Reconsidering the role of psychosocial factors in functional dysphonia

Functional dysphonia, defined as alteration or loss of voice in the absence of physical pathology, is known to be associated with a variety of psychosocial factors including anxiety, depression and reduced quality of life. Models of functional dysphonia have tended to conceptualize the voice disorder as being the result of a failure to acknowledge and/or express this associated distress. The current literature was reviewed to identify psychosocial factors that predispose to, precipitate and perpetuate functional dysphonia and to assess the evidence for these models. Recent studies have identified evidence of genetic susceptibility, occupational susceptibility, a history of sexual and/or physical abuse and perfectionism as being predisposing factors. Precipitants include life events, frequency of vocal use and infections. General fatigue is identified as being a potential perpetuating factor. A recent novel theoretical model of functional dysphonia is reported, which proposes deficits in emotional processing as the core process in voice loss. Current research confirms that functional dysphonia is associated with multiple psychosocial factors. However, these findings are shown to be true of other medically unexplained symptoms in which vocal problems are absent. It is argued that, whilst intuitively appealing, there is insufficient evidence to support the popular notion that the loss of voice is the consequence of unexpressed emotion.