{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:37:51Z","timestamp":1789609071498,"version":"build-2803163510"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T00:00:00Z","timestamp":1736726400000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["227030\/Z\/23\/Z"],"award-info":[{"award-number":["227030\/Z\/23\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>In functional neurological disorder (FND), there is a fundamental disconnect between an apparently intact nervous system and the individuals\u2019 ability to consistently perform motor actions, perceive sensory signals and\/or access effective cognition. Metacognition, the capacity to self-evaluate cognitive performance, appears highly relevant to FND pathophysiology. Poor metacognition is a potential mechanism via which abnormal models of self and the state of the world could arise and persist unchecked. There is therefore a justified enthusiasm that studies of metacognition may give substance to FND\u2019s intangible nature. However, many assume an impairment in metacognition even though experimental studies are still in their infancy. This systematic review provides an analytical checkpoint of the evidence after the first five years of experimental work. We firstly summarize current methods for testing metacognition, prerequisite knowledge that allows readers to independently evaluate the evidence. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we then screened the 21 articles on this topic and review the experimental data of the eight studies that specifically tested metacognition in subjects with FND. Questionnaire metrics used to estimate global metacognition and general confidence in FND revealed a mixed picture of low or normal confidence. Of the five studies that used performance-controlled metrics, the gold-standard to estimate local metacognition in FND, four found metacognition to be equivalent to healthy controls and one paper supported impaired metacognition. We consequently try and broaden the debate and discuss alternative headline scenarios. We review how positive studies may offer insight and debate whether null studies could represent false negatives. However, since most studies find equivalent metacognition to controls, we also discuss whether metacognition could be intact and how this could inform mechanistic models of FND and have potential clinical utility. In summary, this review highlights signal of interest within the data, exposes current limitations and flags the many open questions.<\/jats:p>","DOI":"10.1093\/braincomms\/fcaf014","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T20:23:48Z","timestamp":1736540628000},"source":"Crossref","is-referenced-by-count":7,"title":["Going \u2018meta\u2019: a systematic review of metacognition and functional neurological disorder"],"prefix":"10.1093","volume":"7","author":[{"given":"Anna","family":"Sadnicka","sequence":"first","affiliation":[{"name":"Neurosciences and Cell Biology Research Institute, St George\u2019s University of London , London SW17 0RE ,","place":["UK"]},{"name":"Gatsby Computational Neuroscience Unit, University College London , London W1T 4JG ,","place":["UK"]},{"name":"Department of Clinical and Movement Neurosciences, University College London , London WC1N 3BG ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann-Marie","family":"Strudwick","sequence":"additional","affiliation":[{"name":"Neurosciences and Cell Biology Research Institute, St George\u2019s University of London , London SW17 0RE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P","family":"Grogan","sequence":"additional","affiliation":[{"name":"Trinity Institute of Neuroscience, Trinity College Dublin , Dublin D02 PX31 ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Manohar","sequence":"additional","affiliation":[{"name":"Department of Experimental Psychology, University of Oxford , Oxford OX2 6GG ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Neurosciences and Cell Biology Research Institute, St George\u2019s University of London , London SW17 0RE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,13]]},"reference":[{"issue":"4S","key":"2025012910165661800_fcaf014-B1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.encep.2023.06.008","article-title":"Functional neurological disorder: Past, present and future","volume":"49","author":"Stone","year":"2023","journal-title":"Encephale"},{"issue":"Suppl 