Emotions have traditionally been considered crucial in the development of functional neurological disorder, but the evidence underpinning this association is not clear. We aimed to summarize evidence for association between functional neurological disorder and emotions as formulated by Breuer and Freud in their conception of hysterical conversion. Based on a systematic literature search, we identified 34 controlled studies and categorized them into four groups: (i) autonomic arousal, (ii) emotion-motion interactions, (iii) social modulation of symptoms, and (iv) bodily awareness in FND. We found evidence for autonomic dysregulation in FND; convergent neuroimaging findings implicate abnormal limbic-motor interactions in response to emotional stimuli in FND. Our results do not provide enough empirical evidence for social modulation of the symptoms, but there is a clinical support for the role of suggestion and placebo in FND. Our results provide evidence for abnormal bodily awareness in FND. Based on these findings, we propose that functional neurological symptoms are forms of emotional reactions shaped into symptoms by previous experience with illness and possibly reinforced by actual social contexts. Additional research should investigate the effect of social context on the intensity of functional neurological symptoms and associated brain regions.

Department of Neurology Faculty of Medicine Masaryk University and St Anne's University Hospital Brno Brno Czechia

Department of Psychiatry Faculty of Medicine Masaryk University and University Hospital Brno Brno Czechia

Department of Psychology and Psychosomatics Faculty of Medicine Masaryk University and University Hospital Brno Brno Czechia

Zobrazit více v PubMed

Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. Brain (2010) 133(Pt 5):1537–51. 10.1093/brain/awq068 PubMed DOI

Brown RJ, Reuber M. Psychological and psychiatric aspects of psychogenic non-epileptic seizures (PNES): a systematic review. Clin Psychol Rev. (2016) 45:157–82. 10.1016/j.cpr.2016.01.003 PubMed DOI

Breuer J, Freud S. Studies on Hysteria (1957). Oxford: Basic Books.

Szasz T. The Myth of Mental Illness. London:Secker and Warburg; (1962).

Shoenberg PJ. The symptom as stigma or communication in hysteria. Int J Psychoanal Psyhother. (1975) 4:507–17. PubMed

Kretschmer E. Hysteria: Reflex and Instinct. London: Peter Owen; (1948).

Nijenhuis ERS, Vanderlinden J, Spinhoven P, Vanderlinden J, van DyckR, van der HartO. Somatoform dissociative symptoms as related to animal defensive reactions to predatory imminence and injury. J Abnorm Psychol. (1998) 107:63–73. 10.1037/0021-843X.107.1.63 PubMed DOI

Edwards MJ, Fotopoulou A, Pareés I. Neurobiology of functional (psychogenic) movement disorders. Curr Opin Neurol. (2013) 26:442–7. 10.1097/WCO.0b013e3283633953 PubMed DOI PMC

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; (2013).

Edwards MJ. Neurobiologic theories of functional neurologic disorders. Handb Clin Neurol. (2017) 139:131–7. 10.1016/B978-0-12-801772-2.00012-6 PubMed DOI

Kirmayer LJ, Santhanam R. The anthropology of hysteria. In: Halligan PW, Bass C, Marshall JC. editors. Contemporary Approaches to the Study of Hysteria: Clinical and Theoretical Perspectives. Oxford: Oxford University Press; (2001), p. 251–70.

Kanaan RAA. Freud's hysteria and its legacy. Handb Clin Neurol. (2016) 139:37–44. 10.1016/B978-0-12-801772-2.00004-7 PubMed DOI

Barrett LF, Simmons WK. Interoceptive predictions in the brain. Nat Rev Neurosci. (2015) 16:419–29. 10.1038/nrn3950 PubMed DOI PMC

Chanes L, Barrett LF. Redefining the role of limbic areas in cortical processing. Trends Cogn Sci. (2015) 20:96–106. 10.1016/j.tics.2015.11.005 PubMed DOI PMC

Barrett L, Quigley KS, Hamilton P. An active inference theory of allostasis and interoception in depression. Philos Trans R Soc Lond B Biol Sci. (2016) 371:20160011. 10.1098/rstb.2016.0011 PubMed DOI PMC

