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

Berlot, Rok (author), Nicholson, Timothy R. (author), Asan, Livia (author), Stanton, Biba (author), Pollak, Thomas A. (author), Edwards, Mark J. (author)

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 stressors were associated with an increased prevalence of psychiatric comorbidities, pain, and fatigue. Different stressor types had distinct influences on clinical presentations. Adult-onset adversity was associated with higher rates of psychiatric comorbidities, pain and fatigue. Interpretation: A record of adversities was at least 2·5 times more common in FND than in migraine, and about 1·5 times more common than in GAD, varying by stressor type. Psychosocial stressors were particularly common. The presence of stressors, as well as their type, shapes the presentation of FND. Life history should therefore be considered when assessing individuals with FND.

• Language: English
• Keywords: conversion disorder, FND, functional neurological disorder, life events, stress, trauma
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2025
• Number of pages: 11 str.
• Numbering: Vol. 90, art. 103687
• PID: 20.500.12556/RUL-178402
• UDC: 616.8
• ISSN on article: 2589-5370
• DOI: 10.1016/j.eclinm.2025.103687
• COBISS.SI-ID: 263346179
• Publication date in RUL: 27.01.2026

Record is a part of a journal

• Title: EClinicalMedicine
• Publisher: Elsevier
• ISSN: 2589-5370
• COBISS.SI-ID: 529859097

Licences

• License: CC BY-NC 4.0, Creative Commons Attribution-NonCommercial 4.0 International
• Link: http://creativecommons.org/licenses/by-nc/4.0/
• Description: A creative commons license that bans commercial use, but the users don’t have to license their derivative works on the same terms.

Secondary language

• Language: Slovenian
• Keywords: konverzijska motnja, funkcionalna nevrološka motnja, življenjski dogodki, stres, travma

Projects

• Funder: ARIS - Slovenian Research and Innovation Agency
• Project number: P1-0389
• Name: Medicinska fizika

• Funder: DFG - German Research Foundation
• Funding programme: Clinician Scientist Programme
• Project number: FU356/12–UMEA