Functional neurologic and somatic symptom disorders

Last reviewed: 2 Sep 2023
Last updated: 25 Jan 2023

Summary

Definition

History and exam

Key diagnostic factors

  • unconventional behavior during history
  • emotional processing problems
  • recent psychological or physical stressors
  • remote life stressors
  • multiple illness behaviors
  • unusual neurologic deficits
  • give-way weakness
  • inconsistent examination findings
  • paradoxical sensory findings
  • distractible symptoms
  • inconsistent paralysis
  • generalized seizure-like motor movements without loss of awareness
  • bizarre movements
  • gait disorders
  • functional movement disorders
More key diagnostic factors

Other diagnostic factors

  • cognitive complaints
  • Hoover sign
  • speech disturbance
  • swallowing disturbance
  • pseudoclonus
  • convergence spasm
Other diagnostic factors

Risk factors

  • history of sexual or physical abuse
  • adverse childhood events
  • history of trauma-related disorders
  • female sex
  • alexithymia
  • neuroticism
  • previously poor doctor-patient relationships
More risk factors

Diagnostic investigations

1st investigations to order

  • laboratory testing
  • electroencephalogram (EEG)
More 1st investigations to order

Investigations to consider

  • comprehensive neuropsychological testing
  • standardized personality testing
  • focused symptom inventories
More investigations to consider

Treatment algorithm

ACUTE

functional neurologic disorder

somatic symptom disorder

Contributors

Authors

Cynthia M. Stonnington, MD
Cynthia M. Stonnington

Professor of Psychiatry

Mayo Clinic

Scottsdale

AZ

Disclosures

CMS is an author of a number of references cited in this topic.

Erika Driver-Dunckley, MD
Erika Driver-Dunckley

Professor of Neurology

Mayo Clinic

Scottsdale

AZ

Disclosures

EDD declares that she has no competing interests.

Katherine H. Noe, MD, PhD
Katherine H. Noe

Associate Professor of Neurology

Mayo Clinic

Scottsdale

AZ

Disclosures

KHN declares that she has no competing interests.

Dona Locke, PhD
Dona Locke

Professor of Psychology

Mayo Clinic

Scottsdale

AZ

Disclosures

DL declares a Know-How agreement with Neuroglee Therapeutics that will result in royalties and is unrelated to this topic.

Peer reviewers

Allan House, MD

Professor of Liaison Psychiatry

Director

Leeds Institute of Health Sciences

Leeds

UK

Disclosures

AH declares that he has no competing interests.

  • Functional neurologic and somatic symptom disorders images
  • Differentials

    • Illness anxiety disorder
    • Body dysmorphic disorder
    • Factitious disorder
    More Differentials
  • Guidelines

    • A review and expert opinion on the neuropsychiatric assessment of motor functional neurological disorders
    • Evidence-based practice for the clinical assessment of psychogenic nonepileptic seizures
    More Guidelines
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