Edwards MJ, Adams RA, Brown H, Pareés I, Friston KJ. A Bayesian account of “hysteria”. Brain (2012) 135(Pt 11):3495–512. 10.1093/brain/aws129 PubMed DOI PMC

Van den Bergh O, Witthöft M, Petersen S, Brown R. Symptoms and the body: taking the inferential leap. Neurosci Biobehav Rev. (2017) 74:185–203. 10.1016/j.neubiorev.2017.01.015 PubMed DOI

Friston K. The free-energy principle: a unified brain theory? Nat Rev Neurosci. (2010) 11:127–38. 10.1038/nrn2787 PubMed DOI

den Ouden HEM, Kok P, de Lange FP. How prediction errors shape perception, attention, and motivation. Front Psychol. (2012) 3:548 10.3389/fpsyg.2012.00548 PubMed DOI PMC

Craig ADB. How do you feel–now? The anterior insula and human awareness. Nat Rev Neurosci. (2009) 10:59–70. 10.1038/nrn2555 PubMed DOI

Gu X, Hof PR, Friston KJ, Fan J. Anterior insular cortex and emotional awareness. J Compar Neurol. (2013) 521:3371–88. 10.1002/cne.23368 PubMed DOI PMC

Fotopoulou A, Tsakiris M. Mentalizing homeostasis: the social origins of interoceptive inference. Neuropsychoanalysis (2017) 19:3–28. 10.1080/15294145.2017.1294031 DOI

Koch A, Pollatos O. Cardiac sensitivity in children: sex differences and its relationship to parameters of emotional processing. Psychophysiology (2014) 51:932–41. 10.1111/psyp.12233 PubMed DOI

Ambrosecchia M, Ardizzi M, Russo E, Ditaranto F, Speciale M, Vinai P, et al. . Interoception and autonomic correlates during social interactions. implications for anorexia. Front Hum Neurosci. (2017) 11:219. 10.3389/fnhum.2017.00219 PubMed DOI PMC

Teicher MH, Anderson CM, Ohashi K, Polcari A. Childhood maltreatment: altered network centrality of cingulate, precuneus, temporal pole and insula. Biol Psychiatry (2014) 76:297–305. 10.1016/j.biopsych.2013.09.016 PubMed DOI PMC

Brewer R, Cook R, Bird G. Alexithymia: a general deficit of interoception. R Soc Open Sci. (2016) 3:150664. 10.1098/rsos.150664 PubMed DOI PMC

Füstös J, Gramann K, Herbert BM, Pollatos O. On the embodiment of emotion regulation: interoceptive awareness facilitates reappraisal. Soc Cogn Affect Neurosci. (2013) 8:911–7. 10.1093/scan/nss089 PubMed DOI PMC

Schaefer M, Egloff B, Witthöft M. Is interoceptive awareness really altered in somatoform disorders? Testing competing theories with two paradigms of heartbeat perception. J Abnorm Psychol. (2012) 121:719–24. 10.1037/a0028509 PubMed DOI

Aybek S, Nicholson TR, O'Daly O, Zelaya F, Kanaan RA, David AS. Emotion-motion interactions in conversion disorder: an FMRI study. PloS ONE (2015) 10:e0123273. 10.1371/journal.pone.0123273 PubMed DOI PMC

Aybek S, Nicholson TR, Zelaya F, O'Daly OG, Craig TJ, David AS, et al. . Neural correlates of recall of life events in conversion disorder. JAMA Psychiatry (2014) 71:52–60. 10.1001/jamapsychiatry.2013.2842 PubMed DOI

Blakemore RL, Sinanaj I, Galli S, Aybek S, Vuilleumier P. Aversive stimuli exacerbate defensive motor behaviour in motor conversion disorder. Neuropsychologia (2016) 93(Pt A):229–41. 10.1016/j.neuropsychologia.2016.11.005 PubMed DOI

Espay AJ, Maloney T, Vannest J, Norris MM, Eliassen JC, Neefus E, et al. . Dysfunction in emotion processing underlies functional (psychogenic) dystonia. Move Disord. (2018) 33:136–45. 10.1002/mds.27217 PubMed DOI PMC

