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Suggestibility in functional neurological disorder: a meta-analysis

Suggestibility in functional neurological disorder: a meta-analysis

Wieder, Lillian, Brown, Richard, Thompson, Trevor ORCID: 0000-0001-9880-782X and Terhune, Devin B. (2020) Suggestibility in functional neurological disorder: a meta-analysis. Journal of Neurology, Neurosurgery, and Psychiatry, 92 (2). pp. 150-157. ISSN 0022-3050 (Print), 1468-330X (Online) (doi:

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Objective Responsiveness to direct verbal suggestions (suggestibility) has long been hypothesized to represent a predisposing factor for functional neurological disorder (FND) but previous research has yielded conflicting results. The aim of this study was to quantitatively evaluate whether FND patients display elevated suggestibility relative to controls via meta-analysis.

Methods Four electronic databases were searched in November 2019, with the search updated in April 2020, for original studies assessing suggestibility using standardized behavioural scales or suggestive symptom induction protocols in FND (including somatization disorder) patients and controls. The meta-analysis followed Cochrane, PRISMA, and MOOSE guidelines. Data extraction and study quality coding were performed by two independent reviewers. Standardized suggestibility scores and responsiveness to symptom induction protocols were used to calculate standardized mean differences (SMDs) between groups.

Results Of 26,643 search results, 19 articles presenting 11 standardized suggestibility datasets (FND: n=316; control: n=360) and 11 symptom suggestibility datasets (FND: n=1285; control: n=1409) were included in random-effects meta-analyses. Meta-analyses revealed that FND patients displayed greater suggestibility than controls on standardized behavioural scales (SMD, 0.48 [95% CI, 0.15, 0.81]) and greater responsiveness to suggestive symptom induction (SMD, 1.39 [95% CI, 0.92, 1.86]). Moderation analyses presented mixed evidence regarding the extent to which effect sizes covaried with methodological differences across studies. No evidence of publication bias was found. Conclusions These results corroborate the hypothesis that FND is characterized by heightened responsiveness to verbal suggestion. Atypical suggestibility may confer risk for FND and be a cognitive marker that can inform diagnosis and treatment of this condition.

Item Type: Article
Uncontrolled Keywords: functional neurological disorder, meta-analysis
Subjects: R Medicine > R Medicine (General)
Faculty / School / Research Centre / Research Group: Faculty of Education, Health & Human Sciences
Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified: 27 Jul 2021 09:39

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