The impact of adverse childhood experience on symptom severity in patients with functional neurological symptom disorder (FNSD)

Abstract

Theoretical backgroundAdverse childhood experiences (ACE), especially traumatic ACE have been assumed to play a particular role for patients with functional neurological symptoms (FNS): Emotional responses to traumata hypothetically affect (or ‘convert’ into) bodily symptoms. The present study examined this hypothesis scrutinizing the specific impact of (1) traumatic experiences compared to other adversities such as neglect, (2) early childhood compared to adolescent adverse experiences, (3) on FNS compared to psychological symptoms such as depressive and trauma-related symptoms. MethodsNeglect and abuse experiences during childhood and adolescence were assessed in 82 patients diagnosed with functional neurological symptom disorder (FNSD) and 82 healthy comparison participants (HC) together with self-rated FNS (indexed by somatoform dissociative symptoms, SDQ-20), depressive (BDI) and posttraumatic stress symptoms (PDS). Emotion processing was assessed with the TAS-26, which captures the ability to identify and describe one's own emotions (described as alexithymia), ResultsPatients reported more ACE than HC independent of type and age period, more severe functional neurological symptoms and more alexithymia. Alexithymia mediated not only the relationship between ACE and FNS, but also the relationship between ACE and depressive and ACE and trauma-related symptom severity in cases and controls. ConclusionResults emphasize the impact of neglect and abuse on FNSD, and strengthen the proposed ACE influence on affect regulation with its mediating role for symptom expression in support of the conversion concept. The similar impact of ACE on FNS, depressive and trauma-related symptoms suggest a sensitizing impact of childhood adversities on mental health.