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Functional neurologic and somatic symptom disorders

Last reviewed: 3 Nov 2023
Last updated: 28 Nov 2023



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
  • generalized seizure-like motor movements without loss of awareness
  • 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


functional neurologic disorder

somatic symptom disorder



Cynthia M. Stonnington, MD
Cynthia M. Stonnington

Professor of Psychiatry

Mayo Clinic




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




EDD declares that she has no competing interests.

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

Associate Professor of Neurology

Mayo Clinic




KHN declares that she has no competing interests.

Dona Locke, PhD
Dona Locke

Professor of Psychology

Mayo Clinic




DL declares that she has no competing interests.

Peer reviewers

David Perez, MD, MMSc

Psychiatrist and Assistant Neurologist

Massachusetts General Hospital

Associate Professor of Neurology and Psychiatry

Harvard Medical School




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 the author of a number of papers cited in this topic.

James L Levenson, MD

Rhona Arenstein Professor of Psychiatry

Virginia Commonwealth University



JLL declares that he was the unpaid text editor for the sections of DSM 5 and DSM 5-TR covering the two diagnoses listed in the topic.

Anton Scamvougeras, MBChB, FRCP

Consultant Neuropsychiatrist and Associate Clinical Professor

Department of Psychiatry

University of British Columbia


British Columbia



AS declares that he has no competing interests. AS is the author of one paper cited in the topic.

  • 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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