Espay AJ, Maloney T, Vannest J, Norris MM, Eliassen JC, Neefus E, et al. . Impaired emotion processing in functional (psychogenic) tremor: a functional magnetic resonance imaging study. NeuroImage Clin. (2018) 17:179–87. 10.1016/j.nicl.2017.10.020 PubMed DOI PMC

Fiess J, Rockstroh B, Schmidt R, Steffen A. Emotion regulation and functional neurological symptoms: does emotion processing convert into sensorimotor activity? J Psychosomat Res. (2015) 79:477–83. 10.1016/j.jpsychores.2015.10.009 PubMed DOI

Fiess J, Rockstroh B, Schmidt R, Wienbruch C, Steffen A. Functional neurological symptoms modulate processing of emotionally salient stimuli. J Psychosomat Res. (2016) 91:61–7. 10.1016/j.jpsychores.2016.10.007 PubMed DOI

Hassa T, Sebastian A, Liepert J, Weiller C, Schmidt R, Tüscher O. Symptom-specific amygdala hyperactivity modulates motor control network in conversion disorder. NeuroImage Clin. (2017) 15:143–50. 10.1016/j.nicl.2017.04.004 PubMed DOI PMC

Kozlowska K, Melkonian D, Spooner CJ, Scher S, Meares R. Cortical arousal in children and adolescents with functional neurological symptoms during the auditory oddball task. NeuroImage Clin. (2017) 13:228–36. 10.1016/j.nicl.2016.10.016 PubMed DOI PMC

Morris LS, To B, Baek K, Chang-Webb Y-C, Mitchell S, Strelchuk D, et al. . Disrupted avoidance learning in functional neurological disorder: implications for harm avoidance theories. NeuroImage Clin. (2017) 16:286–94. 10.1016/j.nicl.2017.08.007 PubMed DOI PMC

Szaflarski JP, Allendorfer JB, Nenert R, LaFrance WC, Barkan HI, DeWolfe J, et al. . Facial emotion processing in patients with seizure disorders. Epilepsy Behav. (2018) 79:193–204. 10.1016/j.yebeh.2017.12.004 PubMed DOI

Voon V, Brezing C, Gallea C, Ameli R, Roelofs K, LaFrance WC, et al. . Emotional stimuli and motor conversion disorder. Brain (2010) 133(Pt 5):1526–36. 10.1093/brain/awq054 PubMed DOI PMC

Voon V, Brezing C, Gallea C, Hallett M. Aberrant supplementary motor complex and limbic activity during motor preparation in motor conversion disorder. Move Disord. (2011) 26:2396–403. 10.1002/mds.23890 PubMed DOI PMC

Maurer CW, LaFaver K, Ameli R, Epstein SA, Hallett M, Horovitz SG. Impaired self-agency in functional movement disorders. Neurology (2016) 87:564–70. 10.1212/WNL.0000000000002940 PubMed DOI PMC

Apazoglou Biological and perceived stress in motor functional neurological disorders. Psychoneuroendocrinology (2017) 85:142–50. 10.1016/j.psyneuen.2017.08.023 PubMed DOI

Bakvis P, Roelofs K, Kuyk J, Edelbroek PM, Swinkels WAM, Spinhoven P. Trauma, stress, and preconscious threat processing in patients with psychogenic nonepileptic seizures. Epilepsia (2009) 50:1001–11. 10.1111/j.1528-1167.2008.01862.x PubMed DOI

Bakvis P, Spinhoven P, Putman P, Zitman FG, Roelofs K. The effect of stress induction on working memory in patients with psychogenic nonepileptic seizures. Epilepsy Behav. (2010) 19:448–54. 10.1016/j.yebeh.2010.08.026 PubMed DOI

Bakvis P, Spinhoven P, Roelofs K. Basal cortisol is positively correlated to threat vigilance in patients with psychogenic nonepileptic seizures. Epilepsy Behav. (2009) 16:558–60. 10.1016/j.yebeh.2009.09.006 PubMed DOI

Bakvis P, Spinhoven P, Zitman FG, Roelofs K. Automatic avoidance tendencies in patients with Psychogenic Non Epileptic Seizures. Seizure (2011) 20:628–34. 10.1016/j.seizure.2011.06.006 PubMed DOI

