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Title: Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies.
Austin Authors: Ludwig, Lea;Pasman, Joëlle A;Nicholson, Timothy;Aybek, Selma;David, Anthony S;Tuck, Sharon;Kanaan, Richard A A ;Roelofs, Karin;Carson, Alan;Stone, Jon
Affiliation: Department of Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
Developmental Psychopathology, Radboud University, Nijmegen, Netherlands
Section of Cognitive Neuropsychiatry, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
Laboratory for Behavioral Neurology and Imaging of Cognition, Fundamental Neurosciences Department, Geneva University, Geneva, Switzerland
Epidemiology and Statistics Core, Edinburgh Clinical Research Facility, Edinburgh, UK
Department of Psychiatry, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
Department of Rehabilitation Medicine, NHS Lothian, Edinburgh, UK
Issue Date: Apr-2018
Date: 2018-03-08
Publication information: The Lancet. Psychiatry 2018; 5(4): 307-320
Abstract: Stressful life events and maltreatment have traditionally been considered crucial in the development of conversion (functional neurological) disorder, but the evidence underpinning this association is not clear. We aimed to assess the association between stressors and functional neurological disorder. We systematically reviewed controlled studies reporting stressors occurring in childhood or adulthood, such as stressful life events and maltreatment (including sexual, physical abuse, and emotional neglect) and functional neurological disorder. We did a meta-analysis, with assessments of methodology, sources of bias, and sensitivity analyses. 34 case-control studies, with 1405 patients, were eligible. Studies were of moderate-to-low quality. The frequency of childhood and adulthood stressors was increased in cases compared with controls. Odds ratios (OR) were higher for emotional neglect in childhood (49% for cases vs 20% for controls; OR 5·6, 95% CI 2·4-13·1) compared with sexual abuse (24% vs 10%; 3·3, 2·2-4·8) or physical abuse (30% vs 12%; 3·9, 2·2-7·2). An association with stressful life events preceding onset (OR 2·8, 95% CI 1·4-6·0) was stronger in studies with better methods (interviews; 4·3, 1·4-13·2). Heterogeneity was significant between studies (I2 21·1-90·7%). 13 studies that specifically ascertained that the participants had not had either severe life events or any subtype of maltreatment all found a proportion of patients with functional neurological disorder reporting no stressor. Stressful life events and maltreatment are substantially more common in people with functional neurological disorder than in healthy controls and patient controls. Emotional neglect had a higher risk than traditionally emphasised sexual and physical abuse, but many cases report no stressors. This outcome supports changes to diagnostic criteria in DSM-5; stressors, although relevant to the cause in many patients, are not a core diagnostic feature. This result has implications for ICD-11. None.
DOI: 10.1016/S2215-0366(18)30051-8
ORCID: 0000-0003-0992-1917
Journal: The Lancet. Psychiatry
PubMed URL: 29526521
Type: Journal Article
Appears in Collections:Journal articles

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