Functional disorders: pathogenesis and systematic of clinical presentation

Diukova G.M.; Golubev V.L.; Pogromov A.P.; Mnatsakanyan M.G.

doi:https://doi.org/10.17116/jnevro2016116121137-144

Close metadata

Recommended articles:

Epidemiology of M. genitalium infection. What is known?. Russian Journal of Clinical Dermatology and Venereology. 2025;(2):143-152

Pathogenesis of fibrosis development in ovarian endometriosis. Russian Journal of Archive of Pathology. 2025;(2):73-78

Portopulmonary hypertension. Journal of Respiratory Medicine. 2025;(2):39-44

Bacterial vaginosis: modern views. Russian Journal of Clinical Dermatology and Venereology. 2025;(3):261-268

Study of the role of interleukin-1β in blood serum in patients with acne. Russian Journal of Clinical Dermatology and Venereology. 2025;(4):421-424

Pulmonary heart: definition, classification, pathogenesis, diagnostics. Morphologist’s view. Journal of Respiratory Medicine. 2025;(3):60-64

Analytical review of the pathophysiological mechanisms of ischemia-reperfusion syndrome development in PCI. Russian Journal of Anesthesiology and Reanimatology. 2025;(5):88-97

Endometriosis-associated infertility and the efficacy of dienogest. Russian Journal of Human Reproduction. 2025;(5):58-63

The role of proinflammatory cytokines TNF-α, IL-1, IL-8 and anti-inflammatory cytokines IL-4 and IL-10 in chronic vasomotor rhinitis. Russian Bulletin of Otorhinolaryngology. 2025;(6):55-59

Rosacea: from multifactorial pathogenesis to modern treatment methods. Russian Journal of Clinical Dermatology and Venereology. 2026;(1):23-30

Abstract:

Functional disorders hold a prominent place in the clinical practice of physicians of different specialties. The difficulties in the diagnosis of functional disorders need expensive examinations, and standard treatment is, as a rule, is not effective. Currently, the pathogenesis of these disorders is considered in the frames of the biopsychosocial model. In this literature review, the authors present modern concepts of terminology, classification, main features and general trends of the course of functional disorders. Special attention is drawn to comorbidity, a role of psychogenic factors and cerebral mechanisms of the pathogenesis including cognitive aspects.

Keywords:

functional disorders

psychogenic factors

pathogenesis

Authors:

Diukova G.M.

Kafedra nervnykh bolezneĭ fakul'teta postdiplomnogo professional'nogo obrazovaniia

SPIN RSCI: 4819-8551
Scopus AuthorID: 6603748004
ORCID: 0000-0001-9805-1022

Golubev V.L.

Kafedra nervnykh bolezneĭ FPPOV;
GOU VPO "Pervyĭ Moskovskiĭ gosudarstvennyĭ meditsinskiĭ universitet im. I.M. Sechenova", Moskva

Pogromov A.P.

Sechenov First Moscow State Medical University, Moscow, Russia

Mnatsakanyan M.G.

Sechenov First Moscow State Medical University, Moscow, Russia

Close metadata

References:

