Article Text

Download PDFPDF
36 Study of the prevalence of autistic traits and alexithymia, with associated psychiatric comorbidity, in an outpatient program of patients with functional neurological symptom disorder (FNSD)
  1. Richard Cole,
  2. Michael Elmalem,
  3. Esha Abrol,
  4. Panayiota Petrochilos
  1. National Hospital for Neurology & Neurosurgery, London, UK.


Introduction Whilst higher rates of alexithymia have previously been reported in FNSD, little is known about the prevalence of autistic traits in adults with FNSD. We aim to:

  1. Report on the prevalence of autistic traits in an outpatient group of adults diagnosed with FNSD using the Autism Spectrum Quotient (AQ-10)

  2. Report on the prevalence of alexithymia using the Toronto Alexithymia Scale (TAS-20)

  3. Report on differences in symptom severity of psychiatric comorbidity between those scoring <6 or ≥6 on the AQ-10, and those with or without alexithymia

Method Out of 105 consecutive patients reviewed in an outpatient FNSD program, 91 completed self-report assessments for autistic traits, alexithymia, generalised anxiety, depression, social phobia, somatic symptom severity, attention deficit hyperactivity disorder (ADHD) and dyslexia. Patients were grouped by AQ-10 scores of <6 or ≥6 and compared for significant differences in tested variables using a Mann-Whitney U test. Kruskal-Wallis H tested differences in alexithymia status. Simple effects were tested using pairwise comparisons.

Results 40% screened positive on the AQ-10 (scoring ≥6), and 40% screen positive for alexithymia. When comparing those scoring < or ≥6 on the AQ-10, those with the higher number of autistic traits scored significantly higher on scales of alexithymia, depression, generalised anxiety, social phobia, ADHD, and dyslexia. Positive alexithymia status was significantly associated with a higher number of autistic traits as well symptoms of generalised anxiety, depression, somatic symptoms severity, social phobia and dyslexia.

Conclusion Whilst higher rates of neurodevelopmental disorders have previously been reported in FNSD, we report new evidence for a high proportion of autistic traits and further evidence of a high prevalence of alexithymia in a group of adults with FNSD.1–10 Mechanistic insights are limited however autistic traits may be associated with FNSD due to altered sensitivity to sensory data, as well as cognitive or affective biases, or increased susceptibility to panic. There may be an additional contribution from psychosocial stressors. Clinically, the AQ-10 and TAS-20 may be important tools in the management of FNSD, and a higher prevalence of autistic traits may highlight a need for specialised communication styles in the MDT.11

This builds on research exploring the relationship between autistic traits, alexithymia and FNSD. Previous research suggests that alexithymia and altered interoceptive awareness may be modifying factors in the relationship between autistic traits and FNSD,12 and further research is required to clarify the nature of these relationships.


  1. Demartini B, Nisticò V, Goeta D, Tedesco R, Giordano B, Faggioli R, et al. Clinical overlap between functional neurological disorders and autism spectrum disorders: A preliminary study. Journal of the Neurological Sciences 2021 Oct;429:117648.

  2. Freedman et al. Psychogenic nonepileptic events in pediatric patients with autism.

  3. Hatta K, Hosozawa M, Tanaka K, Shimizu T. Exploring traits of autism and their impact on functional disability in children with somatic symptom disorder. Journal of Autism and Developmental Disorders 2019 Feb 15;49(2):729–37.

  4. Jester KA, Londino DL, Hayman J. 2.68 examining the occurrence of conversion disorder diagnoses and asd among adolescents and young adults in the emergency department. Journal of the American Academy of Child & Adolescent Psychiatry [Internet]. 2019 Oct 1 [cited 2022 Feb 7];58(10):S193. Available from:

  5. McWilliams A, Reilly C, Gupta J, Hadji-Michael M, Srinivasan R, Heyman I. Autism spectrum disorder in children and young people with non-epileptic seizures. Seizure 2019 Dec 1;73:51–5.

  6. Miersch et al. A retrospective study of 131 patients with psychogenic non-epileptic seizures (PNES)- Comorbid diagnoses and outcome after inpatient treatment.

  7. Nimmo-Smith V, Heuvelman H, Dalman C, Lundberg M, Idring S, Carpenter P, et’al. Anxiety disorders in adults with autism spectrum disorder: a population-based study. Journal of Autism and Developmental Disorders. 2020 Jan 1;50(1):308–18.

  8. Pun P, Frater J, Broughton M, Dob R, Lehn A. Psychological profiles and clinical clusters of patients diagnosed with functional neurological disorder. Frontiers in Neurology 2020 Oct 15;11.

  9. Zdankiewicz-Sciga&lstrok;a E, Sciga&lstrok;a D, Sikora J, Kwaterniak W, Longobardi C. Relationship between interoceptive sensibility and somatoform disorders in adults with autism spectrum traits. The mediating role of alexithymia and emotional dysregulation. PLoS ONE. 2021 Aug 1;16(8 August).

  10. Demartini B, Petrochilos P, Ricciardi L, Price G, Edwards MJ, Joyce E. The role of alexithymia in the development of functional motor symptoms (conversion disorder). Journal of Neurology, Neurosurgery & Psychiatry [ Internet]. 2014 Oct 1 [cited 2022 Feb 8];85(10):1132–7. Available from:

  11. Cooper M, Gale K, Langley K, Broughton T, Massey TH, Hall NJ, et al. Neurological consultation with an autistic patient. Practical Neurology [Internet ]. 2021 Oct 8 [cited 2022 Jan 14];practneurol-2020-002856. Available from:

  12. Shah P, Hall R, Catmur C, Bird G. Alexithymia, not autism, is associated with impaired interoception. Cortex 2016 Aug 1;81:215–20.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.