Objective: This study explores personality profiles in patients with Functional Motor Disorder (FMD) compared to healthy controls (HC) using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2).

Background: FMD is a neuropsychiatric condition characterized by motor symptoms such as weakness, paralysis, tremor, dystonia, and gait disturbance; these symptoms cannot be explained by typical medical conditions, but are genuine and cause significant impairment in patients’ daily life. Although psychological factors are no longer a diagnostic criterion for FMD in the DSM-5, they frequently co-occur, and consensus has been reached that FMD should be understood within a bio-psycho-social framework.

Method: We administered the MMPI-2 to 30 FMD patients and 30 HC, analyzing 10 basic clinical scales, 15 content scales, and relevant subscales [1].

Results: FMD patients scored significantly higher than HC, often exceeding the clinical cut-off, on the following basic clinical scales: Hypochondriasis, Depression, Hysteria, Psychopathic Deviance (subscales of Social and Self Alienation), Paranoia, Psychasthenia, and Schizophrenia [Table 1, Figure 1. Figure 2]. These scores reflect excessive attention to somatic sensations, denial of psychological distress, feelings of being unloved and misunderstood, difficulty expressing emotions, distrust of others, persecutory ideation, and autonomic hyperactivity, with constant vigilance for environmental cues that validate fears or biases. Additionally, they exhibited a specific personality configuration named “Passive-aggressive Valley”, characterized by emotional dependence, hostility, and manipulation, yet an inability to express these feelings directly [1] [Figure 1]. Finally, FMD patients reported higher scores than HC in Anxiety, Obsessiveness, Depression, Health Concerns, Low Self- Esteem and Work Interference [Table 1].

Conclusion: FMD patients demonstrate an emotional-cognitive profile that, while not indicative of a personality disorder per se, is more pathological than that of HC. These findings align with previous evidence of alexithymia [2], unexpressed anger, and cognitive inflexibility [3-4]. Recognizing these psychological characteristics is crucial not only in the process of communicating the FMD diagnosis [5] but also in tailoring a multidisciplinary treatment approach.

Table 1

Figure 1

Figure 2

References: [1] Friedman, A. F., Bolinskey, P. K., Levak, R. W., & Nichols, D. S. (2015). Psychological assessment with the MMPI-2/MMPI-2-RF (3rd ed.). Routledge/Taylor & Francis Group.
[2] Demartini B., P. Petrochilos, L. Ricciardi, G. Price, M.J. Edwards, E. Joyce, The role of alexithymia in the development of functional motor symptoms (conversion disorder), J. Neurol. Neurosurg. Psychiatry 85 (10) (2014) 1132–1137.
[3] Pick, S., Goldstein, L. H., Perez, D. L., & Nicholson, T. R. (2019). Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda. Journal of neurology, neurosurgery, and psychiatry, 90(6), 704–711. https://doi.org/10.1136/jnnp-2018-319201
[4] van Dijl, T. L., Videler, A. C., Aben, H. P., & Kop, W. J. (2024). Anger regulation in patients with functional neurological disorder: A systematic review. General hospital psychiatry, 88, 30–47. https://doi.org/10.1016/j.genhosppsych.2024.02.014
[5] Stone, J., Carson, A., & Hallett, M. (2016). Explanation as treatment for functional neurologic disorders. Handbook of clinical neurology, 139, 543–553. https://doi.org/10.1016/B978-0-12-801772-2.00044-8

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MDS Abstracts - https://www.mdsabstracts.org/abstract/personality-profiles-in-patients-with-functional-motor-disorders/