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

An anonymous user with a dutch IP that also edits Paul Garner’s wikipedia page added the following section to the functional somatic syndrome wikipedia page:
Chronic fatigue syndrome is widely regarded within mainstream medical science as a functional somatic syndrome, despite severe opposition from many patients and their advocacy groups.[1][2][3][4][5]
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1. Donnachie E, Schneider A, Enck P (2020-06-17). "Comorbidities of Patients with Functional Somatic Syndromes Before, During and After First Diagnosis: A Population-based Study using Bavarian Routine Data". Scientific Reports. 10 (1): 9810. doi:10.1038/s41598-020-66685-4. ISSN 2045-2322.
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2. Fink P, Schröder A (2010-05). "One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders". Journal of Psychosomatic Research. 68 (5): 415–426. doi:10.1016/j.jpsychores.2010.02.004. ISSN 1879-1360. PMID 20403500. {{cite journal}}: Check date values in: |date= (help)
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3. Linde A (2007-10). "[Chronic fatigue syndrome--a functional somatic syndrome]". Therapeutische Umschau. Revue Therapeutique. 64 (10): 567–574. doi:10.1024/0040-5930.64.10.567. ISSN 0040-5930. PMID 18214210. {{cite journal}}: Check date values in: |date= (help)
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4. Henningsen P, Zimmermann T, Sattel H (2003). "Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review". Psychosomatic Medicine. 65 (4): 528–533. doi:10.1097/01.psy.0000075977.90337.e7. ISSN 1534-7796. PMID 12883101.
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5. Wessely S, Nimnuan C, Sharpe M (1999-09-11). "Functional somatic syndromes: one or many?". Lancet (London, England). 354 (9182): 936–939. doi:10.1016/S0140-6736(98)08320-2. ISSN 0140-6736. PMID 10489969.
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Another user with a Russian IP then edited it to (and added some more sources):
ME/CFS has been regarded by some as an FSS condition.
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Utsikt said:
An anonymous user with a dutch IP that also edits Paul Garner’s wikipedia page added the following section to the functional somatic syndrome wikipedia page:






Another user with a Russian IP then edited it to (and added some more sources):
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The first edit is a pretty clear breach of this wikipedia policy
[URLunfurl="true"]https://en.wikipedia.org/wiki/Wikipedia:Citation_overkill[/URL]
In controversial topics, sometimes editors will stack citations that do not add additional facts or really improve article reliability, in an attempt to "outweigh" an opposing view when the article covers multiple sides of an issue or there are competing claims.
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Edit: Wait this isn’t an official wikipedia policy? I’m a bit confused. Better not take it too seriously.

Edit 2: Okay here’s the official “policy” or more like style guide

Template:Excessive citations inline - Wikipedia

en.wikipedia.org en.wikipedia.org
 
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Reddit thread in the Long Haulers' group: Anybody else get told it’s “Functional Neurological Disorder” (FND) ?

Including this comment, which quotes a neurologist's discussion with the patient —

“you’re having panic attacks you don’t know about, and that’s what’s causing the uncontrollable spasms in your hand and foot.”
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“you have strong emotions you’re not aware of and they’re manifesting without your knowledge.”
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In case anyone was wondering what the practical "thinking" is at the coal-face.

Counterpoint:

My endocrinologist is very mad about all the long COVID patients who are being told they have FND. He thinks it’s BS.
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Good man :thumbup:
 
SNT Gatchaman said:
Reddit thread in the Long Haulers' group: Anybody else get told it’s “Functional Neurological Disorder” (FND) ?

Including this comment, which quotes a neurologist's discussion with the patient —





In case anyone was wondering what the practical "thinking" is at the coal-face.

Counterpoint:



Good man :thumbup:
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Ah, the good old panic attacks..

I’ve had a couple of full on panic attacks and lots of anxiety before getting sick. So when I had a HR of 120+ for 30 hours straight (it’s usually ~70) when lying down and was unable to sleep at all with lots of chest pain and tightness, they said it was a panic attack. The fact that it didn’t at all feel like any of my panic attacks or anxiety wasn’t relevant.

Luckily my psychologist called bullshit on it and essentially said that there is no reason to suspect any psychosocial causes for my problems.

I’ve had a complete workup wrt the heart after that and everything was fine, so I’ve got no idea about what actually happened.
 
The concepts "functional disorder" and "functional neurological disorder" seem to be on the rise.

Do any of the forum members have a feeling for generally what kinds of conditions are given those diagnoses?

Are these diagnoses mainly constructed for conditions like ME/CFS, long covid, fibromyalgia, IBS etc, where most patients, many researchers and many clinicians believe that there is a underlying biomedical problem?

Or are these diagnoses primarily constructed for people with mental health problems, such as anxiety and depression, which manifest as physiological symptoms? And that ME/CFS and the other chronic conditions are kind of are swept up by the expansionist tendencies of the psychology field? Even if the diagnoses were not constructed specifically for ME/CFS etc to start with.

Maybe what I'm thinking about is whether the concepts "functional disorder" and "functional neurological disorder" have some justification, even if their application to ME/CFS is invalid.
 
