Functional Neurological Disorder (FND) - articles, social media and discussion

[SNT Gatchaman]

When available this is likely to be a high profile paper, as this journal is top-ranked.

According to the Journal Citation Reports, the journal has a 2022 impact factor of 73.3. It is ranked no. 1 out of 155 journals in the category Psychiatry and no. 1 out of 144 journals in the Social Sciences Citation Index category.

For reference, Nature is 69.5 and Cell is 66.9 (Nature's Molecular Psychiatry is 13.4).

An editorial in the most recent issue of World Psychiatry is Understanding depression beyond the “mind-body” dichotomy which starts off with —

In both the ICD-11 and the DSM-5, the core symptoms of depression are reported to be depressed mood (e.g., feeling sad, down or hopeless) and markedly diminished interest or pleasure in activities. However, in the ICD-10 diagnostic guidelines, a third core symptom was also identified: “fatigue or low energy”. In two regions of the world (Latin America and East Asia), “fatigue” is the most commonly experienced depressive symptom1. In a third region (Southeast Asia), “issues with the heart” are the most commonly reported depressive symptoms, along with depressed mood1. Do people in these regions just “somatize” what is primarily a “psychological” experience? Do “somatic” symptoms just represent a “mask”, as implied some decades ago by the concept of “masked depression”2?

"Do people in these regions just “somatize” what is primarily a “psychological” experience?" Unlikely. Either the diagnosis of depression in those regions is inaccurate and inappropriately broad or the disease understanding in the other regions is incomplete/naive.

Continues with unnecessarily gendered language, while blaming the patient —

The way these core phenomena are perceived, elaborated and verbalized by the affected person likely depends upon how that person generally functions and appraises her functioning (e.g., how rich and articulated her cognitive life is, or how much she is focused on her body and its functioning), upon the influence of the cultural environment in which she is immersed, and upon the pattern of predisposing and precipitating factors at work in that individual case.

---
Some alternative references —

A mitochondrial nexus in major depressive disorder: Integration with the psycho-immune-neuroendocrine network (2024, Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease)

Association between mitochondrial DNA levels and depression: a systematic review and meta-analysis (2023, BMC Psychiatry)

Mitochondrial dysfunction: A fatal blow in depression (2023, Biomedicine & Pharmacotherapy)

Connecting Dots between Mitochondrial Dysfunction and Depression (2023, Biomolecules)

Mitochondria, Metabolism, and Redox Mechanisms in Psychiatric Disorders (2019, Antioxidants & Redox Signaling)

 

[MEMarge]

Could this be the article:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785980/

"World Psychiatry. 2024 Feb; 23(1): 53–54.
Published online 2024 Jan 12. doi: 10.1002/wps.21151
PMCID: PMC10785980
PMID: 38214630
Functional neurological disorder: defying dualism
Jon Stone, 1 Ingrid Hoeritzauer, 1 Laura McWhirter, 1 and Alan Carson 1
Author information Copyright and License information PMC Disclaimer


Functional neurological disorder (FND) is classified in the DSM‐5‐TR as “functional neurological symptom disorder (conversion disorder)” and in the chapter on mental disorders of the ICD‐11 as “dissociative neurological symptom disorder”......."

 

[Dolphin]

https://twitter.com/user/status/1756405908031111450

 

[JemPD]

Well by that logic since 'flu like symptoms' are pretty 'core' to influenza, so 'these studies need to assess for' influenza

Ditto all the other symptoms experienced by PwME in PEM that are 'core' to other conditions.

Typical FND non-logic.

 

[bobbler]

Owner of Rethink Physical Therapy, PLLC

does PLLC mean 'limited' twice? (like Ltd company is limited liability)

 

[bobbler]

Owner of Rethink Physical Therapy, PLLC

does PLLC mean 'limited' twice? (like Ltd company is limited liability)

ah, I've answered my own question:

"It is a variant of the limited liability company (LLC) structure that protects business owners and investors from personal liability."

