Functional Movement Disorders

Abstract The presumed dichotomy between the fields of neurology and psychiatry offers a major challenge to the construct of functional movement disorder (FMD). FMD has evolved from its root as a “psychogenic” manifestation to a complex neurological disorder anchored on a biopsychosocial framework. Genetics, epigenetics, psychosocial, and traumatic vulnerabilities create the scaffolding on which deficits in attention, emotional processing, sensorimotor integration, and awareness can flourish to generate FMD. Over the past two decades, the possible and probable categories of diagnostic certainty, which require an exclusionary approach to the diagnosis, have been abandoned in favor of ascertaining positive clinical findings demonstrating both inconsistency during periods of observation and incongruence from known neurological disorders, that is, an inclusionary approach to the diagnosis. Adjunct physical and psycho-therapy can considerably improve outcomes but are predicated foremost on the unequivocal acceptance of the diagnosis by the patient. Thus, treatment begins during the diagnostic debriefing through an empathetic explanation of the diagnosis and how it is made: the resolution of symptoms is directly associated with understanding and acceptance of the diagnosis by the patient. While there remain many knowledge gaps, considerable advances have been made in the understanding and treatment of this important source of neurological disability.