The impact of Functional Neurological Disorder (FND)

It’s common but complex and difficult to understand

I have been asked to give a talk on FND with a clinical psychologist colleague. Despite our years of experience assessing and working with FND patients, we recognise that FND remains an evolving and complex field that continuously challenges even seasoned professionals.  Together, our combined experience from neuropsychology and clinical psychology allows us to approach FND holistically, considering both the neurological and psychological components within a biopsychosocial model.

What makes FND so difficult to grasp?

Part of the issue is that FND doesn’t fit neatly into neurology or psychiatry and instead fits somewhere in between the two. 

Another issue is that FND is so varied: it can be characterised by almost any type of neurological symptom ranging from a specific tremor or speech impediment through to non-epileptic seizures through to paralysis and difficulties undertaking activities of daily living.   These symptoms may be inconsistent with other known neurological disorders or with human anatomy and physiology. 

Also, FND is different to other neurological disorders as its thought to be caused by brain network dysfunction (including hyperactivity of the limbic system) as opposed to structural changes.  Importantly this does not exclude the possibility of normal function (at times) and it is sometimes due in part to a psychological cause.   It’s best understood within a biopsychosocial model.

Given the nuanced nature of FND, misconceptions often arise.  We’ve tackled a few of these persistent myths below to help improve understanding and patient care.

Thanks to Lidstone, S. C., Araújo, R., Stone, J., & Bloem, B. R. (2020). Ten myths about functional neurological disorder. European journal of neurology, 27(11), e62–e64. https://doi.org/10.1111/ene.14310

Debunking Myths About Functional Neurological Disorder (FND)

Some myths and stigma continue to hinder effective diagnosis and treatment. Dispelling these myths is critical for providing patients with appropriate care and for supporting personal injury cases where FND maybe misunderstood.

Myth#1 – “FND is Just Malingering”

FND is not malingering! People with FND do not deliberately 'put on’ their symptoms and do not fail performance validity tests at a greater level than other groups.

Myth#2– “FND Patients Can Recover if They Try Harder”

People with FND cannot simply "will” their symptoms away. Unlike other neurological disorders caused by damage, FND is thought to result from miscommunication within the brain’s networks.

Myth#3– FND Is a diagnosis of exclusion

Unlike some conditions, FND is diagnosed by identifying positive clinical signs, such as Hoover’s Sign or tremor entrainment, rather than by excluding other conditions.

Myth#4-There is less harm in missing a diagnosis of FND than missing another neurological disease

No! Any misdiagnosis is distressing but erroneously diagnosing FND, a potentially treatable condition, as another neurological condition can be as harmful as the reverse. It is worth getting diagnosed with FND and treated because unlike some other neurological diagnoses FND can in some cases be curable, although outcomes vary. Myth#5-Patie

Myth#5-Patients have either FND or another neurological disorder.

FND frequently coexists with other neurological conditions, such as epilepsy or Parkinson’s disease, making accurate diagnosis and treatment even more important.