Acting at all stages | Organic disease | Emotional disorder | Socioeconomic/deprivation |
History of previous functional symptoms | Personality disorder | Life events and difficulties |
Predisposing | Genetic factors affecting personality | Perception of childhood experience as adverse | Childhood neglect/abuse |
| Biological vulnerabilities in the nervous system? | Personality traits | Poor family functioning |
| | Poor attachment/coping style | Symptom modelling (via media or personal contact) |
Precipitating | Abnormal physiological event or state (eg, hyperventilation, sleep deprivation, sleep paralysis) | Perception of life event as negative, unexpected | |
| Physical injury/pain | Acute dissociative episode/panic attack | |
Perpetuating | Plasticity in CNS motor and sensory (including pain) pathwaysDeconditioning | Illness beliefs (patient and family)Perception of symptoms as being due to disease/damage/outwith the scope of self-help | The presence of a welfare systemSocial benefits of being illAvailability of legal compensation |
| Neuroendocrine and immunological abnormalities similar to those seen in depression and anxiety | Not feeling believedAvoidance of symptom provocation (eg, by learned conditioning) | Stigma of “mental illness” in society and from medical professionOngoing medical investigations and uncertainty |