Attachment State of Mind and complex traumatization in patients with Functional Motor Disorder (Motor Conversion Disorder)

Introduction: Functional Motor Disorder (FMD) is characterized by motor neurological symptoms that cannot be explained by typical neurological diseases or other medical conditions. The role of psychological factors in the development, severity, and persistence of FMD remains unclear. We investigated the Attachment State of Mind (SoM) in FMD patients using the Adult Attachment Interview (AAI) and retrospectively examined the quality of their traumatic experiences, if any. Methods: Thirty FMD patients and thirty healthy controls (HC) underwent the AAI and were classified according to both the three-way classification (Free/Secure, Dismissing or Entangled SoM) and the four-way classification (Unresolved SoM, indicating unelaborated traumatic events). Frequency and quality of adverse childhood experiences before the age of 14 were assessed via the Complex Trauma Questionnaire (ComplexTQ). Results: Among HC, 53.3% exhibited a Free/Secure SoM, while 73.3% of FMD patients displayed an Insecure SoM (Entangled or, primarily, Dismissing). Individuals with Insecure SoM were three times more likely to manifest FMD. Unresolved Trauma was present in 26.7% of HC and 46.7% of FMD patients, with Unresolved Trauma leading to a fourfold increase in the likelihood of manifesting FMD. FMD patients reported significantly higher neglect from both parents, physical abuse from the mother, and parental loss compared to HC. Discussion: Using a gold-standard instrument for evaluating Attachment SoM, we found that FMD patients had a significantly higher prevalence of Insecure SoM and childhood traumatic unresolved events compared to HC, supporting previous literature assessing FMD Attachment Styles through self-report questionnaires. We discuss the potential pathophysiological, neurobiological, and therapeutic implications of our findings.