Thread by @jungjoha

Sharing “A New Science of Emotion: Implications for Functional Neurological Disorder”, just published in @Brain1878. Great collaboration with @SaraParedesEch1, @popkirov, @LFeldmanBarrett, @PerezMGHLab! Some highlights of the paper below 🧵. (1/15) doi.org/10.1093/brain/…

What are emotions and what role do they play in the pathophysiology of Functional Neurological Disorder (#FND)? We have long debated this, but missed to ask ourselves: "What are emotions in the first place?" (2/15)

10 years ago, Edwards, Adams et al. started the conversation on a Bayesian account of Functional Neurological Disorder: doi.org/10.1093/brain/…. Here, we sought to leverage the latest neuro-constructionist approaches to revisit the role of emotion in #FND. (3/15)

Through our socio-cultural and linguistic influences, we commonly think of emotions as distinct, universal entities that “happen to us” and might (or might not) be detected, processed, and regulated. But is that what emotions really are? (4/15)

Neuroscientists including @LFeldmanBarrett have theorized a re-framing of emotions using the science of predictive processing – including pointing out the brain’s important role in efficient energy management. . (5/15)

A key point: Emotions are constructed in part by categorizing sensory input using available learned concepts. Emotions are not universal. doi.org/10.1093/scan/n…. But what happens when emotion construction goes awry? (6/15)

We posit that #FND and related functional somatic symptoms (e.g., fatigue, pain, GI distress) may arise from a range of potential alterations in the emotion category construction biological process. (7/15)

Our proposal provides a reconceptualization for alexithymia, “panic attack without panic”, & dissociation, plus revisits roles for attachment styles, life experiences, and interoception in #FND. (8/15)

We theorize that altered emotion construction in *some* individuals is sufficient to explain the development and maintenance of #FND and related somatic symptoms. However, this is NOT a “one size fits all” model! (9/15)

Neuroanatomy (cytoarchitectural lamination gradients) informs predictions, prediction error detection and prediction error learning – including that we point out relevant roles for default mode, salience & sensorimotor networks. (10/15)

There are several clinical implications – including revisiting how to interpret potential “mismatches” between people with #FND & clinicians in the interpretation of valence and arousal states. In brief – the patient perspective is correct! (11/15)

Also – this is a rather different formulation than outdated Freudian models – including asking the question might the psychotherapy setting be the place where some emotion concepts are developed in the first place? (12/15)

We propose a number of ways to empirically test this model in people with FND – including the study of emotional granularity (and its relevance), use of high field strength MRI, and expanding the range of interoceptive probes among other possibilities. (13/15)

Many other mechanistic perspectives remain relevant in understanding FND – albeit we believe that this paper addresses an important gap in current formulations. (14/15)

Check out the paper to read more! 🤓🧠📚 (15/15) @FNDSociety @FNDHope @FNDHopeUK @FNDHopeUSA @FNDAction @fndfriends @FNDFrieNDsUK @fndfrance @NeuroAdvisor @PsychiatryAdv @NeurologyToday @PsychTimes @MedscapeNeuro @MedscapePsych @MGHNeuroSci @FndPortal doi.org/10.1093/brain/…