Kozlowska K, Brown KJ, Palmer DM, Williams LM. Specific biases for identifying facial expression of emotion in children and adolescents with conversion disorders. Psychosom Med. (2013) 75:272–80. 10.1097/PSY.0b013e318286be43 PubMed DOI

Kozlowska K, Palmer DM, Brown KJ, McLean L, Scher S, Gevirtz R, et al. . Reduction of autonomic regulation in children and adolescents with conversion disorders. Psychosomat Med. (2015) 77:356–70. 10.1097/PSY.0000000000000184 PubMed DOI

Kozlowska K, Griffiths KR, Foster SL, Linton J, Williams LM, Korgaonkar MS. Grey matter abnormalities in children and adolescents with functional neurological symptom disorder. Neuroimage Clin. (2017) 15:306–14. 10.1016/j.nicl.2017.04.028 PubMed DOI PMC

Pick S, Mellers JDC, Goldstein LH. Autonomic and subjective responsivity to emotional images in people with dissociative seizures. J Neuropsychol. (2018) 12:341–55. 10.1111/jnp.12144 PubMed DOI PMC

Roberts NA, Burleson MH, Weber DJ, Larson A, Sergeant K, Devine MJ, et al. . Emotion in psychogenic nonepileptic seizures: responses to affective pictures. Epilepsy Behav. (2012) 24:107–15. 10.1016/j.yebeh.2012.03.018 PubMed DOI

Ricciardi L, Demartini B, Crucianelli L, Krahé C, Edwards MJ, Fotopoulou A. Interoceptive awareness in patients with functional neurological symptoms. Biol Psychol. (2016) 113:68–74. 10.1016/j.biopsycho.2015.10.009 PubMed DOI

Seignourel PJ, Miller K, Kellison I, Rodriguez R, Fernandez HH, Bauer RM, et al. . Abnormal affective startle modulation in individuals with psychogenic [corrected] movement disorder. Move Disord. (2007) 22:1265–71. 10.1002/mds.21451 PubMed DOI

Yalçin M, Tellioglu E, Gündüz A, Özmen M, Yeni N, Özkara Ç, et al. . Orienting reaction may help recognition of patients with psychogenic nonepileptic seizures. Neurophysiol Clin Clin Neurophysiol. (2017) 47:231–7. 10.1016/j.neucli.2017.02.005 PubMed DOI

Karatzias T, Howard R, Power K, Socherel F, Heath C, Livingstone A. Organic vs. functional neurological disorders: the role of childhood psychological trauma. Child Abuse Negl. (2017) 63:1–6. 10.1016/j.chiabu.2016.11.011 PubMed DOI

Kienle J, Rockstroh B, Bohus M, Fiess J, Huffziger S, Steffen-Klatt A. Somatoform dissociation and posttraumatic stress syndrome - two sides of the same medal? A comparison of symptom profiles, trauma history and altered affect regulation between patients with functional neurological symptoms and patients with PTSD. BMC Psychiatry (2017) 17:248. 10.1186/s12888-017-1414-z PubMed DOI PMC

Kranick S, Ekanayake V, Martinez V, Ameli R, Hallett M, Voon V. Psychopathology and psychogenic movement disorders. Move Disord. (2011) 26:1844–50. 10.1002/mds.23830 PubMed DOI PMC

Ozcetin A, Belli H, Ertem U, Bahcebasi T, Ataoglu A, Canan F. Childhood trauma and dissociation in women with pseudoseizure-type conversion disorder. Nordic J Psychiatry (2009) 63:462–8. 10.3109/08039480903029728 PubMed DOI

Steffen A, Fiess J, Schmidt R, Rockstroh B. “That pulled the rug out from under my feet!” - adverse experiences and altered emotion processing in patients with functional neurological symptoms compared to healthy comparison subjects. BMC Psychiatry (2015) 15:133 10.1186/s12888-015-0514-x PubMed DOI PMC

Ludwig L, Pasman JA, Nicholson T, Aybek S, David AS, Tuck S, et al. . Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies. Lancet Psychiatry (2018) 5:307–20. 10.1016/S2215-0366(18)30051-8 PubMed DOI

