A new science of emotion: implications for functional neurological disorder

Author: Johannes Jungilligens1,2, Sara Paredes-Echeverri2, Stoyan Popkirov1, Lisa Feldman Barrett3,4,5, David L Perez2,5,6
1 Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.
2 Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
3 Department of Psychology, Northeastern University, Boston, MA, USA.
4 Psychiatric Neuroimaging Division, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
5 Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
6 Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Conference/Journal: Brain
Date published: 2022 Jun 2
Other: Special Notes: doi: 10.1093/brain/awac204. , Word Count: 267

Functional neurological disorder (FND) reflects impairments in brain networks leading to distressing motor, sensory, and/or cognitive symptoms that demonstrate positive clinical signs on examination incongruent with other conditions. A central issue in historical and contemporary formulations of FND has been the mechanistic and etiological role of emotions. However, the debate has mostly omitted fundamental questions about the nature of emotions in the first place. In this perspective article, we first outline a set of relevant working principles of the brain (e.g., allostasis, predictive processing, interoception, and affect), followed by a focused review of the theory of constructed emotion to introduce a new understanding of what emotions are. Building on this theoretical framework, we formulate how altered emotion category construction can be an integral component of the pathophysiology of FND and related functional somatic symptoms. In doing so, we address several themes for the FND field including: 1) how energy regulation and the process of emotion category construction relate to symptom generation, including revisiting alexithymia, "panic attack without panic", dissociation, insecure attachment, and the influential role of life experiences; 2) re-interpret select neurobiological research findings in FND cohorts through the lens of the theory of constructed emotion to illustrate its potential mechanistic relevance; and 3) discuss therapeutic implications. While we continue to support that FND is mechanistically and etiologically heterogenous, consideration of how the theory of constructed emotion relates to the generation and maintenance of functional neurological and functional somatic symptoms offers an integrated viewpoint that cuts across neurology, psychiatry, psychology, and cognitive-affective neuroscience.

Keywords: emotion; functional neurological disorder; interoception; neurobiology; theory of constructed emotion.

PMID: 35653495 DOI: 10.1093/brain/awac204