Case history
Case history #1
A 21-year-old woman presents to the accident and emergency department with acute onset of left-sided body twitching after a minor accident in which she hit her head. An eyewitness to the event reports that these symptoms lasted for 20 minutes, during which time her eyes were tightly closed, and her breathing was rapid. Physical examination, laboratory investigations, and imaging studies are normal. Over the next several weeks, she begins experiencing episodes of full-body movements with side-to-side head shaking lasting 5-10 minutes. In the week before the initial symptom onset, her boyfriend (for whom she also worked) broke up with her, and she had a conflict with her parents. She and her boyfriend have since reconciled. There is no reported history of abuse, but there is a family dynamic of high expectations of the patient. Neurological examination and electroencephalogram during a typical episode are normal.
Case history #2
A 35-year-old woman seeks treatment for pelvic pain. On review of systems, she reports several years of various symptoms, including gastrointestinal (GI) problems (constipation, abdominal pain, nausea, and vomiting); headaches; vulvodynia; fatigue; all-over body pains; paraesthesias; and several sensitivities to environmental factors and medications. She has visited the accident and emergency department on several occasions and has been previously admitted to hospital for persistent GI symptoms. Extensive GI work-up, laboratory studies, and laparoscopy to rule out endometriosis have been unrevealing. In spite of this, she remains extremely concerned that the pelvic pain indicates that "something is seriously wrong"; she is struggling to manage her responsibilities at work currently due to intrusive thoughts and worries about her pain and about her health in general. She reports a traumatic childhood, with an alcohol-dependent father and sexual abuse by her grandfather.
Other presentations
Although not formally recognised as part of DSM-5-TR criteria, functional cognitive disorder and postural perceptual dizziness are other clinically recognised subtypes of functional neurological disorder.
Male, middle-aged, and older patients are also seen with functional neurological disorder and somatic symptom and related disorders, although this is less common. Importantly, these disorders can co-exist with other medical and neurological conditions, such as Parkinson's disease, multiple sclerosis, and epilepsy.[8][9][10] Previous health-related traumatic experiences (e.g., myocardial infarction, cancer) in a patient with high illness anxiety is associated with development of somatic symptom disorder.[11]
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