Associations Between Maladaptive Schemas, Early Trauma, Depression, Anxiety, and Stress in Functional Neurological Disorders: An Initial Study

Background:

Research suggests that Functional Neurological Disorder (FND) and personality disorders may share underlying psychological concepts and risk factors, including interpersonal difficulties, emotional dysregulation, and early trauma or stressful life events. Both conditions are also associated with a high prevalence of self-harm and suicidality, delayed diagnosis, and poor clinical outcomes. This review aimed to identify and critically appraise the existing literature to examine the relationship between Cluster B personality disorders and functional seizures or functional movement disorder as the most common presentations of these conditions.

Method:

A systematic search of six databases was conducted in May 2024. A total of 20 studies meeting eligibility criteria were identified, critically appraised using a modified version of the AXIS tool, and synthesised narratively.

Results

Results indicate a high prevalence of co-morbid Cluster B personality disorders in both functional seizures and functional movement disorder, in particular borderline phenomena. Findings also suggest some key shared psychological constructs and associated factors between these presentations, including dissociative experiences, self-harm and suicidality, interpersonal difficulties, childhood trauma or stressful life events, and poor clinical outcomes.

Conclusion:

This review suggests a relationship between these two functional disorders and Cluster B personality pathology. Overall, study quality was good, but limitations across the literature were highlighted, particularly concerning the representativeness of study samples. Further research is required to determine the direction of this relationship and further examine differences in personality pathology between different FND subtypes. This could help to establish a better understanding of these complex conditions and improve clinical care.