• Susannah Pick, Ls Merritt Millman, Emily Ward, Eleanor Short, Biba Stanton, Aat Simone Reinders, Joel S Winston, Timothy R Nicholson, Mark J Edwards, Laura H Goldstein, Anthony S David, Trudie Chalder, Matthew Hotopf, and Mitul A Mehta.
• King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK susannah.pick@kcl.ac.uk.
• J. Neurol. Neurosurg. Psychiatr. 2024 Apr 12; 95 (5): 461470461-470.

BackgroundDifferences in affective processing have previously been shown in functional neurological disorder (FND); however, the mechanistic relevance is uncertain. We tested the hypotheses that highly arousing affective stimulation would result in elevated subjective functional neurological symptoms (FNS), and this would be associated with elevated autonomic reactivity. The possible influence of cognitive detachment was also explored.MethodIndividuals diagnosed with FND (motor symptoms/seizures; n=14) and healthy controls (n=14) viewed Positive, Negative and Neutral images in blocks, while passively observing the stimuli ('Watch') or detaching themselves ('Distance'). The FND group rated their primary FNS, and all participants rated subjective physical (arousal, pain, fatigue) and psychological states (positive/negative affect, dissociation), immediately after each block. Skin conductance (SC) and heart rate (HR) were monitored continuously.ResultsFNS ratings were higher after Negative compared with Positive and Neutral blocks in the FND group (p=0.002, ηp 2=0.386); however, this effect was diminished in the Distance condition relative to the Watch condition (p=0.018, ηp 2=0.267). SC and/or HR correlated with FNS ratings in the Negative-Watch and Neutral-Distance conditions (r values=0.527-0.672, p values=0.006-0.035). The groups did not differ in subjective affect or perceived arousal (p values=0.541-0.919, ηp 2=<0.001-0.015).ConclusionsEmotionally significant events may exert an influence on FNS which is related to autonomic activation rather than altered subjective affect or perceived arousal. This influence may be modulated by cognitive detachment. Further work is needed to determine the relevance and neural bases of these processes in specific FND phenotypes.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

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