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The relationship between types of life events and the onset of functional neurological (conversion) disorder in adults: a systematic review and meta-analysis

Published online by Cambridge University Press:  25 November 2021

Shimaa K. Morsy ,
Selma Aybek ,
Alan Carson ,
Timothy R. Nicholson ,
Jon Stone ,
Ahmed M. Kamal ,
Nashaat A. Abdel-Fadeel ,
Maha A. Hassan  and
Richard A. A. Kanaan Open the ORCID record for Richard A. A. Kanaan [Opens in a new window]
Shimaa K. Morsy
Affiliation:
Department of Psychiatry, Faculty of Medicine, Minia University, Minia61519, Egypt Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia
Selma Aybek
Affiliation:
Psychosomatic Medicine, Neurology Department, University Hospital Inselspital, Bern University, Bern, Switzerland
Alan Carson
Affiliation:
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
Timothy R. Nicholson
Affiliation:
Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Jon Stone
Affiliation:
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
Ahmed M. Kamal
Affiliation:
Department of Psychiatry, Faculty of Medicine, Minia University, Minia61519, Egypt
Nashaat A. Abdel-Fadeel
Affiliation:
Department of Psychiatry, Faculty of Medicine, Minia University, Minia61519, Egypt
Maha A. Hassan
Affiliation:
Department of Psychiatry, Faculty of Medicine, Minia University, Minia61519, Egypt
Richard A. A. Kanaan*
Affiliation:
Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia
*
Author for correspondence: Richard A. A. Kanaan, E-mail: richard.kanaan@unimelb.edu.au
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Abstract

Adverse life events precede the onset of functional neurological disorder (FND, also known as conversion disorder) more commonly than other neuropsychiatric conditions, but their aetiological role is unclear. We conducted a systematic review and quantitative analysis of the type, timing and number of life events preceding the onset of FND in adults, and a meta-analysis of the proportions of types of events in controlled studies. Fifty-one studies of different designs, covering 4247 patients, were eligible for inclusion. There was no clear majority of any type of preceding event. Family problems were the most common category of events, followed by relationship problems. Females were more likely to experience preceding family/relationship problems than males, who reported more work problems. Family problems were the commonest type of preceding event in studies in developing countries, whereas family and health problems were equally common in developed countries. Abuse was associated with early symptom onset, while patients with later onset were more likely to report family problems. The median number of events was one, and the events occurred closer to onset than in controls. Meta-analysis found that family, relationship and work events were all relatively more common in patients than pathological controls, as were events where symptoms might provide a solution to the stressor. In conclusion, although a range of events precede the onset of FND, they do not appear to do so uniformly. This may support a different aetiological role for stressors than in other disorders, although the support is indirect and the quality generally low.

Keywords

Conversion disorderescape eventstrauma
Type
Review Article
Information
Psychological Medicine , Volume 52 , Issue 3 , February 2022 , pp. 401 - 418
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Copyright © The Author(s), 2021. Published by Cambridge University Press

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