Williams LM, Brammer MJ, Skerrett D, Lagopolous J, Rennie C, Kozek K, et al. . The neural correlates of orienting: an integration of fMRI and skin conductance orienting. Neuroreport (2000) 11:3011–5. 10.1097/00001756-200009110-00037 PubMed DOI

Vuilleumier P. Hysterical conversion and brain function. Prog Brain Res. (2005) 150:309–29. 10.1016/S0079-6123(05)50023-2 PubMed DOI

Roelofs K, Pasman J. Stress, childhood trauma, and cognitive functions in functional neurologic disorders. Handb Clin Neurol. (2016) 139:139–55. 10.1016/B978-0-12-801772-2.00013-8 PubMed DOI

Pai A, Suris AM, North CS. Posttraumatic stress disorder in the DSM-5: controversy, change, and conceptual considerations. Behav Sci. (2017) 7:7. 10.3390/bs7010007 PubMed DOI PMC

Dvir Y, Ford JD, Hill M, Frazier JA. Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities. Harvard Rev Psychiatry (2014) 22:149–61. 10.1097/HRP.0000000000000014 PubMed DOI PMC

Glaser D Emotional abuse and neglect (psychological maltreatment): a conceptual framework. Child Abuse Negl. (2002) 26:697–714. 10.1016/S0145-213(02)00342-3 PubMed DOI

Naughton AM, Maguire SA, Mann MK, Lumb RC, Tempest V, Gracias S, et al. . Emotional, behavioral, and developmental features indicative of neglect or emotional abuse in preschool children. JAMA Pediatr. (2013) 167:769. 10.1001/jamapediatrics.2013.192 PubMed DOI

Krüger C, Fletcher L. Predicting a dissociative disorder from type of childhood maltreatment and abuser-abused relational tie. J Trauma Dissociation (2017) 18:356–72. 10.1080/15299732.2017.1295420 PubMed DOI

Perez DL, Matin N, Barsky A, Costumero-Ramos V, Makaretz SJ, Young SS, et al. . Cingulo-insular structural alterations associated with psychogenic symptoms, childhood abuse and PTSD in functional neurological disorders. J Neurol Neurosurg Psychiatry (2017) 88:491–7. 10.1136/jnnp-2016-314998 PubMed DOI PMC

Krall SC, Rottschy C, Oberwelland E, Bzdok D, Fox PT, Eickhoff SB, et al. . The role of the right temporoparietal junction in attention and social interaction as revealed by ALE meta-analysis. Brain Struct Funct. (2015) 220:587–604. 10.1007/s00429-014-0803-z PubMed DOI PMC

Duncan NW, Hayes DJ, Wiebking C, Tiret B, Pietruska K, Chen DQ, et al. . Negative childhood experiences alter a prefrontal-insular-motor cortical network in healthy adults: a preliminary multimodal rsfMRI-fMRI-MRS-dMRI study. Hum Brain Mapp. (2015) 36:4622–37. 10.1002/hbm.22941 PubMed DOI PMC

Ansell EB, Rando K, Tuit K, Guarnaccia J, Sinha R. Cumulative adversity and smaller gray matter volume in medial prefrontal, anterior cingulate, and insula regions. Biol Psychiatry (2012) 72:57–64. 10.1016/j.biopsych.2011.11.022 PubMed DOI PMC

Bryant RA, Das P. The neural circuitry of conversion disorder and its recovery. J Abnor Psychol. (2012) 121:289–96. 10.1037/a0025076 PubMed DOI

van der Kruijs SJM, Bodde NMG, Vaessen MJ, Lazeron RHC, Vonck K, Boon P, et al. Functional connectivity of dissociation in patients with psychogenic non-epileptic seizures. J Neurol Neurosurg Psychiatry (2012) 83:239–47. 10.1136/jnnp-2011-300776 PubMed DOI

Nachev P, Kennard C, Husain M. Functional role of the supplementary and pre-supplementary motor areas. Nat Rev Neurosci. (2008) 9:856–69. 10.1038/nrn2478 PubMed DOI

Oliveri M, Babiloni C, Filippi MM, Caltagirone C, Babiloni F, Cicinelli P, et al. . Influence of the supplementary motor area on primary motor cortex excitability during movements triggered by neutral or emotionally unpleasant visual cues. Exp Brain Res. (2003) 149:214–21. 10.1007/s00221-002-1346-8 PubMed DOI

