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Stress and functional neurological disorders: mechanistic insights

Research output: Contribution to journalArticle

Original languageEnglish
JournalJournal of Neurology, Neurosurgery and Psychiatry
Early online date8 Nov 2018
DOIs
StateE-pub ahead of print - 8 Nov 2018

Documents

  • Stress and Functional Neurological_KEYNEJAD_Firstonline8November2018_GREEN AAM

    Stress_and_Functional_Neurological_KEYNEJAD_Firstonline8November2018_GREEN_AAM.pdf, 443 KB, application/pdf

    15/11/2018

    Accepted author manuscript

    This article has been accepted for publication in Neuropsychiatry, 2018] following peer review, and the Version of Record can be accessed online at
    http://dx.doi.org/10.1136/jnnp-2018-318297
    © Author(s) (or their employer(s)) 2018.

King's Authors

Abstract

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.

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