From emotion processing to metacognition

Abstract

Functional neurological disorder (FND) is the term used (DSM-5) to refer to a disabling neuropsychiatric condition that is frequently encountered in medical practice. It was previously known as conversion disorder (CD) and formerly described as hysteria. It is characterised by neuro­logical symptoms (e.g., weakness, numbness, tremor…) without evidence of any brain lesion. Early neurobiological accounts of this disorder were part of the foundation of psychiatry and neurology, but were then dominated by a purely psychodynamic perspective. The advent of neuroimaging in the past two decades has stimulated renewed interest in the “functional” brain underpinnings of these symptoms, with growing interest and ­increasing attempts to investigate them in a neuroscience perspective. In this brief review, I discuss recent evidence pointing to how top-down mechanisms may alter motor function in patients with motor FND/CD, through coupling with neural systems associated with internal self-monitoring, emotion regulation and memory, and thus lead to the emergence of functional symptoms. More research, however, is still needed to elucidate the causes of FND/CD (why they occur), in addition to their neuro­anatomical substrates (how they occur).