Objective Beliefs and expectations about symptoms and an abnormal direction of attention towards the body have been proposed as important mechanistic factors in the pathophysiology of functional motor symptoms (FMS). We therefore aimed to evaluate patients' awareness/perception of the presence and severity of their own symptoms before and while watching themselves in a video and to compare this with doctors' assessment of the presence and severity of FMS, based on video evaluation.

Method We evaluated 16 patients affected by FMS. Patients were invited to give a “subjective evaluation” of their symptoms. Afterwards, patients were invited to watch a video of themselves and to judge the presence of symptoms in the different body parts, the presence of gait and speech disorders and, if so, to rate the severity. Patients' videos were also assessed by a rater with expertise in FMS (the rater was asked to evaluate the symptoms and to judge the presence of FMS in different body parts).

Results A significant difference between the patient's pre-video and the video-based evaluations as for total severity score (p=0.002; t=3.656) was found. In addition, patients scored higher in total severity score to their own symptoms (p<0.001, t=4.860) as compared to the rater. No significant difference was revealed between the total severity score of the patient's video-based subjective evaluation and the total severity score assigned by the rater (p=0.017, t=2.962 with p set at 0.016) according to Bonferroni correction.

Conclusion Our study shows that patients with FMS tend to overestimate the severity of their symptoms compared to the doctor's esteem. However, when their symptoms were presented in a video and they were asked to rate them, their rates did not differ from the doctor views.