Interoception and stress in patients with Functional Neurological Symptom Disorder

ABSTRACT

Introduction

Research suggests that patients with Functional Neurological Symptom Disorder (pwFND) struggle to identify their own emotions and associated physiological cues (interoceptive sensitivity, IS). However, it is not known how this deficit interacts with stress. This study aimed to assess IS in pwFND at baseline and following stress induction, and relate the findings to self-reported emotion processing difficulties.

Methods

Twenty-six pwFND and 27 healthy controls performed the Heart Beat Detection Task pre- and post-stress induction with the Cold Pressor Test. Participants also completed questionnaires assessing anxiety (GAD-7) and depressive symptomology (PHQ-9), as well as emotion processing (EPS-25).

Results

Patients reported deficits in emotion processing (p < . 001) and had lower IS (p = .032) than healthy controls. IS improved following stress induction across both groups (p = .003) but patients’ IS was lower than that of healthy controls’ pre-and post-stress induction. Exploratory analyses revealed that patients reporting sensory symptoms had lower IS at baseline than patients who did not.

Conclusion

Our findings suggest that pwFND are relatively impaired in the identification of their emotions at baseline and following stress induction. This may be related to the experience of functional sensory symptoms and has implications for the psychological treatment of emotion dysregulation in this population.

KEYWORDS:

• Functional Neurological Symptom Disorder
• interoception
• stress

Acknowledgements

This study was funded by a grant from the Neurosciences Research Fund (004, 2013). We would like to thank the patients for their participation in this study and Hogrefe for permission to use the EPS-25.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes on contributors

Isobel A. Williams is a clinical neuroscientist (PhD) and trainee clinical psychologist.

Markus Reuber is a professor of Clinical Neurology and Honorary Consultant Neurologist.

Liat Levita is a senior lecturer in Developmental Neuroscience.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by Neurosciences Research Fund [grant number 004 (2013)].