Individualized psychotherapy reveals a very high prevalence of adverse life events in functional neurological disorders

Background: Adverse life events are frequent in patients with functional neurological disorder (FND), although their prevalence is highly variable when assessed using standardized methods. We explored whether an extended multimodal evaluation with a personalized approach may yield additional insights. Methods: This cross-sectional study included 83 newly diagnosed FND patients and 82 organic neurological disorder (OND) patients. All participants underwent: (1) a standardized psychological/psychometric evaluation of mood, fatigue, sleep, personality disorders. Adverse life events were specifically investigated using the Life Stressor Checklist-R (LSCL-R); (2) a brief psychotherapeutic intervention consisting in five-eight sessions of psychodynamic psychotherapy. We compared the prevalence of adverse life events in the two evaluations. Results: Increased prevalence of adverse life events was found in FND compared with OND patients using both the LSCL-R (66.3% vs 36.6%) and the brief psychotherapeutic intervention (87.9% vs 45.1%). While in the OND group the two evaluations demonstrated a significant agreement, the brief psychotherapeutic intervention showed traumatic events in a consistent proportion of FND patients reporting no adverse life experiences in the LSCL-R. Traumatic events evaluated using both the LSCL-R and the brief psychotherapeutic intervention were significantly associated with FND group controlling for other clinical characteristics (OR=3.625, 95%CI 1.812-7.250, p<0.001; OR=10.731, 95%CI 4.417-26.071, p<0.001, respectively). Conclusions: A brief psychotherapeutic intervention uncovered a high prevalence of adverse life events in patients with FND, suggesting that a significant number of traumatic experiences remain undetected during standard evaluations. These findings have important implications for the pathogenesis and treatment of FND, and support the inclusion of psychotherapeutic assessment as part of a multidisciplinary approach.