 

[SNT Gatchaman]

Functional neurological disorder (FND) is classified in the DSM‐5‐TR as “functional neurological symptom disorder (conversion disorder)” and in the chapter on mental disorders of the ICD‐11 as “dissociative neurological symptom disorder”

Noting also that in StatPearls, a search for "functional neurological disorder" leads to the article on Conversion disorder, last updated in May 2023. Also available via the NIH. It opens with —

Conversion disorder, also known as functional neurological symptom disorder (FND), is a psychiatric disorder characterized by symptoms affecting sensory or motor function. These signs and symptoms are inconsistent with patterns of known neurologic diseases or other medical conditions. Although conversion disorder has no organic basis, the symptoms significantly impact a patient’s ability to function. Moreover, the symptoms cannot be controlled at will and not considered to be feigned intentionally by the patient. The term “conversion disorder” was first mentioned in literature by Sigmund Freud (1856-1939). The Austrian neurologist and founder of psychoanalysis believed that functional symptoms that could not be explained by neurologic diseases or other underlying medical conditions reflected an unconscious conflict. In this context, the word "conversion" refers to replacing a somatic symptom with a repressed idea. The understanding of conversion disorder is still largely limited and continually evolving.

Psychological, social, and biological factors can all contribute to, precipitate, or perpetuate conversion disorder. Often, there is a trauma, adverse life event, or acute/chronic stressor preceding symptoms of conversion disorder. Many patients with conversion disorder are found to have a history of childhood abuse, both emotional and sexual. Other psychological factors contributing to conversion disorder include poor coping skills and internal psychological conflicts. Patients with conversion disorder are more likely to have certain psychiatric disorders (depression, anxiety, and personality disorders) than patients with known neurologic conditions. They are also more likely to have a history of multiple somatic complaints, including symptoms like generalized fatigue, weakness, or pain, without a known cause. Physical injury or actual neurologic illness (such as a stroke or migraine) may “trigger” the symptoms of conversion disorder. Less educated people, those of lower socioeconomic status, and patients living in developing or rural areas are more likely to develop conversion disorder.

 

[Dx Revision Watch]

If it's not already been mentioned:

"The Functional Neurological Disorder Society is a professional society of healthcare professionals, scientists, and students who are interested in functional neurological disorders"


In a joint session between FNDS and EAPM (European Association of Psychosomatic Medicine), the FND Society's 2024 Conference Program is giving a platform to Michael Sharpe, Peter Henningsen and Per Fink:

Session: Joint Session FNDS + EAPM: Exploring the Range of Functional Disorders

Co-Chairs: W. Curt LaFrance, Jr., MD, MPH and Michael Sharpe, MD, FACLP

8:00 – 8:15 am CEST Fatigue
Michael Sharpe, MD, FACLP

8:20 – 8:35 am CEST Psychosomatic Medicine
Peter Henningsen

8:40 – 8:55 am CEST A National Program in Denmark
Per Fink, MD, PhD, DMSc

9:00 – 10:00 am CEST Panel Discussion


Full Program

 

[Art Vandelay]

An excellent thread from Dr Mark Guthridge on the first patient diagnosed with "Hysteria":



Thread. Medical Hysteria and #InternationalWomensDay In 1882, Anna O is considered 'patient zero' for the diagnosis of "Hysteria" #Hysteria was originally a diagnosis only given to women Anna O fell ill in 1880 after her father died, possibly of Tuberculosis

 

[Arnie Pye]

I wondered if I could find any info on Anna O, whose real name was Bertha Pappenheim. I can't read twitter (X) and I refuse to create an account :

https://en.wikipedia.org/wiki/Bertha_Pappenheim

She apparently did recover, and lived to be 77, dying in 1936 in Germany.

 

[Sly Saint]

Merged thread

FND discussion BBC Radio 2

Jeremy Vine show. FND. John Stone about to be interviewed.
today 13.05

 

[JemPD]

oh Goodness, did anyone hear iy?

 

[JoClaire]

I’m new here.

Looking to see if there are threads that discuss FND in following ways:

1. History of FND dx: when did “rule in” diagnosis start; what precedent for rule in? - even when there are multiple physical characteristics?

2. Other examples of diseases with difficult to pinpoint origin that - with time and money - was found?
(Eg AIDS - their “Walitt” argued its cause behavioral, versus blood transmitted.) (MS - at first hysteria - still is called FND, for many, until it shows up on MRI.)

