Adverse life events and psychosocial stressors in functional neurological disorder: a retrospective cohort and case–control study using a large international electronic health record database

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Background: Adverse life events and other stressors were central to historical 'Freudian' models of functional neurological disorder (FND), which have been increasingly replaced by more nuanced biopsychosocial models. Studies of the aetiological relevance of stressors have been limited by small sample sizes. Methods: Retrospective cohort analyses using a large international electronic health records network (TriNetX), including ICD-10 codes, were performed. Between 2015 and 2025, 147,595 individuals were diagnosed with FND. The rates of adverse life events and psychosocial stressors were compared to matched cohorts with migraine and generalised anxiety disorder (GAD) diagnoses. We also investigated associations between FND and the presence of stressors, including the stressor type and whether it occurred in childhood or adulthood. Findings: < ·0001 for all comparisons). A history of physical and sexual abuse was more prevalent in FND than in comparison groups. Psychological abuse was more common in FND than in migraine, but not when compared to GAD. FND cases with recorded stressors were younger, more often female, and more frequently diagnosed with functional/dissociative seizures than those without stressors. Further, these stressors were associated with an increased prevalence of psychiatric comorbidities, pain, and fatigue. Different stressor types had distinct influences on clinical presentations. Adult-onset adversity was associated with higher rates of psychiatric comorbidities, pain and fatigue. Interpretation: A record of adversities was at least 2·5 times more common in FND than in migraine, and about 1·5 times more common than in GAD, varying by stressor type. Psychosocial stressors were particularly common. The presence of stressors, as well as their type, shapes the presentation of FND. Life history should therefore be considered when assessing individuals with FND. Funding: None.

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