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
Other diagnostic factors
- cognitive complaints
- Hoover sign
- speech disturbance
- swallowing disturbance
- pseudoclonus
- convergence spasm
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
Diagnostic investigations
1st investigations to order
- laboratory testing
- electroencephalogram (EEG)
Investigations to consider
- comprehensive neuropsychological testing
- standardized personality testing
- focused symptom inventories
Treatment algorithm
functional neurologic disorder
somatic symptom disorder
Contributors
Authors
Cynthia M. Stonnington, MD

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

Professor of Neurology
Mayo Clinic
Scottsdale
AZ
Disclosures
EDD declares that she has no competing interests.
Katherine H. Noe, MD, PhD

Associate Professor of Neurology
Mayo Clinic
Scottsdale
AZ
Disclosures
KHN declares that she has no competing interests.
Dona Locke, PhD

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
David L. Perez, MD, MMSc
Psychiatrist and Assistant Neurologist
Massachusetts General Hospital
Associate Professor of Neurology
Harvard Medical School
Boston
MA
Disclosures
DLP has received honoraria for continuing medical education lectures in functional neurologic disorder, research funding for the NH and Sidney R. Baer Jr. Foundation, and royalties from Springer Nature for a textbook on functional movement disorder. DLP has also previously published with the BMJ and is on the editorial board of Epilepsy & Behavior. DLP is an author of a number of references cited in this topic.
Allan House, MD
Professor of Liaison Psychiatry
Director
Leeds Institute of Health Sciences
Leeds
UK
Disclosures
AH declares that he has no competing interests.
Differentials
- Illness anxiety disorder
- Body dysmorphic disorder
- Factitious disorder
More DifferentialsGuidelines
- 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
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