Dissociative disorder presenting as foreign accent syndrome

Abstract

The foreign accent syndrome (FAS) is a rare speech disorder, characterised by the appearance of a new accent, different from the speaker’s native language and perceived as foreign by others. In the majority of patients, FAS is secondary to focal brain damage caused by stroke or other neurological disorders. Infrequently, FAS has been reported in association with psychiatric disorders, including dissociative or conversion disorders. The case of a young woman with recurrent episodes of speaking with a foreign accent is described. Repeated neurological examinations, imaging and electroencephalography did not reveal any brain abnormality. However, there was a history of a difficult childhood, alcohol dependence in the father, parental discord, alleged sexual abuse in the past, interpersonal difficulties and parental death. Episodes were precipitated by stressful life circumstances and resolved spontaneously, or with supportive treatment. She had additional “suspect” symptoms such as non-epileptic seizures, aphonia and motor paralysis. All these features indicated that a dissociative disorder was involved in the genesis of her FAS. The influence of external factors such as the media was unclear. Generally biological factors have been implicated in the onset of FAS, but the presentation in this young woman suggests that psychological factors such as personality, trauma, stressful life events and psychiatric disorder; familial factors such as parental discord and parental death and family conflicts; and, social factors such the possible influence of the media may also be involved in the production of foreign accents by patients.

Keywords: Foreign accent syndrome; Dissociative disorder; Conversion disorder; Psychosocial

Core tip: The foreign accent syndrome (FAS) is a rare speech disorder, characterised by the appearance of a new accent, different from the speaker’s native language and perceived as foreign by others. In the majority of patients, FAS is secondary to focal brain damage, but infrequently, it has been reported in association with psychiatric disorders, including dissociative or conversion disorders. The case of a young woman with FAS is described here, which shows that in rare instances dissociative disorder may be implicated in the genesis of the FAS. The aetiology of FAS is complex, and both biological and psychosocial factors could play a role in its onset.