1","key":"2025012910165661800_fcaf014-B2","doi-asserted-by":"crossref","first-page":"i2","DOI":"10.1136\/jnnp.2004.061655","article-title":"Functional symptoms and signs in neurology: Assessment and diagnosis","volume":"76 Suppl 1","author":"Stone","year":"2005","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2025012910165661800_fcaf014-B3","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2020-323953","article-title":"Decade of progress in motor functional neurological disorder: Continuing the momentum","author":"Perez","year":"2021","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"6","key":"2025012910165661800_fcaf014-B4","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/S1474-4422(21)00422-1","article-title":"Functional neurological disorder: New subtypes and shared mechanisms","volume":"21","author":"Hallett","year":"2022","journal-title":"Lancet Neurol"},{"issue":"12","key":"2025012910165661800_fcaf014-B5","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1136\/jnnp-2017-317823","article-title":"A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: Systematic review","volume":"89","author":"Teodoro","year":"2018","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2025012910165661800_fcaf014-B6","doi-asserted-by":"crossref","first-page":"o64","DOI":"10.1136\/bmj.o64","article-title":"Diagnosis and management of functional neurological disorder","volume":"376","author":"Aybek","year":"2022","journal-title":"BMJ"},{"issue":"Pt 11","key":"2025012910165661800_fcaf014-B7","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"},{"issue":"10","key":"2025012910165661800_fcaf014-B8","doi-asserted-by":"crossref","first-page":"e3000426","DOI":"10.1371\/journal.pbio.3000426","article-title":"Waves of prediction","volume":"17","author":"Friston","year":"2019","journal-title":"PLoS Biol"},{"key":"2025012910165661800_fcaf014-B9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.cortex.2023.11.002","article-title":"The future of metacognition research: Balancing construct breadth with measurement rigor","volume":"171","author":"Katyal","year":"2024","journal-title":"Cortex"},{"key":"2025012910165661800_fcaf014-B10","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1146\/annurev-psych-022423-032425","article-title":"Metacognition and confidence: A review and synthesis","volume":"75","author":"Fleming","year":"2024","journal-title":"Ann Rev Psychol"},{"issue":"44","key":"2025012910165661800_fcaf014-B11","doi-asserted-by":"crossref","first-page":"27268","DOI":"10.1073\/pnas.2003094117","article-title":"Formation of global self-beliefs in the human brain","volume":"117","author":"Rouault","year":"2020","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"1","key":"2025012910165661800_fcaf014-B12","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1038\/s41467-019-09075-3","article-title":"Forming global estimates of self-performance from local confidence","volume":"10","author":"Rouault","year":"2019","journal-title":"Nat Commun"},{"issue":"1","key":"2025012910165661800_fcaf014-B13","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1037\/rev0000045","article-title":"Self-evaluation of decision-making: A general Bayesian framework for metacognitive computation","volume":"124","author":"Fleming","year":"2017","journal-title":"Psychol Rev"},{"issue":"4","key":"2025012910165661800_fcaf014-B14","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1136\/jnnp-2011-300982","article-title":"Jumping to conclusions\u2019 bias in functional movement disorders","volume":"83","author":"Parees","year":"2012","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"4","key":"2025012910165661800_fcaf014-B15","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1038\/s41593-018-0104-6","article-title":"Neural mediators of changes of mind about perceptual decisions","volume":"21","author":"Fleming","year":"2018","journal-title":"Nat Neurosci"},{"issue":"5","key":"2025012910165661800_fcaf014-B16","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1167\/jov.24.5.13","article-title":"Confidence ratings do not distinguish imagination from reality","volume":"24","author":"Dijkstra","year":"2024","journal-title":"J Vis"},{"issue":"2","key":"2025012910165661800_fcaf014-B17","first-page":"448","article-title":"A randomized clinical trial of metacognitive therapy and nortriptyline for anxiety, depression, and difficulties in emotion regulation of patients with functional dyspepsia","volume":"23","author":"Batebi","year":"2020","journal-title":"Res