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

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
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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