Objective: To assess illness perception (IP) in a cohort of patients with Functional Movement Disorders(FMD)

Background: IP is the process by which individuals respond to a health threat by generating cognitive and emotional representations of the illness [1]. IP in patients with FMD has been scarcely investigated [2] even though changing patients’ IP has been shown to be crucial in the prognosis of several diseases. Patients with functional weakness and non-epileptic attacks report similar IP impact of symptoms compared to other neurological diseases [2-5].

Method: A prospective cohort study of FMD patients seen in a specialized FMD unit evaluating demographic, clinical data and IP as measured by the Brief Illness Perception Questionnaire (BIPQ). The scale consists of 9 items (1-8 rated by a 10-point likert scale from “better” to “worse”; Item 9 is an open response to “three most important causal factors”). BIPQ was obtained after a thorough diagnostic explanation and prior to treatment. BIPQ results are reported as median and IQR. Statistical analysis was performed using IBM-SPSS.

Results: Forty-one patients (53.7% females, mean age 49.3±13.6 years) were included. A combination of several FMD (n=15, 36.6%) and gait disturbance (n=14, 34.1%) were the most common phenotypes. Mean duration of symptoms was 64.2 months. Patients reported FMD to significantly affect their lives (9,7-10). FMD caused great concern (9,7-10) and had an emotional impact on patients’ lives (8,7-9). Patients reported to have low control over their symptoms (3,2-5) but believed that treatment might be helpful (8, 6-9). Most believed their illness would continue for a long time (7,5-9) and this perception did not correlate with disease duration (p=0.5). Accident/injury (n=18, 43.9%), stress/worry (n=14, 34.1%), emotional state (n=10; 24.4%), uncertainty (n=5; 12.2%) and overwork (n=5; 12.2%) were the most frequent causal factors reported by patients.

Conclusion: FMD have a significant physical and emotional impact on patients’ lives. Low personal control over symptoms and irreversibility are common beliefs in patients with FMD. Emotional and physical factors are perceived as the cause of the disorder rather than precipitating or aggravating it. Understanding FMD patients’ IP and beliefs is an essential part of the assessment and may provide helpful insight when planning multidisciplinary treatment.

References: 1- E. Broadbent, Keith J. Petrie, Jodie Main and John Weinman. The Brief Illness Perception Questionnaire. Journal of Psychosomatic Research 60 (2006) 631–637.
2- Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. Brain. 2010 May;133(Pt 5):1537-51. 
3- Sharpe M, Stone J, Hibberd C,Warlow C, Duncan R, Coleman R, et al. Neurology outpatients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome. Psychol Med 2009;1–10.
4- Whitehead K, Kandler R, Reuber M. Patients’ and neurologists’ perception of epilepsy and psychogenic nonepileptic seizures. Epilepsia 2013;54:708–17.
5- Stone J, Binzer M, Sharpe M. Illness beliefs and locus of control: a comparison of patients with pseudoseizures and epilepsy. J Psychosom Res 2004;57:541–7.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/illness-perception-in-patients-with-functional-movement-disorders-a-case-series/