Name given for symptoms in the body which appear to be caused by problems in the nervous system but which are not caused by a physical neurological disease or disorder

Aetiology

• Higher percentages of this disorder in people with irritable bowel syndrome, chronic pain patients, patients with PTSD, patients with antisocial personality disorder

Pathophysiology

• Not consciously mediated
• Patient has no control of the attacks
• Related to:
  • Traumatic events
  • Physical/sexual abuse
  • Other stress
  • Anxiety or depression

Clinical features

• Sensory symptoms - positive (e.g. pain) or negative (e.g. anaethesia)
• Concentration, memory and fatigue problems
• Movement symptoms e.g. difficulty moving, extra involuntary movements
• Functional seizures
  • Attacks with prominent motor activity
  • Episodes of collapse with no movement
  • Abreactive attacks - fear, gasping, hyperventilation
  • Duration often prolonged e.g. 10-20 mins

Investigations

• Linguistic analysis
• Ruling out of physical causes e.g. EEG to rule out epilepsy

Management

• Education and support
• Appropriate counselling for any previous traumatic events
• Treatment of any associated anxiety or depression
• CBT standard treatment of choice