Emotional Drivers of Functional Movement Disorder: A Real-World Analysis of Patient-Reported Symptom Data

Abstract

Objective: Functional Movement Disorder (FMD) is characterized by abnormal movements not attributable to known neurological disease. While emotional factors are theorized to play a role in symptom expression, large-scale empirical data on the relationship between specific emotional states and motor symptom severity remains limited. This study examined emotional correlates of motor symptoms using real-world patient-reported data from a mobile health tracking platform.

Methods: Cross-sectional analysis of 3,486 daily symptom logs containing motor symptoms (tremors, weakness, gait disturbance, dystonia) from 1,194 patients using the NeuroLog symptom tracking application (Painter, 2025). Emotional states, triggers, and symptom severity (0-10 scale) were compared between motor and non-motor symptom days.

Results: Motor symptom days showed significantly higher overall severity (M = 6.41) compared to non-motor days (M = 5.21). Anxiety (n = 828) and frustration (n = 809) were the most frequently reported emotions on motor symptom days. Sadness consistently predicted highest severity across all motor subtypes (tremors: 7.51, weakness: 7.30, dystonia: 7.53, gait: 7.61). Positive emotional states (calm, content) were associated with 1.2-point lower severity. Depression, anger, and interpersonal conflict emerged as the highest-severity triggers.

Conclusions: Emotional states demonstrate robust associations with functional motor symptom expression and severity. Sadness emerges as a particularly potent correlate of symptom severity, while positive emotional states appear protective. These findings have clinical implications and support emotional regulation interventions as well as schema-focused therapy in FMD.

Keywords: Functional Movement Disorder, Functional Neurological Disorder, emotion, affect, motor symptoms, tremor, weakness, dystonia