tailored multidisciplinary treatment that can involve physical and psychological therapy approaches.
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Early adverse life experiences, negative affectivity, neuroticism, depression, and anxiety have been identified as psychological predisposing conditions for persistent physical symptoms.
“Early adverse life experiences, negative affectivity, neuroticism, depression, and anxiety have been identified as psycho logical predisposing conditions for persistent physical symptoms”
From Persistent physical symptoms: definition, genesis, and management (2024) · cites this paper as [69]
The “Predisposition, precipitants, perpetuants, and outcomes” section identifies childhood adversity as a risk factor for FND and says depression and anxiety frequently coexist with it. The PPPD section says neuroticism may predispose to persistent dizziness. The paper does not identify negative affectivity as a predisposing condition, and its findings concern specific functional disorders rather than persistent physical symptoms generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCommon biomedical factors, such as persistent inflammation and dysregulation of the immune, autonomic, metabolic, and microbiome systems, as well as genetic and epigenetic factors, can cause somatic symptoms to persist or intensify.
“Common biomedical factors, such as persistent inflammation and dysregulation of the immune, autonomic, metabolic, and microbiome systems, as well as genetic and epigenetic factors, can cause somatic symptoms to persist or intensify”
From Persistent physical symptoms: definition, genesis, and management (2024) · cites this paper as [69]
In “Predisposition, precipitants, perpetuants, and outcomes” (page unavailable), the paper discusses genetic variation associated with symptom severity, possible epigenetic processes, and reduced heart-rate variability in FND. It does not establish that persistent inflammation or immune, metabolic, or microbiome dysregulation causes somatic symptoms to persist or intensify; its discussion of genetic and epigenetic factors is also more tentative than the claim. (LLM, conf=0.84)
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Gender as a Risk Factor for Functional Movement Disorders: The Role of Sexual Abuse
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Pain processing in functional and idiopathic dystonia: An exploratory study
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Functional or not functional; that’s the question
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Functional (psychogenic) stereotypies
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Inpatient Treatment of Functional Neurological Disorder: A Scoping Review
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Functional Movement Disorders in Elderly
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Prepulse inhibition of the blink reflex is abnormal in functional movement disorders
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Functional jerks, tics, and paroxysmal movement disorders.
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The frequency and framing of cognitive lapses in healthy adults
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Suggestive seizure induction for inpatients with suspected psychogenic nonepileptic seizures
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The Arc de Siècle: functional neurological disorder during the ‘forgotten’ years of the 20th century
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Self-citationIctal SPECT in Psychogenic Nonepileptic and Epileptic Seizures
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Attended with and head-turning sign can be clinical markers of cognitive impairment in older adults
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Utility of tremor electrophysiology studies
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Functional Movement Disorders in Elderly
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Gender Disparity and Abuse in Functional Movement Disorders: a multi-center case-control study
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Unfeignable biomarkers in functional neurological disorder: drifting back to Pierre Janet
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Persistent physical symptoms: definition, genesis, and management
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Self-citationIncidence and prevalence of functional neurological disorder: a systematic review
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Self-citationWhy functional neurological disorder is not feigning or malingering
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Self-citationUnderstanding Functional Neurological Disorder: Recent Insights and Diagnostic Challenges
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Functional neurological disorder is a feminist issue
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Self-citationIdentification of biopsychological trait markers in functional neurological disorders
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Self-citationPersistent Postural-Perceptual Dizziness
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Self-citationIatrogenic harm in functional neurological disorder
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Self-citationStigma in functional neurological disorder (FND) – A systematic review
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Self-citationFunctional neurological disorder and placebo and nocebo effects: shared mechanisms
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The overlooked burden of persistent physical symptoms: a call for action in European healthcare
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“47 A different understanding also underlies the diagnostic category of functional neurological disorders (FND), 48 which are one of the most common conditions in neurological practice.”
Self-citationOverview of Movement Disorders Secondary to Drugs
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Neuropsychological evaluation of functional cognitive disorder: A narrative review
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Diagnosing Epilepsy with Normal Interictal EEG Using Dynamic Network Models
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Functional neurological disorder: defying dualism
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Self-citationHow stigma unfolds for patients with Functional Neurological Disorder
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Transient resting-state salience-limbic co-activation patterns in functional neurological disorders
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Self-citationPersistent postural-perceptual dizziness: A functional neuro-otologic disorder
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The Financial Burden of Functional Neurological Disorders
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Functional Neurologic Disorder, La Lésion Dynamique
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Neuropsychiatric phenotypes in functional movement disorder
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Recent advances in understanding the neurobiology of pediatric functional neurological disorder
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“Functional cognitive disorder (FCD) is a common cause of non-neurodegenerative memory complaints seen in primary care, memory clinics and other specialised services [1–3].”
Self-citationFunctional neurological disorder in Europe: regional differences in education and health policy
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Self-citationMoving Beyond Movement: Diagnosing Functional Movement Disorder
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Self-citationSojka, P., Serranová, T., Khalsa, S. S., Perez, D. L., & Diez, I. P. (2024) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.20240070 · Cited by 20 · see citing works
Time is ticking for TikTok tics: A retrospective follow‐up study in the post‐COVID‐19 isolation era
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Incongruence in FND: time for retirement
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Self-citationBOLD signal variability as potential new biomarker of functional neurological disorders
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Self-citationFunctional Neurological Disorder: Diagnostic Pitfalls and Differential Diagnostic Considerations
Finkelstein, S. A., & Popkirov, S. (2023) · Neurologic Clinics · doi:10.1016/j.ncl.2023.04.001 · Cited by 19 · see citing works
Dissociation in patients with epilepsy and functional seizures: A narrative review of the literature
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Neurometabolic alterations in children and adolescents with functional neurological disorder
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A new perspective on positive symptoms: expression of damage or self-defence mechanism of the brain?
