Trauma History Mapping and Family Psychoeducation Protocol(THMFP): A Structured Trauma-Informed Clinical Formulation Framework for Functional Neurological and Psychosomatic Disorders
DOI:
https://doi.org/10.54878/zs9bz509Keywords:
Functional neurological disorder, psychosomatic medicine, trauma-informed care, dissociation, family psychoeducation, neuropsychological formulationAbstract
Functional Neurological Disorders (FND), dissociative conditions, and psychosomatic presentations remain clinically challenging due to fragmented care pathways, diagnostic uncertainty, and inconsistent integration of psychological and neurological perspectives. This paper presents the Trauma History Mapping and Family Psychoeducation Protocol (THMFP), a structured clinical framework designed to support trauma-informed formulation and psychoeducation in patients with functional and psychosomatic symptoms. THMFP integrates three core components: (1) systematic trauma history mapping, (2) neuropsychological and psychosomatic formulation, and (3) consent-based family psychoeducation. The protocol is grounded in contemporary models of FND emphasizing predictive processing, salience network dysregulation, autonomic nervous system imbalance, and trauma-related emotional processing. The model was developed through retrospective clinical application in a sample of approximately 28 patients presenting with functional and psychosomatic symptoms, alongside a comparison group of 15 individuals with stress-related but non-functional presentations. Observational outcomes suggested improved diagnostic clarity, enhanced patient understanding, and improved engagement with care; however, no standardized outcome measures were applied. THMFP is presented as a structured clinical formulation and psychoeducation framework requiring further validation through prospective and controlled studies.
References
Aybek, S., Perez, D. L., Nicholson, T. R., Stone, J., Carson, A., Gelauff, J., ... & Hallett, M. (2023). Functional neurological disorder: New directions in diagnosis and treatment. The Lancet Neurology, 22(2), 142–154.
Baslet, G. (2011). Psychogenic non-epileptic seizures: A treatment review. What Have We Learned Since the Beginning of the Millennium? Neuropsychiatric Disease and Treatment, 7, 585–598.
Baslet, G., Roiko, A., & Prensky, E. (2020). Heterogeneity in functional neurological disorders: Understanding the role of psychological trauma. Epilepsy & Behavior, 108, 107073.
Brown, R. J., & Reuber, M. (2016). Psychological and psychiatric aspects of functional neurological disorders. Current Opinion in Neurology, 29(4), 507–512.
Carson, A., Lehn, A., & Ludwig, L. (2016). Explaining functional disorders in the neurology clinic: A photo story. Practical Neurology, 16(1), 56–61.
Carson, A., Stone, J., Hibberd, C., Murray, G., Duncan, R., Coleman, R., ... & Sharpe, M. (2011). Disability, distress and unemployment in neurology outpatients with symptoms unexplained by organic disease. Journal of Neurology, Neurosurgery & Psychiatry, 82(7), 810–813.
Critchley, H. D., & Garfinkel, S. N. (2017). Interoception and emotion. Current Opinion in Psychology, 17, 7–14.
Craig, A. D. (2009). How do you feel—now? The anterior insula and human awareness. Nature Reviews Neuroscience, 10(1), 59–70.
Damasio, A. R. (1999). The feeling of what happens: Body and emotion in the making of consciousness. Harcourt Brace.
Edwards, M. J., Adams, R. A., Brown, H., Pareés, I., & Friston, K. J. (2012). A Bayesian account of "hysteria." Journal of Neurology, Neurosurgery & Psychiatry, 83(8), 842–850
Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., ... & Morgante, F. (2018). Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurology, 75(9), 1132–1141.
Fani, N., & Ressler, K. J. (2018). Imaging genetics of anxiety disorders. NeuroImage, 53, 822–831. Friston, K. (2010). The free-energy principle: A unified brain theory? Nature Reviews Neuroscience, 11(2), 127–138.
Friston, K. (2018). Does predictive coding have a future? Nature Neuroscience, 21(8), 1019–1021.
Goldstein, L. H., & Mellers, J. D. C. (2019). Recent developments in our understanding of the semiology and treatment of functional neurological disorders. Current Opinion in Neurology, 32(4), 442–447.
Goldstein, L. H., Robinson, E. J., Mellers, J. D. C., Stone, J., Carson, A., Reuber, M., ... & Chalder, T. (2020). Cognitive behavioural therapy for adults with dissociative seizures. The Lancet Psychiatry, 7(6), 491–505.
Hallett, M. (2016). Functional neurological disorder: Is it a neurological condition? Journal of Neurology, 263(6), 1211–1213.
Hallett, M., Aybek, S., Dworetzky, B. A., McWhirter, L., Staab, J. P., & Stone, J. (2022). Functional neurological disorder: New subtypes and shared mechanisms. The Lancet Neurology, 21(6), 537–550.
Kozlowska, K., English, M., Savage, B., & Chudleigh, C. (2021). Functional somatic symptoms in children and adolescents: A stress-system approach to assessment and treatment (2nd ed.). Palgrave Macmillan.
Lanius, R. A., Vermetten, E., & Pain, C. (2010). The impact of early life trauma on health and disease: The hidden epidemic. Cambridge University Press.
Lanius, R. A., Frewen, P. A., Vermetten, E., & Yehuda, R. (2020). Fear conditioning and early life trauma. American Journal of Psychiatry, 177(7), 563–571.
LeDoux, J. E. (2012). Rethinking the emotional brain. Neuron, 73(4), 653–676.
McEwen, B. S. (2017). Neurobiological and systemic effects of chronic stress. Chronic Stress, 1, 1–11.
Nicholson, T. R., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., Mildon, B., ... & Stone, J. (2020). Outcome measures for functional neurological disorder: A review. Journal of Neurology, Neurosurgery & Psychiatry, 91(10), 1032–1040.
Paulus, M. P., & Stein, M. B. (2010). Interoception in anxiety and depression. Brain Structure and Function, 214(5–6), 451–463
Perez, D. L., Nicholson, T. R., Asadi-Pooya, A. A., Bègue, I., Butler, M., Carson, A., ... & Hallett, M. (2021). Neuroimaging in functional neurological disorder: State of the field and research agenda. NeuroImage: Clinical, 30, 102623.
Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton.
Price, C. J., & Hooven, C. (2018). Interoceptive awareness skills for emotion regulation. Frontiers in Psychology, 9, 798.
Schönenberg, M., Mares, L., & Jusyte, A. (2023). Trauma, dissociation, and functional neurological symptoms: A systematic review. Journal of Psychiatric Research, 161, 235–247.
Sharpe, M., Carson, A., & Stone, J. (2021). Functional neurological disorder: Clinical challenges and future directions. The BMJ, 373, n1356.
Stone, J. (2021). Functional neurological disorders: The neurological assessment as treatment. Practical Neurology, 21(1), 5–8.
Stone, J., Carson, A., Duncan, R., Roberts, R., Warlow, C., Hibberd, C., ... & Sharpe, M. (2010). Symptoms unexplained by organic disease in neurology outpatients. Brain, 133(5), 1537–1551.
van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
Voon, V., Cavanna, A. E., Coburn, K., Sampson, S., Reeve, A., & LaFrance, W. C. (2016). Functional neuroanatomy and neurophysiology of functional neurological disorders. Journal of Neuropsychiatry and Clinical Neurosciences, 28(3), 168–190.
World Health Organization. (2022). World mental health report: Transforming mental health for all. World Health Organization.
Yehuda, R., & Lehrner, A. (2018). Intergenerational transmission of trauma effects. World Psychiatry, 17(3), 243–257.