3) What is evidence ME/CFS is not FND or FND-like?
*I always thought 2-day CPET was strongest research demonstrating impairment. But I’ve seen comments here that CPET papers aren’t highly regarded by physicians? May have publishing bias.
* Why would this even have to be proved? (Gah.)
Why do you believe it’s not? (personal experience?)

4)Can’t recall if I saw this here- trends to behavior-alize*/moralize disease in general. Always been there but saw an article discussing it as a growing trend, CBT, mindfulness, exercise, diet, etc.
*I saw another word for this. Had to make this one up
____________

Sorry if this is an overwhelming first post. I tried searching for some of these topics and reading some related threads. But I’m still trying to figure out best way to navigate with muddy brain.

 

[SNT Gatchaman]

Looking to see if there are threads that discuss FND in following ways:

I tried searching for some of these topics and reading some related threads. But I’m still trying to figure out best way to navigate with muddy brain.

There's quite a lot. I'm sure you've found this already, but click the tags at the top left of the screen to find more than you wanted.



Your questions are not straightforward to answer I think. One reason is the terminology and obfuscation used in the literature. Another is the difference between what is said and what is practiced. Lip service is played to "no need for psychological factors in the diagnosis" but patients are still referred to psychologists for treatment, or simply discharged with a shrug as "nothing organic the neurologist can treat." The change to positive rule-in signs started coming into play around 2011 I think.

Recently comments were made on social media questioning why we had an interest: implying if not directly stating that we should stay in our lane. Some FND patients are very keen on the diagnosis, though as far as I can see that doesn't translate to useful treatments or recovery rates. Many ME/LC are diagnosed with FND and as you note there are attempts to turn ME into an FND / somatic symptom disorder / body distress syndrome.

One example of ME not being FND-like is brain oxygenation as measured with NIRS. Near-infrared spectroscopy in evaluating psychogenic pseudosyncope—a novel diagnostic approach (2020, QJM: An International Journal of Medicine) showed "Our novel finding indicates that cerebral perfusion remains stable throughout despite positive symptom reproduction in PPS patients."

In comparison Impaired postural cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance (2002, The Journal of Pediatrics) found "the majority of patients with CFS had decreased oxy-Hb concentration of the brain during upright posture".

Additionally we have multiple studies showing reduction in cerebral blood flow on orthostatic challenge (using Doppler US) and NIRS-demonstrated deoxgyenation with other tasks —

Prefrontal cortex oxygenation during incremental exercise in chronic fatigue syndrome (2008, Clinical Physiology and Functional Imaging)

Reduced Cerebrovascular Oxygenation in Individuals with Post-Acute COVID-19 Syndrome PACS “long COVID” (2023, SpringerLink)

Neurocognitive and psychiatric symptoms following infection with COVID-19: Evidence from laboratory and population studies (2023, Brain, Behavior, & Immunity - Health)

Prefrontal dysfunction in post-COVID-19 hyposmia: an EEG/fNIRS study (2023, Frontiers in Human Neuroscience)

 

[Andy]

I’m new here.

Looking to see if there are threads that discuss FND in following ways:

1. History of FND dx: when did “rule in” diagnosis start; what precedent for rule in? - even when there are multiple physical characteristics?

2. Other examples of diseases with difficult to pinpoint origin that - with time and money - was found?
(Eg AIDS - their “Walitt” argued its cause behavioral, versus blood transmitted.) (MS - at first hysteria - still is called FND, for many, until it shows up on MRI.)

3) What is evidence ME/CFS is not FND or FND-like?
*I always thought 2-day CPET was strongest research demonstrating impairment. But I’ve seen comments here that CPET papers aren’t highly regarded by physicians? May have publishing bias.
* Why would this even have to be proved? (Gah.)
Why do you believe it’s not? (personal experience?)

4)Can’t recall if I saw this here- trends to behavior-alize*/moralize disease in general. Always been there but saw an article discussing it as a growing trend, CBT, mindfulness, exercise, diet, etc.
*I saw another word for this. Had to make this one up
____________

Sorry if this is an overwhelming first post. I tried searching for some of these topics and reading some related threads. But I’m still trying to figure out best way to navigate with muddy brain.

Some other hopefully useful sources of information for you.

#1 - This blog by @dave30th might be helpful, also discussed up-thread here.