Psychother"},{"issue":"5998","key":"2025012910165661800_fcaf014-B18","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1126\/science.1191883","article-title":"Relating introspective accuracy to individual differences in brain structure","volume":"329","author":"Fleming","year":"2010","journal-title":"Science"},{"issue":"7","key":"2025012910165661800_fcaf014-B19","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.biopsych.2021.05.013","article-title":"How local and global metacognition shape mental health","volume":"90","author":"Seow","year":"2021","journal-title":"Biol Psychiatry"},{"key":"2025012910165661800_fcaf014-B20","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1162\/opmi_a_00091","article-title":"Metacognitive information theory","volume":"7","author":"Dayan","year":"2023","journal-title":"Open Mind (Camb)"},{"key":"2025012910165661800_fcaf014-B21","doi-asserted-by":"crossref","first-page":"103196","DOI":"10.1016\/j.concog.2021.103196","article-title":"Examining the robustness of the relationship between metacognitive efficiency and metacognitive bias","volume":"95","author":"Xue","year":"2021","journal-title":"Conscious Cogn"},{"issue":"1","key":"2025012910165661800_fcaf014-B22","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.tics.2020.10.007","article-title":"Sources of metacognitive inefficiency","volume":"25","author":"Shekhar","year":"2021","journal-title":"Trends Cogn Sci"},{"issue":"18","key":"2025012910165661800_fcaf014-B23","doi-asserted-by":"crossref","first-page":"6117","DOI":"10.1523\/JNEUROSCI.6489-11.2012","article-title":"Prefrontal contributions to metacognition in perceptual decision making","volume":"32","author":"Fleming","year":"2012","journal-title":"J Neurosci"},{"issue":"1","key":"2025012910165661800_fcaf014-B24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst Rev"},{"issue":"4","key":"2025012910165661800_fcaf014-B25","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1080\/13546805.2020.1791061","article-title":"Dissociation and interoception in functional neurological disorder","volume":"25","author":"Pick","year":"2020","journal-title":"Cogn Neuropsychiatry"},{"key":"2025012910165661800_fcaf014-B26","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.parkreldis.2021.03.029","article-title":"Exploring three levels of interoception in people with functional motor disorders","volume":"86","author":"Ricciardi","year":"2021","journal-title":"Parkinsonism Relat Disord"},{"issue":"2","key":"2025012910165661800_fcaf014-B27","doi-asserted-by":"crossref","first-page":"fcac041","DOI":"10.1093\/braincomms\/fcac041","article-title":"Metacognition in functional cognitive disorder","volume":"4","author":"Bhome","year":"2022","journal-title":"Brain Commun"},{"issue":"1","key":"2025012910165661800_fcaf014-B28","doi-asserted-by":"crossref","first-page":"P19","DOI":"10.1093\/geronb\/57.1.P19","article-title":"Psychometric properties of a new metamemory questionnaire for older adults","volume":"57","author":"Troyer","year":"2002","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"issue":"4","key":"2025012910165661800_fcaf014-B29","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1093\/brain\/awac363","article-title":"Functional cognitive disorder affects reaction time, subjective mental effort and global metacognition","volume":"146","author":"Teodoro","year":"2023","journal-title":"Brain"},{"key":"2025012910165661800_fcaf014-B30","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.neuropsychologia.2018.04.018","article-title":"Metacognition of visuomotor decisions in conversion disorder","volume":"114","author":"Begue","year":"2018","journal-title":"Neuropsychologia"},{"issue":"3","key":"2025012910165661800_fcaf014-B31","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1002\/mds.29303","article-title":"Impaired metacognition of voluntary movement in functional movement disorder","volume":"38","author":"Verrel","year":"2023","journal-title":"Mov Disord"},{"key":"2025012910165661800_fcaf014-B32","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.cortex.2019.12.009","article-title":"Raised visual contrast thresholds with intact attention and metacognition in functional motor disorder","volume":"125","author":"Matthews","year":"2020","journal-title":"Cortex"},{"issue":"10","key":"2025012910165661800_fcaf014-B33","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.3390\/brainsci11101368","article-title":"Metacognitive performance on memory and visuospatial tasks in functional cognitive