Emotion processing in functional neurological disorder

Objective: Alexithymia and hypomentalization, two traits associated with childhood emotional abuse/neglect, have not previously been studied in people with mixed-symptom functional neurological disorder (FND). This case-control study these traits in people with FND compared to healthy control participants, and explored the relationships between alexithymia, mentalization, and somatic and neurological symptoms of a generalized nature. Method: Twenty-nine participants with FND and 41 healthy control participants completed a battery of self-report measures. Between-group differences in alexithymia and hypomentalization were investigated using parametric tests, and binary logistic regression analyses examined whether alexithymia and hypomentalization were predictive of FND (vs control) group status, after controlling for depressive symptoms, anxiety symptoms and education attainment. Linear regression analyses examined whether alexithymia and hypomentalization were also associated with physical and neurological symptoms across the entire sample. Results: Participants with FND had significantly higher score on measures of alexithymia, hypomentalization, somatic symptoms and neurological symptoms compared to healthy control participants. Between-group differences in alexithymia and neurological symptoms remained significant after controlling for covariates. High scores on the alexithymia and mentalization measures were also predictive of high scores on the measures of somatic and neurological symptoms across the entire sample. Conclusion: Alexithymia and hypomentalization do appear to be significant issues for people with FND, and may contribute to the tendency to express distress via physical symptoms. Exploring these traits with individual service users may contribute to a more comprehensive conceptualisation of their difficulties, and inform treatment approaches that are engaging and supportive