Cortical thickness alterations linked to somatoform and psychological dissociation in functional neurological disorders

Authors

David L. Perez, Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Nassim Matin, Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.Follow
Benjamin Williams, Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Kaloyan Tanev, Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Nikos Makris, Center for Morphometric Analysis, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts.
W Curt LaFrance, Neuropsychiatry and Behavioral Neurology Division, Rhode Island Hospital, Departments of Psychiatry and Neurology, Brown University, Alpert Medical School, Providence, Rhode Island.
Bradford C. Dickerson, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts.

Document Type

Article

Abstract

BACKGROUND: Links between dissociation and functional neurological disorder (FND)/conversion disorder are well-established, yet the pathophysiology of dissociation remains poorly understood. This MRI study investigated structural alterations associated with somatoform and psychological dissociation in FND. We hypothesized that multimodal, paralimbic cingulo-insular regions would relate to the severity of somatoform dissociation in patients with FND. METHODS: FreeSurfer cortical thickness and subcortical volumetric analyses were performed in 26 patients with motor FND and 27 matched healthy controls. Patients with high dissociation as measured by the Somatoform Dissociation Questionnaire-20 (SDQ) or Dissociative Experiences Scale (DES) were compared to controls in stratified analyses. Within-group analyses were also performed with SDQ and DES scores in patients with FND. All cortical thickness analyses were whole-brain corrected at the cluster-wise level. RESULTS: Patients with FND and high somatoform dissociation (SDQ > 35) showed reduced left caudal anterior cingulate cortex (ACC) cortical thickness compared to controls. In within-group analyses, SDQ scores inversely correlated with left caudal ACC cortical thickness in patients with FND. Depersonalization/derealization scores positively correlated with right lateral occipital cortical thickness. Both within-group findings remained statistically significant controlling for trait anxiety/depression, borderline personality disorder and post-traumatic stress disorder, adverse life events, and motor FND subtypes in post-hoc analyses. CONCLUSION: Using complementary between-group and within-group analyses, an inverse association between somatoform dissociation and left caudal ACC cortical thickness was observed in patients with FND. A positive relationship was also appreciated between depersonalization/derealization severity and cortical thickness in visual association areas. These findings advance our neuropathobiological understanding of dissociation in FND. Hum Brain Mapp 39:428-439, 2018. © 2017 Wiley Periodicals, Inc.

Medical Subject Headings

Adult; Anxiety (diagnostic imaging); Borderline Personality Disorder (diagnostic imaging, psychology); Cerebral Cortex (diagnostic imaging); Cohort Studies; Depression (diagnostic imaging); Dissociative Disorders (diagnostic imaging, psychology); Female; Humans; Linear Models; Magnetic Resonance Imaging; Male; Organ Size; Psychometrics; Somatoform Disorders (diagnostic imaging, psychology); Stress Disorders, Post-Traumatic (diagnostic imaging, psychology)

Publication Date

1-1-2018

Publication Title

Human brain mapping

E-ISSN

1097-0193

Volume

39

Issue

1

First Page

428

Last Page

439

PubMed ID

29080235

Digital Object Identifier (DOI)

10.1002/hbm.23853

Recommended Citation

Perez, David L.; Matin, Nassim; Williams, Benjamin; Tanev, Kaloyan; Makris, Nikos; LaFrance, W Curt; and Dickerson, Bradford C., "Cortical thickness alterations linked to somatoform and psychological dissociation in functional neurological disorders" (2018). Neurology. 1504.
https://scholar.barrowneuro.org/neurology/1504