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BMC Psychiatry

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Open Access 01-12-2015 | Research article

“That pulled the rug out from under my feet!” – adverse experiences and altered emotion processing in patients with functional neurological symptoms compared to healthy comparison subjects

Authors: Astrid Steffen, Johanna Fiess, Roger Schmidt, Brigitte Rockstroh

Published in: BMC Psychiatry | Issue 1/2015

Abstract

Background

Medically unexplained movement or sensibility disorders, recently defined in DSM-5 as functional neurological symptoms (FNS), are still insufficiently understood. Stress and trauma have been addressed as relevant factors in FNS genesis. Altered emotion processing has been discussed.

The present study screened different types and times of adverse experiences in childhood and adulthood in patients with FNS as well as in healthy individuals. The relationship between stress profile, aspects of emotion processing and symptom severity was examined, with the hypothesis that particularly emotional childhood adversities would have an impact on dysfunctional emotion processing as a mediator of FNS.

Methods

Adverse childhood experiences (ACE), recent negative life events (LE), alexithymia, and emotion regulation style were assessed in 45 inpatients diagnosed with dissociative disorder expressing FNS, and in 45 healthy comparison subjects (HC).

Results

Patients reported more severe FNS, more (particularly emotional) ACE, and more LE than HC. FNS severity varied with emotional ACE and negative LE, and LE partially mediated the relation between ACE and FNS. Alexithymia and suppressive emotion regulation style were stronger in patients than HC, and alexithymia varied with FNS severity. Structural equation modeling verified partial mediation of the relationship between emotional ACE and FNS by alexithymia.

Conclusions

Early, emotional and accumulating stress show a substantial impact on FNS-associated emotion processing, influencing FNS. Understanding this complex interplay of stress, emotion processing and the severity of FNS is relevant not only for theoretical models, but, as a consequence also inform diagnostic and therapeutic adjustments.

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FNS is used in DSM-5 as descriptive term without addressing hypothetical mechanisms. The additionally used terms dissociative disorder or dissociative symptoms refer to the (ICD-10-)diagnoses and their emphasis on dissociation as central to the disorder. Furthermore, we try to focus on somatoform dissociative symptoms, i.e. physical deficits such as hypesthesia or gait disturbance, thereby acknowledging the often neglected contrast to psychoform dissociative symptoms such as amnesia or identity disorders; for a definition see [8, 16].

Regarding FNS in the present sample, ICD-10 and DSM diagnostic criteria overlap, as FNS (DSM-5) include negative somatoform dissociative/conversion symptoms as used in ICD-10 and DSM-IV.

Internal consistency (Cronbach’s α = 0.92) and test-retest reliability (r_tt = 0.89) reported for German version. Construct and criterion validity were confirmed by [37].

Test-retest reliability confirmed by correlation coefficients ranging from r_tt = 0.68 to r_tt = 0.80 [39]. Internal consistency of the GSI : α = 0.97 [61].

Internal consistency (Cronbach’s α = 0.68), good convergent validity [63].

Internal consistency: α = 0.88; good convergent validity (r > 0.72 [44]).

The individual onset of puberty was defined as the age at menarche (women) and as the age at voice break or the age at onset of shaving (men), respectively.

Test-retest reliability: r_tt = 0.78 to r_tt = 0.83 [46]. Construct validity has been shown by [45].

Internal consistencies α = 0.67 to α = 0.84; good convergent validity [49].

Internal consistencies: Cronbach’s α = 0.76 for cognitive reappraisal and α = 0.74 for suppression; good convergent validity [50].

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Title: “That pulled the rug out from under my feet!” – adverse experiences and altered emotion processing in patients with functional neurological symptoms compared to healthy comparison subjects
Authors: Astrid Steffen
Johanna Fiess
Roger Schmidt
Brigitte Rockstroh
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2015
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-015-0514-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

“That pulled the rug out from under my feet!” – adverse experiences and altered emotion processing in patients with functional neurological symptoms compared to healthy comparison subjects

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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