Objective The mechanisms leading to the development of functional motor symptoms (FMS) are of pathophysiological and clinical relevance, yet are poorly understood. The aim of the present study was to evaluate whether impaired emotional processing at the cognitive level (alexithymia) is present in patients affected by FMS. We conducted a cross-sectional study in a population of patients with FMS and in two control groups [patients with organic movement disorders (OMD) and healthy volunteers].

Method Fifty-five patients with FMS, 33 patients affected by OMD and 34 healthy volunteers were recruited. The assessment included: the 20-item Toronto Alexithymia Scale (TAS-20), the Montgomery-Asberg Depression Rating Scale (MADRS), the Reading the Mind in the Eyes' Test and the Structured Clinical Interview for Personality Disorders (SCID II).

Results Alexithymia was present in 34.5% of patients with FMS, 9.1% with OMD and 5.9% of the healthy volunteers, which was significantly higher in the FMS group (χ square (2)=14.129.

Conclusion Alexithymia, a personality construct denoting the inability to identify emotions at a cognitive level, may explain why some patients misattribute autonomic symptoms of anxiety, e.g. tremor, paraesthesiae, paralysis, to that of a physical illness.