Early maladaptive schemas in functional movement disorders: A cross-sectional study

Early maladaptive schemas (EMS) are predisposing psychological factors for various disorders but raised little concern in Functional Movement Disorders (FMD). We aimed to assess the intensity of EMS in patients with FMD compared to Parkinson's Disease (PD) or Organic Dystonia (OD). We analysed their association with the severity of motor symptoms, anxiety, depression, dissociative symptoms and childhood trauma events.

We sent the Young Schema Questionnaire Short Form 3 (YSQ-S3, French version) by mail to patients who had participated in a previous study. Eighteen schemas from the YSQ-S3 were compared between the 3 groups using linear and linear mixed models. Their associations were analysed with the scores of the modified Abnormal Involuntary Movement Scale (AIMS), the Hospital Anxiety and Depression Scale (HADS), the Composite International Diagnostic Interview questionnaire (CIDI) and the Somatoform Dissociation Questionnaire (SDQ-20).

32 patients with FMD, 28 patients with PD, 20 patients with OD filled the questionnaire. The Excessive Responsibility and High Standards schema domain score was significantly higher in the FMD group (MDE ± SE: FMD vs PD: 13.00 ± 3.52, p = 0.005; FMD vs OD: 17.34 ± 3.90, p < 0.001). The Self-Sacrifice schema scores were significantly more intense in the FMD group (group*schema: p < 0.001 and Cohen's f2 = 0.07; MDE ± SE: patients vs PD: 6.59 ± 1.30, p < 0.001; FMD vs OD: 9.57 ± 1.43, p < 0.001). No association was found between YSQ-S3 scores and age, gender, educational level, AIMS, HADS, CIDI, and SDQ-20.

Higher intensity of self-sacrifice schema scores was reported in patients with FMD, suggesting that it may be a significant predisposing and/or perpetuating factor in FMD.