disorder","volume":"11","author":"Pennington","year":"2021","journal-title":"Brain Sci"},{"key":"2025012910165661800_fcaf014-B34","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.3389\/fpsyg.2016.01812","article-title":"Metacognition and perspective-taking in Alzheimer\u2019s disease: A mini-review","volume":"7","author":"Bertrand","year":"2016","journal-title":"Front Psychol"},{"issue":"1","key":"2025012910165661800_fcaf014-B35","doi-asserted-by":"crossref","first-page":"niad023","DOI":"10.1093\/nc\/niad023","article-title":"Common computations for metacognition and meta-metacognition","volume":"2023","author":"Zheng","year":"2023","journal-title":"Neurosci Conscious"},{"issue":"1","key":"2025012910165661800_fcaf014-B36","doi-asserted-by":"crossref","first-page":"niac014","DOI":"10.1093\/nc\/niac014","article-title":"Confidence at the limits of human nested cognition","volume":"2022","author":"Recht","year":"2022","journal-title":"Neurosci Conscious"},{"issue":"2","key":"2025012910165661800_fcaf014-B37","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1093\/brain\/awz387","article-title":"Reduced drift rate: A biomarker of impaired information processing in functional movement disorders","volume":"143","author":"Sadnicka","year":"2020","journal-title":"Brain"},{"issue":"1","key":"2025012910165661800_fcaf014-B38","doi-asserted-by":"crossref","first-page":"299","DOI":"10.3390\/jcm12010299","article-title":"Autism spectrum disorder may be highly prevalent in people with functional neurological disorders","volume":"12","author":"Gonzalez-Herrero","year":"2022","journal-title":"J Clin Med"},{"issue":"6","key":"2025012910165661800_fcaf014-B39","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.biopsych.2017.12.017","article-title":"Psychiatric symptom dimensions are associated with dissociable shifts in metacognition but not task performance","volume":"84","author":"Rouault","year":"2018","journal-title":"Biol Psychiatry"},{"key":"2025012910165661800_fcaf014-B40","doi-asserted-by":"crossref","first-page":"630143","DOI":"10.3389\/fpsyg.2021.630143","article-title":"Evidence for age-equivalent and task-dissociative metacognition in the memory domain","volume":"12","author":"Zakrzewski","year":"2021","journal-title":"Front Psychol"},{"key":"2025012910165661800_fcaf014-B41","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.concog.2014.06.007","article-title":"Effects of age on metacognitive efficiency","volume":"28","author":"Palmer","year":"2014","journal-title":"Conscious Cogn"},{"issue":"12","key":"2025012910165661800_fcaf014-B42","doi-asserted-by":"crossref","first-page":"3268","DOI":"10.1037\/xge0001209","article-title":"Identifying cultural differences in metacognition","volume":"151","author":"van der Plas","year":"2022","journal-title":"J Exp Psychol Gen"},{"key":"2025012910165661800_fcaf014-B43","author":"Wei\u00dfbach"},{"key":"2025012910165661800_fcaf014-B44","doi-asserted-by":"crossref","first-page":"e72356","DOI":"10.7554\/eLife.72356","article-title":"Judgments of agency are affected by sensory noise without recruiting metacognitive processing","volume":"11","author":"Constant","year":"2022","journal-title":"Elife"},{"issue":"8","key":"2025012910165661800_fcaf014-B45","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.1037\/xge0001371","article-title":"Expectations about precision bias metacognition and awareness","volume":"152","author":"Olawole-Scott","year":"2023","journal-title":"J Exp Psychol Gen"}],"container-title":["Brain Communications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/braincomms\/advance-article-pdf\/doi\/10.1093\/braincomms\/fcaf014\/61428677\/fcaf014.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/braincomms\/article-pdf\/7\/1\/fcaf014\/61428677\/fcaf014.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/braincomms\/article-pdf\/7\/1\/fcaf014\/61428677\/fcaf014.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T10:26:45Z","timestamp":1738146405000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/braincomms\/article\/doi\/10.1093\/braincomms\/fcaf014\/7953182"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,24]]},"references-count":45,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,12,24]]}},"URL":"https:\/\/doi.org\/10.1093\/braincomms\/fcaf014","relation":{},"ISSN":["2632-1297"],"issn-type":[{"value":"2632-1297","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025]]},"published":{"date-parts":[[2024,12,24]]},"article-number":"fcaf014"}}