Personality Disorders in Functional and Idiopathic Dystonia

Background: Distinguishing functional dystonia (FD) from idiopathic dystonia (ID) remains a major clinical challenge because both conditions are diagnosed primarily on clinical grounds and may be accompanied by non-motor psychiatric symptoms. Although personality abnormalities have been described in functional neurological disorders, their relevance in the differential diagnosis of dystonia remains insufficiently studied, and comparative data on FD and ID are lacking, particularly in the Russian population. Patients and Methods: A total of 178 patients with idiopathic dystonia (focal and segmental dystonia, ID) and 32 patients with functional dystonia (FD) were observed. A clinical interview by a psychiatrist was conducted; the SCID-II-PD questionnaire and the Five-Factor Personality Questionnaire (5-PFQ) were used to assess PD. Results: Patients with FD more often than patients with ID had such PD as dependent, paranoid, passive-aggressive, borderline, schizoid and schizotypal (p < 0.001), as well as obsessive-compulsive (p < 0.013) and avoidant (p < 0.049) according to SCID-II-PD. In FD, personalities of the eccentric cluster A predominate; patients with FD are characterized in personality terms by significantly greater introversion, detachment, naturalness (irresponsibility, impulsivity, carelessness), emotional restraint and practicality (conservatism, low sensitivity, rigidity) according to 5-PFQ. Conclusions: Patients with FD differ from patients with ID in both categorical and dimensional personality characteristics. The predominance of cluster A personality pathology and the identified pattern of personality-related variables may have potential value as adjunctive markers in the clinical differentiation of FD from ID. Further external validation is required before these findings can be incorporated into diagnostic algorithms.