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Self-citationFunctional neurological seizures and migraine: A systematic review and case series
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Functional neurological disorder: A common reason for a neurology inpatient referral
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Self-citationThe blink reflex and its modulation – Part 2: Pathophysiology and clinical utility
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Vickers, M. L., Menhinnitt, R. S., Choi, Y. K., Malacova, E., Eriksson, L., Churchill, A. W., Oddy, B., Boon, K., Randall, C., Braun, A. N., et al. (2024) · Autism · doi:10.1177/13623613241272958 · Cited by 17 · see citing works
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Creating a “Brain-Mind-Body Interface Disorders” Diagnostic Category Across Specialties
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Post-acute COVID-19 neuropsychiatric symptoms are not associated with ongoing nervous system injury
Taquet, M., Skórniewska, Z., Zetterberg, H., Geddes, J. R., Mummery, C. J., Chalmers, J. D., Ho, L., Horsley, A. R., Marks, M., Poinasamy, K., et al. (2023) · Brain Communications · doi:10.1093/braincomms/fcad357 · Cited by 14 · see citing works
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Migraine and functional neurological disorder (FND)—a review of comorbidity and potential overlap
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Self-citationPetrie, D., Lehn, A., Barratt, J., Hughes, A., Roberts, K. G., Fitzhenry, S., & Gane, E. M. (2023) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13718 · Cited by 14 · see citing works
Reconsidering Persistent Somatic Symptoms: A Transdiagnostic and Transsymptomatic Approach
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Functional neurological disorder: Practical management
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Self-citationSleep disorders in functional neurological disorder - a systematic review and meta-analysis
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Synchronization-based graph spatio-temporal attention network for seizure prediction
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Finkelstein, S. A., O’Neal, M. A., Baslet, G. C., Dworetzky, B. A., Godena, E. J., Maggio, J., Millstein, D. J., Milligan, T. A., & Perez, D. L. (2023) · Neurologic Clinics · doi:10.1016/j.ncl.2023.02.007 · Cited by 12 · see citing works
Self-citationFactors perpetuating functional cognitive symptoms after mild traumatic brain injury
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Clinical neurophysiology of functional motor disorders: IFCN Handbook Chapter
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Physical Rehabilitation of Motor Functional Neurological Disorders: A Narrative Review
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An update on psychogenic nonepileptic seizures
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The neuropsychology of functional neurological disorders
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The Functional Role of Conscious Sensation of Movement.
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Self-citationSpeech and language therapy: A treatment case series of 20 patients with functional speech disorder
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Functional Neurological Disorder: Historical Trends and Urgent Directions
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Vance, R. C., Clarke, S., O’Keeffe, F. M., Galligan, T., Doherty, A. M., Flynn, C., Kelleher, E., Laffan, A., Doherty, C. P., & Gillan, D. (2024) · Brain and Behavior · doi:10.1002/brb3.3362 · Cited by 10 · see citing works
How do I manage functional visual loss
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Self-citationSalivary oxytocin and amygdalar alterations in functional neurological disorders
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Healthcare employment as a risk factor for functional neurological disorder: A case–control study
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The role of neuropsychology in the care of patients with functional neurological symptom disorder
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Interoception and Mental Health
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Precipitating Factors for Functional Cognitive Disorder
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Self-citationBiopsychosocial prognostic indicators in Functional Neurological Disorder: A systematic review
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Interoception and dissociation in migraine: a case–control study of chronic and episodic subtypes
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- Authors
- Hallett, M., Aybek, S., Dworetzky, B. A., McWhirter, L., Staab, J. P., & Stone, J.
- Affiliations
- National Institutes of Health (US)
- University Hospital of Bern (CH)
- Brigham and Women's Hospital (US)
- University of Edinburgh (GB)
- Mayo Clinic (US)
- Corresponding author
- Hallett, Mark
- Venue
- The Lancet Neurology
- Publisher
- Elsevier BV
- Published
- 2022-06
- Volume
- 21
- Issue
- 6
- Pages
- 537-550
- ISSN
- 1474-4422 (ISSN-L)
- PMC
- PMC9107510
- OpenAlex
- W4223971211
- Cited by
- 538
- References
- 128
- Citations by year
- 2026: 154 · 2025: 159 · 2024: 126 · 2023: 81 · 2022: 17 · 2014: 1
- FWCI
- 16.48
- Type
- journal article
- Language
- en
- Update notices
- erratum (2022-06-01)
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet Neurology (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Funders
- National Institute of Neurological Disorders and Stroke
- U.S. Army Medical Research and Development Command
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (PP00P3_176985)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- conversion disorder, psychogenic non-epileptic seizures, functional movement disorders, functional cognitive disorder, psychological stress, predictive coding, brain network dysfunction, neurophysiological markers, multidisciplinary treatment
- MeSH terms
- Brain, Conversion Disorder, Humans, Seizures
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