Stone J, Carson A, Duncan R, Coleman R, Roberts R, Warlow C, Hibberd C, Murray G, Cull R, Pelosi A, Cavanagh J, Matthews K, Goldbeck R, Smyth R, Walker J, MacMahon AD, Sharpe M. Symptoms ‘unexplained by organic disease’ in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain. 2009;132:2878-2888. doi: doi: 10.1093/brain/awp220
Stone J, Carson A, Duncan R, Coleman R, Roberts R, Warlow C et al. Who is referred to neurology clinics? — the diagnoses made in 3781 new patients. Clin Neurol Neurosurg. 2010;112(9):747-751. doi: doi: 10.1016/j.clineuro.2010.05.011
Perkin GD. An analysis of 7836 successive new outpatient referrals. J Neurol Neurosurg Psychiatr. 1989;52:447-448. doi: 10.1136/jnnp.52.4.447
Brandt T, Dieterich M, Strupp M. Psychogenic Forms of Vertigo and Dizziness. In Book «Vertigo and Dizziness. Common Complaints». Springer. 2005;115-122. doi: 10.1007/1-84628-081-8_5
Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712-721. doi: doi: 10.1016/j.cgh.2012.02.029
Chang L. Review article: epidemiology and quality of life in functional gastrointestinal disorders. Alimentary Pharmacology & Therapeutics. 2004;20:7:31-39. doi: 10.1111/j.1365-2036.2004.02183
Pogromov AP, Mnatsakanyan MG On the question of the prevalence of irritable bowel syndrome in the Russian Federation. Clinical Medicine. 2016; (In Russ.).
ABC of Medically Unexplained Symptoms. January Ed. Christopher Burton. 2013, BMJ Books. ISBN: 978-1-119-96725-5.(монография)
Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Archives of General Psychiatry. 2005;62:903-910. doi: 10.1001/archpsyc.62.8.903
Delius L, Fahrenberg J. Psychovegetative Syndrome. Stuttgart: Thieme; 1966.
International Statistical Classification of Diseases and Related Health Problems V: Mental and Behavioral Disorders, 10th Revision (ICD-10). Geneva, WHO,1992. (In Russ.).
DSM III. Diagnostic and Statistical Manual of Mental Disorders. Revised Third Edition. Washington, 1980.
DSM-IV. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. By the American Psychiatric Association. APA: Washington, DC. 1994. doi: doi: 10.1017/S0033291700035765
Sharpe M, Mayou R, Bass C. Concepts, theories and terminology. In: Treatment of functional somatic symptoms. (ed. Mayou R, Bass C. and Sharpe M). Oxford: Oxford University Press; 1995.
Ursin H, Eriksen HR. Sensitization, subjective health complaints and sustained arousal. Ann N Y Acad Sci. 2001;933:119-129. doi: 10.1111/j.1749-6632.2001.tb05819.x
Fink P, Toft T, Hansen MS, Ornbol E, Olesen F. Symptoms and syndromes of bodily distress: an exploratory study of 978 internal medical, neurological, and primary care patients. Psychosom Med. 2007;69:30-39. doi: 10.1097/PSY.0b013e31802e46eb
Budtz-Lilly A, Schröder A, Rask MT, Fink P, Vestergaard M and Rosendal M. Bodily distress syndrome: A new diagnosis for functional disorders in primary care? BMC Family Practice. 2015;16:180. doi: 10.1186/s12875-015-0393-8
Sarzi-Puttini P, Atzeni F, Di Franco M, Buskila D, Alciati A, Giacomelli C, Rossi A, Bazzichi L. Dysfunctional syndromes and fibromyalgia: a 2012 critical digest. Clin Exp Rheumatol. 2012;30(6 suppl 74):143-151. PMID: 23261014
Woolf CJ. What is this thing called pain? J Clin Invest. 2010;120(11):3742-3744. doi: 10.1172/JCI45178
Trimble M. Functional disease. BMJ. 1982;285:1768-1770. doi: doi: 10.1136/bmj.285.6357.1768
DSM-5 Fifth Edition Of The Diagnostic And Statistical Manual Of Mental Disorders. 2013. doi: 10.1176/appi.books.9780890425596