Rodigari A, Oliveri M. Disrupting SMA activity modulates explicit and implicit emotional responses: an rTMS study. Neurosci Lett. (2014) 579:30–4. 10.1016/j.neulet.2014.07.012 PubMed DOI

Borchardt V, Krause AL, Li M, van Tol MJ, Demenescu LR, Buchheim A, et al. . Dynamic disconnection of the supplementary motor area after processing of dismissive biographic narratives. Brain Behav. (2015) 5:e00377. 10.1002/brb3.377 PubMed DOI PMC

Fan Y, Duncan NW, de Greck M, Northoff G. Is there a core neural network in empathy? An fMRI based quantitative meta-analysis. Neurosci Biobehav Rev. (2011) 35:903–11. 10.1016/j.neubiorev.2010.10.009 PubMed DOI

Grèzes J, Dezecache G. How do shared-representations and emotional processes cooperate in response to social threat signals? Neuropsychologia (2014) 55:105–14. 10.1016/j.neuropsychologia.2013.09.019 PubMed DOI

Holstege G. Chapter 14 Descending motor pathways and the spinal motor system: limbic and non-limbic components. Prog Brain Res. (1991) 87:307–421. 10.1016/S0079-6123(08)63057-5 PubMed DOI

Gothard KM. The amygdalo-motor pathways and the control of facial expressions. Front Neurosci. (2014) 8:43. 10.3389/fnins.2014.00043 PubMed DOI PMC

Ghashghaei HT, Hilgetag CC, Barbas H. Sequence of information processing for emotions based on the anatomic dialogue between prefrontal cortex and amygdala. NeuroImage (2007) 34:905–23. 10.1016/j.neuroimage.2006.09.046 PubMed DOI PMC

Morecraft RJ, McNeal DW, Stilwell-Morecraft KS, Gedney M, Ge J, Schroeder CM, et al. . Amygdala interconnections with the cingulate motor cortex in the rhesus monkey. J Compar Neurol. (2007) 500:134–65. 10.1002/cne.21165 PubMed DOI

Grèzes J, Valabrègue R, Gholipour B, Chevallier C. A direct amygdala-motor pathway for emotional displays to influence action: a diffusion tensor imaging study. Hum Brain Mapp. (2014) 35:5974–83. 10.1002/hbm.22598 PubMed DOI PMC

Toschi N, Duggento A, Passamonti L. Functional connectivity in amygdalar-sensory/(pre)motor networks at rest: new evidence from the human connectome project. Eur J Neurosci. (2017) 45:1224–9. 10.1111/ejn.13544 PubMed DOI

Grèzes J, Dezecache G, Eskenazi T. Limbic to motor interactions during social perception. In: Toga AW. editor. Brain Mapping. Cambridge, MA: Elsevier; (2015). p. 1027–30.

Diano M, Tamietto M, Celeghin A, Weiskrantz L, Tatu M-K, Bagnis A, et al. . Dynamic changes in amygdala psychophysiological connectivity reveal distinct neural networks for facial expressions of basic emotions. Sci Rep. (2017) 7:45260. 10.1038/srep45260 PubMed DOI PMC

Westlund Schreiner M, Klimes-Dougan B, Mueller BA, Eberly LE, Reigstad KM, Carstedt PA, et al. Multi-modal neuroimaging of adolescents with non-suicidal self-injury: Amygdala functional connectivity. J Affect Disord. (2017) 221:47–55. 10.1016/j.jad.2017.06.004 PubMed DOI PMC

Nock MK, Prinstein MJ. A functional approach to the assessment of self-mutilative behavior. J Consult Clin Psychol. (2004) 72:885–90. 10.1037/0022-006X.72.5.885 PubMed DOI

Buck R, Losow JI, Murphy MM, Costanzo P. Social facilitation and inhibition of emotional expression and communication. J Pers Soc Psychol. (1992) 63:962–8. 10.1037/0022-3514.63.6.962 PubMed DOI

Fernandez-Dols JM, Ruiz-Belda M-A, Mandler G. Spontaneous facial behavior during intense emotional episodes: artistic truth and optical truth. In: Russell JA, Fernandez-Dols JM. editors. The Psychology of Facial Expression. Cambridge: Cambridge University Press; (1997). p. 255–74.

