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Dissociation and its biological and clinical associations in functional neurological disorder: systematic review and meta-analysis
- Malcolm C. Campbell, Abigail Smakowski, Maya Rojas-Aguiluz, Laura H. Goldstein, Etzel Cardeña, Timothy R. Nicholson, Antje A. T. S. Reinders, Susannah Pick
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- Journal:
- BJPsych Open / Volume 9 / Issue 1 / January 2023
- Published online by Cambridge University Press:
- 01 December 2022, e2
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Background
Studies have reported elevated rates of dissociative symptoms and comorbid dissociative disorders in functional neurological disorder (FND); however, a comprehensive review is lacking.
AimsTo systematically review the severity of dissociative symptoms and prevalence of comorbid dissociative disorders in FND and summarise their biological and clinical associations.
MethodWe searched Embase, PsycInfo and MEDLINE up to June 2021, combining terms for FND and dissociation. Studies were eligible if reporting dissociative symptom scores or rates of comorbid dissociative disorder in FND samples. Risk of bias was appraised using modified Newcastle–Ottawa criteria. The findings were synthesised qualitatively and dissociative symptom scores were included in a meta-analysis (PROSPERO CRD42020173263).
ResultsSeventy-five studies were eligible (FND n = 3940; control n = 3073), most commonly prospective case–control studies (k = 54). Dissociative disorders were frequently comorbid in FND. Psychoform dissociation was elevated in FND compared with healthy (g = 0.90, 95% CI 0.66–1.14, I2 = 70%) and neurological controls (g = 0.56, 95% CI 0.19–0.92, I2 = 67%). Greater psychoform dissociation was observed in FND samples with seizure symptoms versus healthy controls (g = 0.94, 95% CI 0.65–1.22, I2 = 42%) and FND samples with motor symptoms (g = 0.40, 95% CI −0.18 to 1.00, I2 = 54%). Somatoform dissociation was elevated in FND versus healthy controls (g = 1.80, 95% CI 1.25–2.34, I2 = 75%). Dissociation in FND was associated with more severe functional symptoms, worse quality of life and brain alterations.
ConclusionsOur findings highlight the potential clinical utility of assessing patients with FND for dissociative symptomatology. However, fewer studies investigated FND samples with motor symptoms and heterogeneity between studies and risk of bias were high. Rigorous investigation of the prevalence, features and mechanistic relevance of dissociation in FND is needed.
Contributors
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- By Federico Agliardi, Andrea Alpiger, Gianluca Bianchi Fasani, Lars Harald Blikra, Brian D. Bornhold, Edward N. Bromhead, Marko H.K. Bulmer, D. Calvin Campbell, Marie Charrière, Masahiro Chigira, John J. Clague, John Coggan, Giovanni B. Crosta, Tim Davies, Marc-Henri Derron, Mark Diederichs, Erik Eberhardt, Carlo Esposito, Robin Fell, Paolo Frattini, Corey R. Froese, Monica Ghirotti, Valentin Gischig, James S. Griffiths, Stephen R. Hencher, Reginald L. Hermanns, Kris Holm, Seyyedmahdi Hosseyni, Niels Hovius, Christian Huggel, Florian Humair, Oldrich Hungr, D. Jean Hutchinson, Michel Jaboyedoff, Matthias Jakob, Julien Jakubowski, Randall W. Jibson, Katherine S. Kalenchuk, Nikolay Khabarov, Oliver Korup, Luca Lenti, Serge Leroueil, Simon Loew, Oddvar Longva, Patrick MacGregor, Andrew W. Malone, Salvatore Martino, Scott McDougall, Mika McKinnon, Mauri McSaveney, Patrick Meunier, Dennis Moore, Jeffrey R. Moore, David C. Mosher, Michael Obersteiner, Lucio Olivares, Thierry Oppikofer, Luca Pagano, Massimo Pecci, Andrea Pedrazzini, David Petley, Luciano Picarelli, David J.W. Piper, John Psutka, Nicholas J. Roberts, Gabriele Scarascia Mugnozza, David Stapledon, Douglas Stead, Richard E. Thomson, Paolo Tommasi, J. Kenneth Torrance, Nobuyuki Torii, Gianfranco Urciuoli, Gonghui Wang, Christopher F. Waythomas, Malcolm Whitworth, Heike Willenberg, Xiyong Wu
- Edited by John J. Clague, Simon Fraser University, British Columbia, Douglas Stead, Simon Fraser University, British Columbia
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- Book:
- Landslides
- Published online:
- 05 May 2013
- Print publication:
- 23 August 2012, pp vii-x
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- By Sonia Ancoli-Israel, Ragnar Asplund, Michel Billiard, Theresa M. Buckley, Rohit Budhiraja, Robert N. Butler, Daniel J. Buysse, Scott S. Campbell, Daniel P. Cardinali, Julie Carrier, Cynthia L. Comella, Jana R. Cooke, Pietro Cortelli, Agnès Demazieres, Glenna A. Dowling, Luigi Ferini-Strambi, Philip R. Gehrman, Nalaka Sudheera Gooneratne, David S. Hallegua, Patrick J. Hanly, David G. Harper, Orla P. Hornung, Magdolna Hornyak, Michal Karasek, Milton Kramer, Andrew D. Krystal, Malcolm H. Lader, Rachel Leproult, Kenneth L. Lichstein, Andrea H.S. Loewen, Rémy Luthringer, Laurin J. Mack, Evelyn Mai, Atul Malhotra, Jennifer L. Martin, Judy Mastick, Monique A.J. Mets, Andrew A. Monjan, Timothy H. Monk, Daniel Monti, Jaime M. Monti, Patricia J. Murphy, C. Ineke Neutel, Eric A. Nofzinger, Seithikurippu R. Pandi-Perumal, Scott B. Patton, Donald B. Penzien, Max H. Pittler, Giora Pillar, Marc J. Poulin, Louis J. Ptácek, Stuart F. Quan, Jeanetta C. Rains, Megan E. Ruiter, Bruce D. Rybarczyk, Colin M. Shapiro, Vijay Kumar Sharma, D. Warren Spence, Kai Spiegelhalder, Luc Staner, Stephanie A. Studenski, Nikola N. Trajanovic, Eve Van Cauter, Gregory S. Vander Wal, Joris C. Verster, Aleksandar Videnovic, Matthew P. Walker, Daniel J. Wallace, David K. Welsh, David P. White, Barbara Wider, Theresa B. Young, Stefano Zanigni
- Edited by S. R. Pandi-Perumal, Jaime M. Monti, Universidad de la República, Uruguay, Andrew A. Monjan, National Institute on Aging, Bethesda, Maryland
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- Book:
- Principles and Practice of Geriatric Sleep Medicine
- Published online:
- 04 August 2010
- Print publication:
- 26 November 2009, pp ix-xii
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