Biopsychosocial complexity in functional neurological disorder 2023 Joos et al

Background
Functional Neurological Disorder (FND) is considered a biopsychosocial disorder nowadays, with chronicity in >50% of cases. The INTERMED Self-Assessment Questionnaire (IMSA) assesses the various domains and indicates biopsychosocial complexity.

Objective
FND patients were compared with a sample of psychosomatic (PSM) patients as well as post-stroke patients.

Methods
The three samples (N = 287 altogether) were largely in inpatient and day clinic psychotherapeutic treatment or inpatient neurological rehabilitation. The IMSA covers all three biopsychosocial domains as well as health care utilisation in the time frame of the past, the present and the future. In addition, affective burden (GAD-7, PHQ-9), somatoform symptoms (PHQ-15), dissociation (FDS) and quality of life (SF-12) were evaluated.

Results
FND and PSM patients scored highly in the IMSA, with ≥70% regarded as complex, compared to 15% of post-stroke patients. Affective, somatoform and dissociation scores were high in FND and PSM patients. Mental and somatic quality of life were lower in these groups compared to post-stroke patients.

Discussion
FND patients showed high biopsychosocial strain, similar to a typical sample of inpatient and day clinic, i.e. severely affected, PSM patients, and they were more affected than post-stroke patients. These data emphasize that FND should be evaluated with a biopsychosocial perspective. The IMSA likely represents a valuable tool, which has to be assessed by further longitudinal studies.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0163834323001081

 

What is the route from Engel's biopsychosocial "model" to a "biopsychosocial disorder" ? Does this mean a patient can be 'socially disordered' ?

 

I should bally well think they were!

The effects of stigma on mental health and quality of life are i think well documented.
Stroke patients = zero stigma.
FND/Psychosomatic = massive far reaching stigma, affecting all relationships (family, friends, work, health care, society at large). Not to mention the major difficulty accessing social support in the form of social services/care support, financial support etc.

Stroke patients are, by & large in my experience, treated with appropriate compassion, have little trouble proving they need support and nobody thinks they are lying/malingering FII or just plain pathetic/crazy.

The researchers have the cause & effect backwards. As. Usual.

 

Not to mention when they have disability or exhaustion effects or adjustments needed for things like speaking or walking I would hope that for their condition the exact wrong information and advice has not been OK'd for laypersons to levy at them. I'd imagine for example someone interrupting a stroke patient and telling them the reason they are exhausted is because they need to 'do more', or deciding 'their life is more busy so they'll put upon them' etc would be the one looked upon with disgust still these days? And that such people wouldn't be 'helping their recovery'.

 

It's hard to take such colloquial language seriously in an academic paper. If they want to be relatable and matey, might as well open with "Yo yo yo, what up homies? Today we talkin' Fn'D, innit.'"

"Science. What is it all about?"

 

I quote my answer to another thread (which I can't find now!)