Objective Functional neurological disorder (FND) is a common presentation in both primary and secondary care, and contributes to around 30% of initial presentations to neurology. Depersonalisation is commonly associated with FND and is particularly associated with more severe and debilitating presentations. Another factor that has been found to contribute to both FND and depersonalisation is a history of childhood sexual abuse (CSA). We designed a study to test the hypothesis that a history of CSA would result in increased severity of depersonalisation and other dissociative symptoms in FND patients compared to those with no experience of sexual abuse.
Method Questionnaires were administered to 38 participants (13 men and 25 women), all of whom were patients with a diagnosis of FND who attended a neuropsychiatry outpatient clinic at the Princess Royal Hospital. These included the STAI Trait Anxiety Scale, the Rosenberg Self Esteem Scale (RSES), the Beck Depression Inventory (BDI), the Cambridge Depersonalization Scale (CDS), and the Dissociative Experiences Scale (DES-II). The results of these were then compared for patients with (CSA(+)) and without (CSA(-)) a CSA history.
It is part of standard clinical practice to discuss any history of childhood trauma (including CSA) with patients in this clinic, and it was therefore possible to ascertain this information from patients’ notes. CSA in this case was considered to be any experience of undesired sexual behaviour or contact below the age of 16.
Results CSA(+) FND patients scored higher on the CDS (p<0.015), and particularly on the subscales for Emotional Numbing (p<0.05) and Alienation From Surroundings” (p<0.005). CSA(+) patients also scored lower on the RSES (p=0.005), and higher on the BDI (p=0.023). We also divided the cohort into patients with non-epileptic attack disorder (NEAD) (n=29) and those with other functional neurological symptoms (FNS) (n=9) and found that NEAD patients scored higher on the CDS Emotional Numbing subscale (p<0.043). Within the NEAD subgroup, CSA(+) patients scored higher on the Alienation From Surroundings CDS subscale (p<0.003), and lower on the RSES (p<0.044).
Conclusion CSA is associated with higher levels of depersonalization in FND patients, as well as greater levels of depression and lower self-esteem. NEAD patients are more susceptible to experiencing “emotional numbing” than other FND patients, and within the subgroup of NEAD patients a CSA history is associated with increased “alienation from surroundings” and lower self-esteem. From these findings, it appears that CSA is associated with depersonalization in FND patients.