Symptom severity in patients with functional motor symptoms: Patient's perception and doctor's clinical assessment

• We evaluated patients' awareness of their FMS before and while watching themselves in a video.
• We compare patient's rating with doctors' assessment of the presence and severity of FMS.
• Patients with FMS judged the severity of their FMS to be lower when observing their symptoms on a video recording.
• The ratings while patients are watching their FMS in a video did not differ from those of an independent rater.
• Patients with FMS have an abnormal perception of their FMS and they tend to overestimate them.

BackgroundBeliefs and expectations about symptoms and an abnormal direction of attention towards the body have been proposed as important mechanistic factors in the pathophysiology of functional motor symptoms (FMS). We therefore aimed to evaluate patients' awareness/perception of the presence and severity of their own symptoms before and while watching themselves in a video and to compare this with doctors' assessment of the presence and severity of FMS, based on video evaluation.MethodsWe evaluated 16 patients affected by FMS. Patients were invited to give a “subjective evaluation” of their symptoms. Afterwards, patients were invited to watch a video of themselves and to judge the presence of symptoms in the different body parts and, if so, to rate the severity. Patients' videos were also assessed by a rater with expertise in FMS.ResultsPatients judged their symptoms to be more severe on subjective evaluation than when viewing a video of themselves (p = 0.002; t = 3.656). Subjective evaluation of symptom severity by patients was higher than that of raters viewing a video of the patient (p < 0.001, t = 4.860), but there was only a trend towards a difference between video ratings of severity by patients and independent raters (p = 0.017, t = 2.962 with p set at 0.016 according to Bonferroni correction).ConclusionsOur study shows that patients with FMS tend to overestimate the severity of their symptoms compared independent rating. However, when viewing a video of themselves they rated their symptoms as less severe and closer to those of independent raters.