Functional neurological disorder and functional somatic syndromes among sexual and gender minority people: A scoping review.

To describe the current literature on functional neurological disorder and functional somatic syndromes among sexual and gender minority people (SGM). A search string with descriptors of SGM identity and functional disorders was entered into PubMed, Embase, Web of Science, PsycInfo, and CINAHL for articles published before May 24, 2022, yielding 3121 items entered into Covidence, where 835 duplicates were removed. A neurologist and neuropsychiatrist screened titles and abstracts based on predefined criteria, followed by full-text review. A third neurologist adjudicated discrepancies. Eligible publications underwent systematic data extraction and statistical description. Our search identified 26 articles on functional disorders among SGM people. Most articles were case (13/26, 46%) or cross-sectional (4/26, 15%) studies. Gender minority people were represented in 50% of studies. Reported diagnoses included fibromyalgia (n = 8), functional neurological disorder (n = 8), somatic symptom disorder (n = 5), chronic fatigue syndrome (n = 3), irritable bowel syndrome (n = 2), and other functional conditions (n = 3). Three cohort studies of fibromyalgia or somatic symptom disorder reported an overrepresentation of gender minority people compared to cisgender cohorts or general population measures. Approximately half of case studies reported pediatric or adolescent onset (7/13, 54%), functional neurological disorder diagnosis (7/13, 54%), and symptom improvement coinciding with identity-affirming therapeutic interventions (7/13, 58%). Despite a methodologically rigorous literature search, there are limited data on functional neurological disorder and functional somatic syndromes among SGM people. Several studies reported increased prevalence of select conditions among transgender people. More observational studies are needed regarding the epidemiology and clinical course of functional disorders among SGM people.

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Declaration of Competing Interest All authors have completed the ICMJE Unified Competing Interest form. The following authors have no disclosures to report: Dr. Fusunyan, Mr. Stave, Student Dr. Roldán, and Dr. Maschi. Dr. Lerario has served as plaintiff expert witness for Weiss Law, PC and receives consultancy payments regarding transgender neurological health care from medical colleges and universities within the US. Dr. Keuroghlian reports receiving textbook royalties from McGraw Hill. Dr. Turban reports receiving textbook royalties from Springer Nature and expert witness payments from The American Civil Liberties Union and Lambda Legal. He has received a pilot research award for general psychiatry residents from The American Academy of Child & Adolescent Psychiatry and its industry donors (Arbor & Pfizer) and a research fellowship from The Sorensen Foundation. Dr. Perez receives royalties from Springer for a functional movement disorder textbook, honoraria for continuing medical education lectures on functional neurological disorder, is a paid associate editor of Brain and Behavior, and receives funding from the National Institutes of Health and Sidney R. Baer Jr. Foundation unrelated to this work. Dr. Rosendale receives research funding from the American Academy of Neurology and National Institutes of Health StrokeNet Fellowship. She receives royalties from McGraw Hill for authorship of a chapter in Current Medical Diagnosis and Treatment 2022 and 2023.