{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:34:03Z","timestamp":1792190043325,"version":"4.4.0"},"reference-count":72,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Functional neurological disorder (FND) presents disabling symptoms that fluctuate, migrate across systems and yet routinely show preserved structural integrity\u2014features that can frustrate diagnosis and patient education. Crucially, these symptoms are genuine and reflect altered brain regulation across multiple systems rather than tissue damage or conscious control. This paper offers a clinically usable account of these puzzles by reframing FND as a disorder of precision control within predictive coding. The brain\u2019s confidence (precision) in its own predictions is modelled as a dynamic quantity that can surge with arousal, settle back towards baseline and slowly recalibrate over longer periods. Placing this mechanism in a four-level hierarchy (affective, interoceptive, proprioceptive, spinal) shows how arousal can temporarily make an unhelpful expectation dominate, suppress corrective feedback, and produce motor, sensory, cognitive or visceral symptoms\u2014often in combination. The same dynamics explain rule-in positive signs such as distractibility, entrainment and give-way weakness, and clarify the lived experience of reduced agency without implying wilfulness or malingering.<\/jats:p>\n                  <jats:p>For clinicians, the framework provides an intuitive way to explain symptoms to patients (\u2018a temporary gain miscalibration that overweights predictions and underweights sensory feedback\u2019), and to justify why physiotherapy (amplifying proprioceptive feedback), psychotherapy (reducing arousal) and mindfulness or biofeedback (raising the effective threshold for arousal-driven \u2018gain spikes\u2019) can all help by recalibrating that weighting. The framework also yields concrete, falsifiable tests, linking bedside observation to measurable biomarkers and offering ways to refine it further. By centring dynamic precision, the account unifies diagnosis, communication and treatment planning, and provides a mechanistic foundation for precision-guided care in FND.<\/jats:p>","DOI":"10.1093\/brain\/awag101","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T15:47:59Z","timestamp":1773330479000},"page":"3311-3324","source":"Crossref","is-referenced-by-count":3,"title":["Precision dynamics of predictive coding in functional neurological disorder"],"prefix":"10.1093","volume":"149","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2651-9754","authenticated-orcid":false,"given":"Stanley","family":"Lyndon","sequence":"first","affiliation":[{"name":"Harvard Medical School , Boston, MA 02115 ,","place":["USA"]},{"name":"Division of Neuropsychiatry, Mass General Brigham , Boston, MA 02115 ,","place":["USA"]},{"name":"Center for Brain\/Mind Medicine, Mass General Brigham , Boston, MA 02115 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"2026100419574042600_awag101-B1","doi-asserted-by":"crossref","first-page":"3495","DOI":"10.1093\/brain\/aws129","article-title":"A Bayesian account of \u2018hysteria\u2019","volume":"135","author":"Edwards","year":"2012","journal-title":"Brain"},{"key":"2026100419574042600_awag101-B2","doi-asserted-by":"crossref","first-page":"79","DOI":"10.3389\/fnsys.2016.00079","article-title":"The predictive processing paradigm has roots in Kant","volume":"10","author":"Swanson","year":"2016","journal-title":"Front Syst Neurosci"},{"key":"2026100419574042600_awag101-B3","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/nous.12062","article-title":"The self-evidencing brain","volume":"50","author":"Hohwy","year":"2016","journal-title":"No\u00fbs"},{"key":"2026100419574042600_awag101-B4","doi-asserted-by":"crossref","first-page":"20170792","DOI":"10.1098\/rsif.2017.0792","article-title":"The Markov blankets of life: Autonomy, active inference and the free energy principle","volume":"15","author":"Kirchhoff","year":"2018","journal-title":"J R Soc Interface"},{"key":"2026100419574042600_awag101-B5","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1111\/nyas.14321","article-title":"Evaluating the neurophysiological evidence for predictive processing as a model of perception","volume":"1464","author":"Walsh","year":"2020","journal-title":"Ann N Y Acad Sci"},{"key":"2026100419574042600_awag101-B6","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.3389\/fpsyg.2016.01792","article-title":"Neural elements for predictive coding","volume":"7","author":"Shipp","year":"2016","journal-title":"Front Psychol"},{"key":"2026100419574042600_awag101-B7","doi-asserted-by":"crossref","first-page":"105473","DOI":"10.1016\/j.neubiorev.2023.105473","article-title":"The empirical status of predictive coding and active inference","volume":"157","author":"Hodson","year":"2024","journal-title":"Neurosci Biobehav Rev"},{"key":"2026100419574042600_awag101-B8","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.neuron.2012.10.038","article-title":"Canonical microcircuits for predictive coding","volume":"76","author":"Bastos","year":"2012","journal-title":"Neuron"},{"key":"2026100419574042600_awag101-B9","doi-asserted-by":"crossref","first-page":"4547","DOI":"10.1038\/s41467-023-40141-z","article-title":"Experimental validation of the free-energy principle with in vitro neural networks","volume":"14","author":"Isomura","year":"2023","journal-title":"Nat Commun"},{"key":"2026100419574042600_awag101-B10","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.tins.2022.09.007","article-title":"Where is the error? 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