Methylphenidate-associated improvement in complex functional/ dissociative disorder: A case report

What clinically manifests as symptoms of dissociation may, at its core, reflect an underlying disintegration of processes spanning cognitive-, affective-, perceptive- and sensorimotor systems, resulting in a fragmented and heterogeneous experience of self. Dissociative disorders are best understood not as unitary conditions, but as multidimensional constellations encompassing both somatoform manifestations, often described as functional neurological symptoms, and psychoform expressions of dissociation. Emerging neurobiological evidence suggests that this heterogeneity is grounded in alterations across large-scale brain networks subserving cognitive control, emotion regulation, stress processing, and somatic visceral perception. These network level disruptions likely reflect dysregulated interactions between prefrontal control systems and limbic circuitry, affecting attentional- and arousal regulation. Here, we describe the case of a 22-year-old woman with complex posttraumatic stress disorder and a severe mixed functional/dissociative disorder with functional paraparesis. She presented with dissociative amnesia, depersonalization / derealization, and recurrent identity state transitions with pronounced emotional and attentional dysregulation. Her remarkable clinical improvement following methylphenidate, including full recovery of ambulation, provides a compelling observation that may illuminate the role of catecholaminergic systems in dissociative processes and functional neurological symptoms. We contextualize this response within the current scarce evidence on dopaminergic modulation in dissociative disorders, particularly regarding increased cognitive control and stabilization of affect and identity states. These converging strands point to the potential utility of methylphenidate and related agents in reducing functional/ dissociative symptomatology, warranting systematic investigation in future clinical studies.