Aaron LA, Buchwald D. A Review of the Evidence for Overlap among Unexplained Clinical Conditions Ann Intern Med. 2001;134(9 Part 2):868-881. doi: 10.7326/0003-4819-134-9_Part_2-200105011-00011
Goldenberg D, Simms R, Geiger A, Komaroff A. High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice. Arthritis Rheum. 1990;33:381-387. doi: 10.1002/art.1780330311
Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many? Lancet. 1999;354(11):936-939. doi: doi: 10.1016/S0140-6736(98)08320-2
Rolfe A, Burton Ch. Epidemiology and Impact in Primary and Secondary Care. CHAPTER 2 in ABC of medically unexplained symptoms. Ed. by Ch Burton 2013 by John Wiley & Sons Ltd. pp. 5-6.
Tashchayn OV, Mnatsakanyan MG, Pogromov AP, Diukova GM, Khalyapina DV, Morozova YN Associated symptoms in IBS patients. Medical advice. 2015;5:124-128. (In Russ.).
Rodríguez MÁB, Afari N, Buchwald DS. A Review of the Evidence for Overlap between Urological and Nonurological Unexplained Clinical Conditions J Urol. 2009;182(5):2123-2131. doi: doi: 10.1016/j.juro.2009.07.036
Walker EA, Gelfand AN, Gelfand MD, Green C, Katon WJ. Chronic pelvic pain and gynecological symptoms in women with irritable bowel syndrome. J Psychosom Obstet Gynaecol. 1996;17:39-46. doi: 10.3109/01674829609025662
Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clinical Epidemiology. 2014;6:71-80. doi: doi: 10.2147/CLEP.S40245
Stone J, Sharpe M, Rothwell PM, Warlow CP. The 12 year prognosis of unilateral functional weakness and sensory disturbance. J Neurol Neurosurg Psychiatry. 2003;74:591-596. doi: 10.1136/jnnp.74.5.591
Dinos S, Khoshaba B, Ashby D, White PD, Nazroo J, Wessely S, Bhui KS. A systematic review of chronic fatigue, its syndromes and ethnicity: prevalence, severity, co-morbidity and coping. Int J Epidemiol. 2009;38:1554-1570. doi: 10.1093/ije/dyp147
McCarberg BH. Clinical overview of fibromyalgia. Am J Ther. 2012;19:357-368. doi: 10.1097/MJT.0b013e3181ff7bee
Chang L, Margaret M. Heitkemper Gender differences in irritable bowel syndrome. J Gastroenterology. 2002;123(5):1686-1701. doi: doi: 10.1053/gast.2002.36603
Drossman DA, Whitehead WE, Camilleri M. Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology. 1997;112:2120-2137. doi: doi: 10.1053/gast.1997.v112.agast972120
Flier SN, Rose S. Is functional dyspepsia of particular concern in women? A review of gender differences in epidemiology, pathophysiologic mechanisms, clinical presentation, and management. Am J Gastroenterol. 2006;101:644-653. doi: 10.1111/j.1572-0241.2006.01015.x
Meleine M, Matricon J. Gender-related differences in irritable bowel syndrome: Potential mechanisms of sex hormones. World J Gastroenterol. 2014;20(22):6725-6743. doi: 10.3748/wjg.v20.i22.6725
Heitkemper M, Jarett M, Bond EF, Chang L. Impact of sex and gender on irritable bowel syndrome. Biol Res Nurs. 2003;5:56-65. doi: 10.1177/1099800403005001006
Pogromov AP, Zuev V.M., Mnatsakanyan MG, Tashchyan OV Ovchinnikova DV Irritable bowel syndrome in women of reproductive age. Reproductive medicine (Kazakhstan). 2015;3-4(24-25):45-52. (In Russ.).
Van der Kolk B, Posttraumatic stress disorder and the nature of trauma. Dialogues in Clinical Neuroscience. 2000;2:1:7-22.
Sherin JE, Nemeroff CB. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in Clinical Neuroscience. 2011;13:3:263-278.
