Introduction: The psychological contribution to functional neurological and somatic symptom disorders is a major topic in current medical debate. Objective: For an understanding of the processes leading to functional somatic symptoms, it is paramount to explore their relationship with stress and life events and to elucidate the contribution of cultural factors. Methods: A total of 937 case records of civilian and military patients with functional somatic disorders treated in London during World War 1 were analysed. Group differences in symptom profiles and contemporaneous diagnoses were tested with χ2 tests. Results: Paralyses and speech disturbances were significantly more common in soldiers (43.3 and 17.2% of cases) than in civilian male (28.1 and 6.5%) and female patients (32.4 and 7.5%), whereas female patients had the highest rates of pain (48.6%) and somatic symptoms (67%). Triggers were identified in around two-thirds of cases and included accidents, physical illness, and work stress, in addition to the combat experience of the soldier patients. The nature of the trigger influenced symptom expression, with acute (combat and noncombat) events being particularly prone to trigger loss of motor function. Symptom profiles showed a great deal of multi-morbidity and overlap, although some symptom clusters were more (motor and speech disturbance) or less common (pain and loss of energy) in soldiers than civilians. Triggering life events in civilians were similar to those reported by patients with somatic symptom disorders today, with an important role of physical factors. Patterns of multi-morbidity and symptom clusters also resembled those of modern cohorts. Conclusions: Analysis of historical records, illness trajectories, and treatments can enhance the understanding of the presentation, mechanisms, and course of functional neurological and related disorders and their consistency over time.

中文翻译：

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功能性神经疾病的诱因和临床表现：第一次世界大战的教训

简介：对功能性神经和躯体症状障碍的心理影响是当前医学争论的一个主要话题。目的：为了了解导致功能性躯体症状的过程，探索它们与压力和生活事件的关系并阐明文化因素的贡献至关重要。方法：对一战期间在伦敦接受治疗的功能性躯体障碍的平民和军队患者的 937 例病例记录进行了分析。症状谱和同期诊断的组差异用 χ2 检验进行检验。结果：瘫痪和言语障碍在士兵中（占病例的 43.3% 和 17.2%）明显高于平民男性（28.1% 和 6.5%）和女性患者（32.4% 和 7.5%），而女性患者的疼痛（48.6%）和躯体症状（67%）率最高。在大约三分之二的病例中确定了触发因素，除了士兵患者的战斗经历外，还包括事故、身体疾病和工作压力。触发因素的性质影响了症状表达，急性（战斗和非战斗）事件特别容易触发运动功能丧失。症状概况显示出大量的多发病和重叠，尽管一些症状群在士兵中比平民更常见（运动和言语障碍）或更不常见（疼痛和能量损失）。在平民中引发的生活事件与当今躯体症状障碍患者报告的事件相似，其中物理因素的重要作用。多发病和症状群的模式也类似于现代队列的模式。结论：对历史记录、疾病轨迹和治疗的分析可以增强对功能性神经和相关疾病的表现、机制和病程及其随时间变化的一致性的理解。