Adverse life events and psychosocial stressors in functional neurological disorder: a retrospective cohort and case–control study using a large international electronic health record database
Abstract
Summary Background Adverse life events and other stressors were central to historical ‘Freudian’ models of functional neurological disorder (FND), which have been increasingly replaced by more nuanced biopsychosocial models. Studies of the aetiological relevance of stressors have been limited by small sample sizes. Methods Retrospective cohort analyses using a large international electronic health records network (TriNetX), including ICD-10 codes, were performed. Between 2015 and 2025, 147,595 individuals were diagnosed with FND. The rates of adverse life events and psychosocial stressors were compared to matched cohorts with migraine and generalised anxiety disorder (GAD) diagnoses. We also investigated associations between FND and the presence of stressors, including the stressor type and whether it occurred in childhood or adulthood. Findings Rates of abuse or neglect (1·33%), assault (2·42%), and psychosocial and socioeconomic difficulties (10·63%) were significantly higher in FND compared to migraine (0·42%/0·93%/3·43%, respectively) and GAD (0·75%/1·29%/7·69%, respectively) (p < ·0001 for all comparisons). A history of physical and sexual abuse was more prevalent in FND than in comparison groups. Psychological abuse was more common in FND than in migraine, but not when compared to GAD. FND cases with recorded stressors were younger, more often female, and more frequently diagnosed with functional/dissociative seizures than those without stressors. Further, these…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 147,595 participants or records.
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