Videlock EJ, Adeyemo M, Licudine A, Hirano M, Ohning G, Mayer M, Mayer EA, Chang L Childhood trauma is associated with hypothalamic pituitary adrenal axis responsiveness in irritable bowel syndrome. Gastroenterology. 2009;137:1954-1962. doi: doi: 10.1053/j.gastro.2009.08.058
Felitti VJ et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14:245-258. doi: doi: 10.1016/S0749-3797(98)00017-8
Tanaka Y, Kanazawa M, Fukudo S, Drossman DA. Biopsychosocial model of irritable bowel syndrome. J Neurogastroenterol Motil. 2011;17:131-139. doi: 10.5056/jnm.2011.17.2.131
Heim C, Wagner D, Maloney E, Papanicolaou DA, Solomon L, Jones JF, Unger ER, Reeves WC. Early adverse experience and risk for chronic fatigue syndrome: results from a population-based study. Arch Gen Psychiatry. 2006;63:1258-1266. doi: 10.1001/archpsyc.63.11.1258
Drossman DA, Leserman J, Nachman G, Li Z, Gluck H, Toomey TC et al. Sexual and Physical Abuse in Women with Functional or Organic Gastrointestinal Disorders. Ann Intern Med. 1990;113:828-833. doi: 10.7326/0003-4819-113-11-828
Heim C, Ehlert U, Hanker J, Hellhammer DH. Abuse-Related Posttraumatic Stress Disorder and Alterations of the Hypothalamic-Pituitary-Adrenal Axis in Women With Chronic Pelvic Pain Psychosomatic Medicine. 1998;60:3:309-318. doi: 10.1097/00006842-199805000-00017
Roelofs K, Keijsers GPJ, Hoogduin KAL, Näring GWB, Moene FC. Childhood Abuse in Patients With Conversion Disorder. Am J Psychiatry. 2002;159:1908-1913. doi: 10.1176/appi.ajp.159.11.1908
Smith PF, Darlington CL. Personality changes in patients with vestibular dysfunction. Front Hum Neurosci. 2013. doi.org.sci-hub.io/10.3389/fnhum.2013.00678
Staab JP, Rohe DE, Eggers SDZ, Shepard NT. Anxious, introverted personality traits in patients with chronic subjective dizziness. Journal of Psychosomatic Research. 2014;76:80-83. doi: doi: 10.1016/j.jpsychores.2013.11.008
Urs NM, Jones JF, Lin J-MS, Maloney E, Reeves WC, Heim C. Personality Features and Personality Disorders in Chronic Fatigue Syndrome: A Population-Based Study. Psychother Psychosom. 2010;79:312-318. doi: 10.1159/000319312
http://www.neurosymptoms.org/-Functional and Dissociative Neurological Symptoms: a patient’s guide.
Reid S, Chalder T, Cleare A, Hotopf M, Wessely S. Chronic fatigue syndrome. BMJ Clinical Evidence. 2008;08:1101.
Arnold LM, Clauw DJ, Dunegan LJ, Turk DC, Fibro Collaborative. A Framework for Fibromyalgia Management for Primary Care Providers. Mayo Clin Proc. 2012;87(5):488-496. doi: doi: 10.1016/j.mayocp.2012.02.010
Lembo AJ. Current and Emerging Therapies for Irritable Bowel Syndrome. Gastroenterology & Hepatology. 2015;11:4:9-15
Demartini B, Batla A, Petrochilos P, Fisher L, Edwards MJ, Joyce E. Multidisciplinary treatment for functional neurological symptoms: a prospective study. J Neurol. 2014;261:2370-2377. doi: 10.1007/s00415-014-7495-4
Fjorback LO, Arendt M, Ørnbøl E, Walach H, Rehfeld E, Schröder A, Fink P. Mindfulness therapy for somatization disorder and functional somatic syndromes — Randomized trial with one-year follow-up. J Psychosom Res. 2012. doi: 10.1016/j.jpsychores.2012.09.010
Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. 2007;69(9):881-888. doi: 10.1097/PSY.0b013e31815b00c4
Grover M, Drossman DA. Psychotropic agents in functional gastrointestinal disorders. Current Opinion in Pharmacology. 2008;8:715-723. doi: 10.1016/j.coph.2008.07.012
