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Gender disparity and abuse in functional movement disorders: a multi-center case-control study

Journal of Neurology volume 269, pages 3258–3263 (2022)Cite this article

Abstract

Background

To determine gender differences in rates of sexual and physical abuse in functional movement disorders compared to controls and evaluate if the gender disparity of functional movement disorders is associated with abuse history.

Methods

We performed a retrospective case-control study of self-reported trauma data from 696 patients (512 women) with functional movement disorders from six clinical sites compared to 141 controls (98 women) and population data. Chi-square was used to assess gender and disorder associations; logistic regression was used to model additive effects of abuse and calculate the attributable fraction of abuse to disorder prevalence.

Results

Higher rates of sexual abuse were reported by women (35.3%) and men (11.5%) with functional movement disorders compared to controls (10.6% of women; 5.6% of men). History of sexual abuse increased the likelihood of functional movement disorders among women by an odds ratio of 4.57 (95% confidence interval 2.31–9.07; p < 0.0001) and physical abuse by an odds ratio of 2.80 (95% confidence interval 1.53–5.12; p = 0.0007). Population attributable fraction of childhood sexual abuse to functional movement disorders in women was 0.12 (0.05–0.19). No statistically significant associations were found in men, but our cohort of men was underpowered despite including multiple sites.

Conclusions

Our study suggests that violence against women may account for some of the gender disparity in rates of functional movement disorders. Most people with functional movement disorders do not report a history of abuse, so it remains just one among many relevant risk factors to consider.

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Data availability

A summary of data not shared in this article can be reviewed pending individual organizational approval.

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Acknowledgements

The authors thank the many patients who participated in this study and the clinical and research staff at NINDS, University of Louisville, University of Edinburgh, University of Toronto, NHS South London and Southeast Scotland and the Portland VA. The authors also thank the Global Burden of Disease 2019 Collaborators, IHME, for sharing data used to calculate population attributable factor and to Alan Carson for advice.

Funding

Funding for collection of data analyzed in this study comes from: the Intramural Program of the National Institute of Neurological Disorders and Stroke, Bethesda, MD USA; Chief Scientist Office, Scottish Executive, Edinburgh EH1 3DG, Scotland UK; National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College, London, UK.

Author information

Authors and Affiliations

  1. Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA

    Isaiah Kletenik

  2. Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA

    Isaiah Kletenik, Samantha K. Holden, Stefan H. Sillau & Brian D. Berman

  3. Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA

    Isaiah Kletenik & Samantha K. Holden

  4. Movement Disorders Center, University of Colorado School of Medicine, Aurora, CO, USA

    Samantha K. Holden & Brian D. Berman

  5. Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland

    Nicola O’Connell

  6. Division of Psychiatry, University Health Network and the University of Toronto, Toronto, ON, Canada

    Lindsey MacGillivray

  7. Department of Psychiatry, Northwest Parkinson’s Disease Research, Education, and Clinical Center, Portland, OR, USA

    Joel Mack

  8. Department of Neurology, Veterans Affairs Portland Health Care System, Portland, OR, USA

    Joel Mack

  9. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA

    Beatrix Haddock & M. Ashworth Dirac

  10. Departments of Health Metrics and Family Medicine, University of Washington, Seattle, WA, USA

    M. Ashworth Dirac

  11. Institute of Mental Health, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK

    Anthony S. David

  12. Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Timothy R. Nicholson

  13. Department of Neurology, University of California-Irvine School of Medicine, Irvine, CA, USA

    Sanaz N. Attaripour Isfahani

  14. Department of Neurology, Stony Brook University School of Medicine, Stony Brook, NY, USA

    Carine W. Maurer

  15. Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of Toronto, Toronto, ON, Canada

    Sarah C. Lidstone

  16. Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA

    Mark Hallett

  17. Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Kathrin LaFaver

  18. Department of Neurology, Movement Disorder Division, University of Louisville, Louisville, KY, USA

    Kathrin LaFaver

  19. Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA

    Brian D. Berman

  20. Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK

    Jon Stone

Authors
  1. Isaiah Kletenik
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  2. Samantha K. Holden
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  3. Stefan H. Sillau
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  4. Nicola O’Connell
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  5. Lindsey MacGillivray
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  6. Joel Mack
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  7. Beatrix Haddock
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  8. M. Ashworth Dirac
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  9. Anthony S. David
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  10. Timothy R. Nicholson
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  11. Sanaz N. Attaripour Isfahani
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  12. Carine W. Maurer
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  13. Sarah C. Lidstone
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  14. Mark Hallett
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  15. Kathrin LaFaver
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  16. Brian D. Berman
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  17. Jon Stone
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Contributions

IK project conception, organization and execution. Statistical analysis design and data acquisition. Manuscript drafting and editing. SKH project organization and execution. Statistical analysis design. Manuscript review and critique. SHS statistical analysis design and execution. Manuscript editing. NO’C major role in the acquisition of data and revision of the manuscript. LM major role in the acquisition of data and revision of the manuscript. JM major role in the acquisition of data and revision of the manuscript. BH major role in the acquisition of data and interpretation. MAD major role in the acquisition of data and interpretation. ASD major role in the acquisition of data and interpretation. TRN major role in the acquisition of data and interpretation. SNAI major role in the acquisition of data and interpretation. CWM major role in the acquisition of data and interpretation. SCL major role in the acquisition of data and interpretation. MH project conception, major role in data acquisition, interpretation of data and manuscript revision. KL project conception, major role in data acquisition, interpretation of data and manuscript revision. BDB project conception, organization and execution. Statistical analysis design. Manuscript revision. JS project conception, organization and execution. Major role in data acquisition. Statistical analysis design. Manuscript critique and revision.

Corresponding author

Correspondence to Isaiah Kletenik.

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Conflicts of interest

The authors have no relevant conflicts of interest to report.

Ethical approval

Data collection was with patient consent and approved by local institutional review boards under NIH 07-N-0190, Louisville 15.1043; Edinburgh Lothian Research Ethics Committee; NHS South London 08/H0606/71 + 5; Portland by VA Portland IRB; Toronto REB 21-5070 and, therefore, in accordance with the ethical standards of the 1964 Declaration of Helsinki and amendments. This secondary analysis was conducted entirely on retrospective de-identified data so was not considered human subject research and relied on those existing approvals.

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Kletenik, I., Holden, S.K., Sillau, S.H. et al. Gender disparity and abuse in functional movement disorders: a multi-center case-control study. J Neurol 269, 3258–3263 (2022). https://doi.org/10.1007/s00415-021-10943-6

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  • DOI: https://doi.org/10.1007/s00415-021-10943-6

Keywords

  • Functional movement disorder
  • Psychogenic
  • Sexual abuse
  • Trauma
  • Gender