Krahé C, Springer A, Weinman JA, Fotopoulou A. The social modulation of pain: others as predictive signals of salience - a systematic review. Front Hum Neurosci. (2013) 7:386. 10.3389/fnhum.2013.00386 PubMed DOI PMC

Nicholson TR, Aybek S, Craig T, Harris T, Wojcik W, David AS, et al. . Life events and escape in conversion disorder. Psychol Med. (2016) 46:2617–26. 10.1017/S0033291716000714 PubMed DOI PMC

Steinkopf L. The signaling theory of symptoms: an evolutionary explanation of the placebo effect. Evol Psychol. (2015) 13:1474704915600559 10.1177/1474704915600559 PubMed DOI PMC

Tiokhin L. Do symptoms of illness serve signaling functions? (Hint: Yes). Q Rev Biol. (2016) 91:177–95. 10.1086/686811 PubMed DOI

Burghardt GM. Cognitive ethology and critical anthropomorphism: a snake with two heads and hognose snakes that play dead. In: Ristau CA. editor. Comparative Cognition and Neuroscience. Cognitive Ethology: The Minds of Other Animals: Essays in Honor of Donald, R. Griffin. Hillsdale, NJ: Lawrence Erlbaum Associates; (1991). p. 53–90.

Wenegrat B. Theater of Disorder : Patients, Doctors, and the Construction of Illness. Oxford University Press; (2001). Available online at: https://global.oup.com/academic/product/theater-of-disorder-9780195140873?cc=cz&lang=en&

Crittenden PM. Attachment and risk for psychopathology. J Dev Behav Pediatr. (1995) 16(Supp. 3):S12–6. 10.1097/00004703-199506001-00004 PubMed DOI

Kozlowska K. The developmental origins of conversion disorders. Clin Child Psychol Psychiatry (2007) 12:487–510. 10.1177/1359104507080977 PubMed DOI

Lewis-Fernández R, Gorritz M, Raggio GA, Peláez C, Chen H, Guarnaccia PJ. Association of trauma-related disorders and dissociation with four idioms of distress among Latino psychiatric outpatients. Culture Med Psychiatry (2010) 34:219–43. 10.1007/s11013-010-9177-8 PubMed DOI PMC

Åslund C, Starrin B, Nilsson KW. Social capital in relation to depression, musculoskeletal pain, and psychosomatic symptoms: a cross-sectional study of a large population-based cohort of Swedish adolescents. BMC Public Health (2010) 10:715. 10.1186/1471-2458-10-715 PubMed DOI PMC

Benedetti F. Placebo and the new physiology of the doctor-patient relationship. Physiol Rev. (2013) 93:1207–46. 10.1152/physrev.00043.2012 PubMed DOI PMC

Goyal G, Kalita J, Misra UK. Utility of different seizure induction protocols in psychogenic nonepileptic seizures. Epilepsy Res. (2014) 108:1120–7. 10.1016/j.eplepsyres.2014.02.015 PubMed DOI

Thenganatt MA, Jankovic J. Psychogenic tremor: a video guide to its distinguishing features. Tremor Other Hyperkinet Move (2014) 4:253. 10.7916/D8FJ2F0Q PubMed DOI PMC

Peckham EL, Hallett M. Psychogenic movement disorders. Neurol Clin (2009) 27:801–19, vii. 10.1016/j.ncl.2009.04.008 PubMed DOI PMC

Ricciardi L, Edwards MJ. Treatment of functional (psychogenic) movement disorders. Neurotherapeutics (2014) 11:201–7. 10.1007/s13311-013-0246-x PubMed DOI PMC

Deeley Q Hypnosis as a model of functional neurologic disorders. Handb Clin Neurol. (2016) 139:95–103. 10.1016/B978-0-12-801772-2.00009-6 PubMed DOI

Terhune DB, Cleeremans A, Raz A, Lynn SJ. Hypnosis and top-down regulation of consciousness. Neurosci Biobehav Rev. (2017) 81(Pt A):59–74. 10.1016/j.neubiorev.2017.02.002 PubMed DOI