Staab JP, Ruckenstein MJ, Amsterdam JD. A Prospective Trial of Sertraline for Chronic Subjective Dizziness. Laryngoscope. 2004;114:1637-1641. doi: 10.1097/00005537-200409000-00025
Diukova GM, Adilova SM, Zamergrad MV Features of clinical manifestations of panic disorder, depending on the accompanying dizziness and efficacy of paroxetine in their therapy. Medical Board. 2014;10:70-75. (In Russ.).
Balaban CD, Thayer JF Neurological bases for balance anxiety links. J Anxiety Disorders. 2001;15:53-79. doi: 10.1016/S0887-6185(00)00042-6
Vuilleumier P. Hysterical conversion and brain function. Prog Brain Res. 2005;150:309-329. doi: 10.1016/S0079-6123(05)50023-2
Schrag AE, Mehta AR, Bhatia KP, Brown RJ, Frackowiak RSJ, Trimble MR, Ward NS, Rowe JB. The functional neuroimaging correlates of psychogenic versus organic dystonia. Brain. 2013;136:770-781. doi: doi: 10.1093/brain/awt008
Edwards MJ, Fotopoulou A. Paree´s I. Neurobiology of functional (psychogenic) movement disorders. Curr Opin Neurol. 2013;26:442-447. doi: 10.1097/WCO.0b013e3283633953
Ricciardi I, Edwards M, Functional (psychogenic) movement disorders. In: Parkinson’s disease and movement disorders (sixth ed.), J. Jankovic, E. Tolosa. 2015.
Leontiev DA. Psychology of freedom: to the problem of self-determination of the individual. Psychological Journal. 2000;21:1. (In Russ.).
David N. Functional anatomy of the sense agency. In: Neuropsychology of the sense agency. 2010;69-86. doi: 10.1007/978-88-470-1587-6_4
David N. New frontiers in the neuroscience of the sense agency. In: Frontiers in human neuroscience. 2012;6:1-4. doi: 10.3389/fnhum.2012.00161
Moore J, Fletcher P. Sense agency in health and disease: a review of cue integration approaches. Consciousness and Cognition. 2012;21:1:59-68. doi: 10.1016/j.concog.2011.08.010
Kranick S, Hallet M. Neurology of Volition. Review Exp Brain Res. 2013. doi: 10.1007/s00221-013-3399-2
Pacherie E. Self-agency. In: The Oxford Handbook of the Self, Oxford University Press; 2010. doi: 10.1093/oxfordhb/9780199548019.003.0020
Edwards M, Schrag A. Hyperkinetic psychogenic movement disorders. A. In: Handbook of clinical disorders. ELSEVIER; 2011;100(3 rd Series):719-729. doi: 10.1016/B978-0-444-52014-2.00051-3
Haggard P, Chambon V. Sense of agency Current Biology. 2012;22:10:390-392. doi: doi: 10.1016/j.cub.2012.02.040
Edwards M, Moretto G, Schwingenschuh P, Katschnig P, Bhatia K.P., Haggard P. Abnormal sense of intention preceding voluntary movement in patients with psychogenic tremor. Neuropsychologia. 2011;49:2791-2793. doi: 10.1016/j.neuropsychologia.2011.05.021
Ingram RE. Self-focused attention in clinical disorders: review and a conceptual model. Psychological Bulletin. 1990;107:2:156-176. doi: 10.1037/0033-2909.107.2.156
Bob P. Brain, Mind and Consciousness, Springer. 2011;142. doi: 10.1007/978-1-4614-0436-1
Dreikurs R. Psychology in the classroom, (2nd edition), Harper and Row, New York. 1968. doi: 10.1002/1520-6807(196904)
Edwards M, Bhatia K. Functional (psychogenic) movement disorders: merging mind and brain. Lancet/neurology. 2012;11:3:250-260. doi: doi: 10.1016/S1474-4422(11)70310-6
Diukova GM, Golubev VL Neurological approaches to the diagnosis of hysteria. Journal of Neurology and Psychiatry. C.C. Korsakov. 1994;5:95-100. (In Russ.).
Fahn S, Jankovic J, Hallet M. Psychogenic movement disorders. In: Principles and Practice of Movement Disorders. ELSEVIER. 2011;513-527. doi: 10.1016/b978-1-4377-2369-4.00025-1