#2 - @ME/CFS Skeptic has written a blog series on this sort of subject, discussed here, ME/CFS SKeptic: A new blog series on the dark history of psychosomatic medicine

#3 - Not sure we will necessarily have any threads on exactly this topic. In general, the assertion that ME/CFS is an FND (or somatic symptom disorder, body distress syndrome or any other variant) is based on the fact that we don't know the disease process, standard tests come back 'normal', and the literature that FND proponents cherry-pick claim that ME/CFS is amenable to CBT and physical therapy. Proponents are also quite happy to assume that findings for fatigue in other conditions are relevant to ME/CFS - PEM is either ignored or reduced to something like 'tiredness after exertion' - all of which is straight out of the playbook of the BPS ME/CFS 'researchers'.

Ultimately, for proponents, the bar for 'evidence' that ME/CFS is FND/functional is incredibly low, while the bar for 'evidence' that ME/CFS isn't FND/functional is incredibly high.

Hope that helps in some way.

 

[JoClaire]

There's quite a lot. I'm sure you've found this already, but click the tags at the top left of the screen to find more than you wanted.

View attachment 21516

Your questions are not straightforward to answer I think. One reason is the terminology and obfuscation used in the literature. Another is the difference between what is said and what is practiced. Lip service is played to "no need for psychological factors in the diagnosis" but patients are still referred to psychologists for treatment, or simply discharged with a shrug as "nothing organic the neurologist can treat." The change to positive rule-in signs started coming into play around 2011 I think.

Recently comments were made on social media questioning why we had an interest: implying if not directly stating that we should stay in our lane. Some FND patients are very keen on the diagnosis, though as far as I can see that doesn't translate to useful treatments or recovery rates. Many ME/LC are diagnosed with FND and as you note there are attempts to turn ME into an FND / somatic symptom disorder / body distress syndrome.

One example of ME not being FND-like is brain oxygenation as measured with NIRS. Near-infrared spectroscopy in evaluating psychogenic pseudosyncope—a novel diagnostic approach (2020, QJM: An International Journal of Medicine) showed "Our novel finding indicates that cerebral perfusion remains stable throughout despite positive symptom reproduction in PPS patients."

In comparison Impaired postural cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance (2002, The Journal of Pediatrics) found "the majority of patients with CFS had decreased oxy-Hb concentration of the brain during upright posture".

Additionally we have multiple studies showing reduction in cerebral blood flow on orthostatic challenge (using Doppler US) and NIRS-demonstrated deoxgyenation with other tasks —

Prefrontal cortex oxygenation during incremental exercise in chronic fatigue syndrome (2008, Clinical Physiology and Functional Imaging)

Reduced Cerebrovascular Oxygenation in Individuals with Post-Acute COVID-19 Syndrome PACS “long COVID” (2023, SpringerLink)

Neurocognitive and psychiatric symptoms following infection with COVID-19: Evidence from laboratory and population studies (2023, Brain, Behavior, & Immunity - Health)

Prefrontal dysfunction in post-COVID-19 hyposmia: an EEG/fNIRS study (2023, Frontiers in Human Neuroscience)

Thanks so much!

Some other hopefully useful sources of information for you.

#1 - This blog by @dave30th might be helpful, also discussed up-thread here.

#2 - @ME/CFS Skeptic has written a blog series on this sort of subject, discussed here, ME/CFS SKeptic: A new blog series on the dark history of psychosomatic medicine

#3 - Not sure we will necessarily have any threads on exactly this topic. In general, the assertion that ME/CFS is an FND (or somatic symptom disorder, body distress syndrome or any other variant) is based on the fact that we don't know the disease process, standard tests come back 'normal', and the literature that FND proponents cherry-pick claim that ME/CFS is amenable to CBT and physical therapy. Proponents are also quite happy to assume that findings for fatigue in other conditions are relevant to ME/CFS - PEM is either ignored or reduced to something like 'tiredness after exertion' - all of which is straight out of the playbook of the BPS ME/CFS 'researchers'.

Ultimately, for proponents, the bar for 'evidence' that ME/CFS is FND/functional is incredibly low, while the bar for 'evidence' that ME/CFS isn't FND/functional is incredibly high.

