| Predisposing | - Genetic factors affecting personality
- Biologic vulnerabilities in the nervous system?
| - Perception of childhood experience as adverse
- Personality traits
- Poor attachment/coping style
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| Precipitating | - Abnormal physiologic event or state (eg, hyperventilation, sleep deprivation, sleep paralysis)
- Physical injury/pain
| - Perception of life event as negative, unexpected
- Acute dissociative episode/panic attack
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| Perpetuating | - Plasticity in CNS motor and sensory (including pain) pathways
- Deconditioning
- Neuroendocrine and immunologic abnormalities similar to those seen in depression and anxiety
| - Perception of symptoms as unamenable to rehabilitation therapy
- Not being believed
- Avoidance of symptom provocation
- Fear of falling or seizures
| - Stigma against functional disorders in society and from clinicians
- Clinician failure to make or communicate a diagnosis when present
- Iatrogenic harm (eg, surgery, opiates, or other medication)
- Legal compensation cases
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