A new science of emotion: implications for functional neurological disorder

Functional neurological disorder reflects impairments in brain networks leading to distressing motor, sensory and/or cognitive symptoms that demonstrate positive clinical signs on examination incongruent with other conditions. A central issue in historical and contemporary formulations of functional neurological disorder has been the mechanistic and aetiological role of emotions. However, the debate has mostly omitted fundamental questions about the nature of emotions in the first place. In this perspective article, we first outline a set of relevant working principles of the brain (e.g. allostasis, predictive processing, interoception and affect), followed by a focused review of the theory of constructed emotion to introduce a new understanding of what emotions are. Building on this theoretical framework, we formulate how altered emotion category construction can be an integral component of the pathophysiology of functional neurological disorder and related functional somatic symptoms. In doing so, we address several themes for the functional neurological disorder field including: (i) how energy regulation and the process of emotion category construction relate to symptom generation, including revisiting alexithymia, 'panic attack without panic', dissociation, insecure attachment and the influential role of life experiences; (ii) re-interpret select neurobiological research findings in functional neurological disorder cohorts through the lens of the theory of constructed emotion to illustrate its potential mechanistic relevance; and (iii) discuss therapeutic implications. While we continue to support that functional neurological disorder is mechanistically and aetiologically heterogenous, consideration of how the theory of constructed emotion relates to the generation and maintenance of functional neurological and functional somatic symptoms offers an integrated viewpoint that cuts across neurology, psychiatry, psychology and cognitive-affective neuroscience. Jungilligens, Paredes-Echeverri et al. use the theory of constructed emotion to revisit the role of emotion in the pathophysiology of functional neurological disorder. In doing so, they offer an integrated viewpoint that cuts across neurology, psychiatry, psychology and cognitive-affective neuroscience.

Automated summary

Functional neurological disorder is characterized by impairments in brain networks leading to distressing motor, sensory, and cognitive symptoms that show clinical signs incongruent with other conditions. The debate regarding the role of emotions in the mechanistic and etiological aspects of the disorder often overlooks fundamental questions about the nature of emotions. Understanding the theory of constructed emotion can provide new insights into the generation and maintenance of symptoms, offering an integrated viewpoint across neurology, psychiatry, psychology, and cognitive-affective neuroscience.