Ricciardi L, Demartini B, Morgante F, Parees I, Nielsen G, Edwards MJ. Symptom severity in patients with functional motor symptoms: patient's perception and doctor's clinical assessment. Parkinsonism Relat Disord. (2015) 21:529–32. 10.1016/j.parkreldis.2015.02.022 PubMed DOI

Pareés I, Saifee TA, Kassavetis P, Kojovic M, Rubio-Agusti I, Rothwell JC, et al. . Believing is perceiving: mismatch between self-report and actigraphy in psychogenic tremor. Brain (2012) 135:117–23. 10.1093/brain/awr292 PubMed DOI

Lemche E, Brammer MJ, David AS, Surguladze SA, Phillips ML, Sierra M, et al. . Interoceptive–reflective regions differentiate alexithymia traits in depersonalization disorder. Psychiatry Res. (2013) 214:66–72. 10.1016/j.pscychresns.2013.05.006 PubMed DOI PMC

Perez DL, Dworetzky BA, Dickerson BC, Leung L, Cohn R, Baslet G, et al. . An integrative neurocircuit perspective on psychogenic nonepileptic seizures and functional movement disorders : neural functional unawareness. Clin EEG Neurosci. (2014) 46:4–15. 10.1177/1550059414555905 PubMed DOI PMC

Boeckle M, Liegl G, Jank R, Pieh C. Neural correlates of conversion disorder: overview and meta-analysis of neuroimaging studies on motor conversion disorder. BMC Psychiatry (2017). 16:195. 10.1186/s12888-016-0890-x PubMed DOI PMC

Freud S, Breuer J. Studies on Hysteria (Basic Books Classics). New York, NY: Hogarth Press; (1895/1955).

Newman L, Sivaratnam C, Komiti A. Attachment and early brain development – neuroprotective interventions in infant–caregiver therapy. Transl Dev Psychiatry (2015) 3:28647 10.3402/tdp.v3.28647 DOI

McLaughlin KA, Sheridan MA, Tibu F, Fox NA, Zeanah CH, Nelson CA. Causal effects of the early caregiving environment on development of stress response systems in children. Proc Natl Acad Sci USA. (2015) 112:5637–42. 10.1073/pnas.1423363112 PubMed DOI PMC

Calkins SD, Graziano PA, Berdan LE, Keane SP, Degnan KA. Predicting cardiac vagal regulation in early childhood from maternal-child relationship quality during toddlerhood. Dev Psychobiol. (2008) 50:751–66. 10.1002/dev.20344 PubMed DOI PMC

Kozlowska K, Walker P, McLean L, Carrive P. Fear and the defense cascade: clinical implications and management. Harvard Rev Psychiatry (2014) 23:263–87. 10.1097/HRP.0000000000000065 PubMed DOI PMC

Hagenaars MA, Stins JF, Roelofs K. Aversive life events enhance human freezing responses. J Exp Psychol. (2012) 141:98–105. 10.1037/a0024211 PubMed DOI

Kozlowska K, Palmer DM, Brown KJ, Scher S, Chudleigh C, Davies F, et al. . Conversion disorder in children and adolescents: a disorder of cognitive control. J Neuropsychol. (2015) 9:87–108. 10.1111/jnp.12037 PubMed DOI

van der Kruijs SJM, Vonck KEJ, Langereis GR, Feijs LMG, Bodde NMG, Lazeron RHC, et al. Autonomic nervous system functioning associated with psychogenic nonepileptic seizures: analysis of heart rate variability. Epilepsy Behav. (2016) 54:14–9. 10.1016/j.yebeh.2015.10.014 PubMed DOI

Bowlby J. The nature of the child's tie to his mother. Int J Psychoanal. (1958) 39:350–73. PubMed

Taylor DC. Hysteria, play-acting and courage. Br J Psychiatry (1986) 149:37–41. 10.1192/bjp.149.1.37 PubMed DOI

Hohwy J. Delusions, illusions and inference under uncertainty. Mind Lang. (2013) 28:57–71. 10.1111/mila.12008 DOI

Individual differences in interoceptive accuracy and prediction error in motor functional neurological disorders: A DTI study

Processing of Emotions in Functional Movement Disorder: An Exploratory fMRI Study