Hope that helps in some way.

Thanks so much, Andy.

 

[JoClaire]

There's quite a lot. I'm sure you've found this already, but click the tags at the top left of the screen to find more than you wanted.

View attachment 21516

Your questions are not straightforward to answer I think. One reason is the terminology and obfuscation used in the literature. Another is the difference between what is said and what is practiced. Lip service is played to "no need for psychological factors in the diagnosis" but patients are still referred to psychologists for treatment, or simply discharged with a shrug as "nothing organic the neurologist can treat." The change to positive rule-in signs started coming into play around 2011 I think.

Recently comments were made on social media questioning why we had an interest: implying if not directly stating that we should stay in our lane. Some FND patients are very keen on the diagnosis, though as far as I can see that doesn't translate to useful treatments or recovery rates. Many ME/LC are diagnosed with FND and as you note there are attempts to turn ME into an FND / somatic symptom disorder / body distress syndrome.

One example of ME not being FND-like is brain oxygenation as measured with NIRS. Near-infrared spectroscopy in evaluating psychogenic pseudosyncope—a novel diagnostic approach (2020, QJM: An International Journal of Medicine) showed "Our novel finding indicates that cerebral perfusion remains stable throughout despite positive symptom reproduction in PPS patients."

In comparison Impaired postural cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance (2002, The Journal of Pediatrics) found "the majority of patients with CFS had decreased oxy-Hb concentration of the brain during upright posture".

Additionally we have multiple studies showing reduction in cerebral blood flow on orthostatic challenge (using Doppler US) and NIRS-demonstrated deoxgyenation with other tasks —

Prefrontal cortex oxygenation during incremental exercise in chronic fatigue syndrome (2008, Clinical Physiology and Functional Imaging)

Reduced Cerebrovascular Oxygenation in Individuals with Post-Acute COVID-19 Syndrome PACS “long COVID” (2023, SpringerLink)

Neurocognitive and psychiatric symptoms following infection with COVID-19: Evidence from laboratory and population studies (2023, Brain, Behavior, & Immunity - Health)

Prefrontal dysfunction in post-COVID-19 hyposmia: an EEG/fNIRS study (2023, Frontiers in Human Neuroscience)

Thanks so much Gachaman!

 

[SNT Gatchaman]

One example of ME not being FND-like is brain oxygenation as measured with NIRS. Near-infrared spectroscopy in evaluating psychogenic pseudosyncope—a novel diagnostic approach (2020, QJM: An International Journal of Medicine) showed "Our novel finding indicates that cerebral perfusion remains stable throughout despite positive symptom reproduction in PPS patients."

However, I had forgotten that a more recent study showed that patients diagnosed with both FND (psychogenic pseudosyncope/PPS type) and ME/CFS do show reduced cerebral perfusion. Psychogenic Pseudosyncope: Real or Imaginary? Results from a Case-Control Study in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS Patients (2022, Medicina) —

This study demonstrates that in ME/CFS patients suspected of having PPS, or conversion, CBF measurements end-tilt show a large decline compared with a control group of ME/CFS patients. Therefore, hypoperfusion offers an explanation of the orthostatic intolerance and syncopal spells in these patients, where it is clear that origin might not be behavioral or psychogenic, but have a clear somatic pathophysiologic background

There's something of a Venn diagram, but I guess the main message is recognising the systematic error. Diagnosing "FND" and ceasing all other investigations because of that will lead to missed diagnoses and perpetuate knowledge gaps.

 

[JoClaire]

I had forgotten that a more recent study

Thank you!

I believe this was in the list of other studies you sent and I found it very notable.

I'd say that once you find physical evidence that explains the symptom - there is no evidence for keeping the FND diagnosis.

No overlap and no Venn.

It's ironically maddening their tea party of slippery logic and ever-evolving labels and narratives.

I really appreciate you sharing all of this!

multiple studies s

(I think it was in this list. Too shaky to look and verify. I still am learning to REST when I'm shaky!)

 

[Sean]

I'd say that once you find physical evidence that explains the symptom - there is no evidence for keeping the FND diagnosis.

Unfortunately that never stops the FND advocates. They just claim it as objective evidence that they are correct. The blatant contradiction is simply ignored.