Editorial: Is Long Covid a Functional Disorder? 2023 Pick

Andy

Andy

Retired committee member
In the UK alone, there are an estimated 1.5 million people experiencing symptoms persisting over a year after infection with SARS-CoV-2. 72% report that their symptoms interfere with daily function and 15% (or around 340 000) report that their daily function is ‘limited a lot’.1 Post-COVID-19 Syndrome or Long Covid is common and often debilitating, and yet it remains poorly understood. Even in the most severe cases, standard medical tests are frequently normal. In light of the ongoing uncertainty around its nature, some clinicians and researchers are beginning to suggest Long Covid be considered a ‘functional disorder’. This editorial discusses the current state of knowledge of the condition and whether applying the ‘functional’ label would be helpful.

Open access, https://journals.sagepub.com/doi/10.1177/11795727221141193
 
"‘Functional disorders’ are described as resulting from pathological changes in bodily ‘function’ rather than ‘structure’. This conceptualisation is thought to offer an explanation as to why standard medical investigations are commonly unremarkable. Other conditions that fall under the umbrella of ‘functional disorder’ include Fibromyalgia, ME/CFS, Chronic Pelvic Pain, Functional Dyspepsia, Functional Neurological Disorder and Overactive Bladder Syndrome."

"The term ‘functional’ evolved from now outdated terms such as ‘psychosomatic’ or ‘hysterical’. Unfortunataly, however, the insidious and stigmatising question of whether a condition is ‘in your head’ or not continues to rear its head. Simply replacing ‘psychosomatic’ with ‘functional’ can seem, at its worst, somewhat cloak and dagger. Its use in this way risks furthering an unhelpful and inaccurate distinction between mind and body. Yet another critique of Descartes’ Cartesian dualism is not required – this has been widely written about elsewhere.5 Any disease or injury, be it Long Covid or a broken arm is experienced in the mind. Designating Long Covid a ‘functional disorder’ may perpetuate stigma and impede scientific curiosity."

"We must continue to ask questions, learn from our patients, pursue research and study treatment options, both pharmacological and rehabilitative. Ideally, over time, we are able to move from a symptom-based diagnosis to one supported by validated and dedicated tests. Labelling the condition as ‘functional’ will not move us any closer to these important goals."
 
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