Liie said:
Maybe what I'm thinking about is whether the concepts "functional disorder" and "functional neurological disorder" have some justification, even if their application to ME/CFS is invalid.
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They potentially relate to some meaningful clinical groupings, for example people displaying non epileptic seizures, but ‘functional’ is generally used as a synonym for ‘psychogenic’ which is not evidenced and are increasingly lumped together so people with IBS are offered the same treatment as people with non epileptic seizures or people with ME/CFS. Usually this is directive CBT and exercise supported by studies as bad as those used to justify CBT/GET for us.

Also there seems to be currently empire building with even when an underlying biomedical condition is identified they want to hang onto the idea of a concurrent functional disorder, as if somehow having a stroke or MS means you are more at risk of an additional functional condition.

Though there are meaningful clinical groupings within the ‘functional’ label and many feel validated that their very real symptoms are being validated, I strongly believe that the term functional either reflects the diagnostician’s theoretical biases or is used rather than admit that we just don’t know.
 
Merged posts
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Long COVID vs. functional neurological disorder: Punching down
Shelley Dawson

Chapter from book Clashing Vulnerabilities, Disability and Conflict

[Line breaks added]

Abstract
Shelley Dawson’s chapter documents a situation where clashing vulnerabilities are not only not recognised; they are vigorously disavowed and denied. She discusses how a new emerging diagnosis, Long COVID, is being formulated in distinction to another neurological condition, functional neurological disorder (FND).

Dawson examines how people associated with similarly medically ambiguous (and socially suspicious) neurological conditions such as myalgic encephalomyelitis/chronic fatigue syndrome and, now, Long COVID, are treating FND as what in language studies is called a “false friend” (embarazada in Spanish doesn’t mean “embarrassed”. It means “pregnant”).

Web | Paywall
 
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forestglip said:
Long COVID vs. functional neurological disorder: Punching down
Shelley Dawson

Chapter from book Clashing Vulnerabilities, Disability and Conflict
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Podcast with the author: https://www.sciencewritenow.com/lis...tive-of-functional-neurological-disorders-fnd

She is presented like this:

Dr Shelley Dawson is a sociolinguist/discourse analyst [...] She investigates functional neurological disorder from a discourse perspective
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The rest of the podcast participants seem to be FND people.
 
Seems that for these people "Language matters' but not arithmetic. Th e intro says:

But an estimated 4 to 12 out of 100,000 people develop FND, and it’s the second most common presentation in neurology clinics worldwide.

Now that is about 1 in 10,000 people with FND (could be about right). But MS is about 1 in 1000 and headache about 1 in 1, of which maybe 1 in 10 see a neurologist, and peripheral neuropathy is about 1 in 20. So how does FND come to be the second most common...

Give me a policeman over a dyslingual/socialist anacourse any day.
 
Jonathan Edwards said:
But an estimated 4 to 12 out of 100,000 people develop FND, and it’s the second most common presentation in neurology clinics worldwide.

Now that is about 1 in 10,000 people with FND (could be about right). But MS is about 1 in 1000 and headache about 1 in 1, of which maybe 1 in 10 see a neurologist, and peripheral neuropathy is about 1 in 20. So how does FND come to be the second most common...
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It seems to be a common claim. Two examples:

Functional Neurological Disorder: Historical Trends and Urgent Directions, 2023, Journal of Neurology Research (Link)
The worldwide distribution of FND has been rapidly increasing. The incidence rate of FND between 1976 and 2010 was 4 to 12 per 100,000 patients per year [21, 47-49] and the prevalence was 50 per 100,000 population [50]. In 2010, FND was found to be the second most common reason for new outpatient neurological evaluation [51].
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Seminars in General Adult Psychiatry, p.369, 2024 (Link)
It is commonly stated that FND is the second most common disorder in neurology outpatient clinics, echoing the prescient observations of Sydenham. although this may only be strictly true when a broad view of functional symptoms is taken.25,26 FND is certainly common in emergency departments, particularly when presenting in similar fashion to acute stroke, cauda equina syndrome or epileptic seizure.27 There are some estimates that suggest that 1 in 10 acute neurology admissions are for FND. 28 Despite these often acute presentations, it is not infrequent for patients to wait several years after the onset of their symptoms to receive a diagnosis of FND.20
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Of the studies I looked at, they all seem to cite the same study:


Who is referred to neurology clinics?--the diagnoses made in 3781 new patients, 2010
J Stone, A Carson, R Duncan, R Roberts, C Warlow, C Hibberd, R Coleman, R Cull, G Murray, A Pelosi, J Cavanagh, K Matthews, R Goldbeck, R Smyth, J Walker, M Sharpe

Objective
Information on the nature and relative frequency of diagnoses made in referrals to neurology outpatient clinics is an important guide to priorities in services, teaching and research. Previous studies of this topic have been limited by being of only single centres or lacking in detail. We aimed to describe the neurological diagnoses made in a large series of referrals to neurology outpatient clinics.

Method
Newly referred outpatients attending neurology clinics in all the NHS neurological centres in Scotland, UK were recruited over a period of 15 months. The assessing neurologists recorded the initial diagnosis they made. An additional rating of the degree to which the neurologist considered the patient's symptoms to be explained by disease was used to categorise those diagnoses that simply described a symptom such as 'fatigue'.

Results
Three thousand seven hundred and eighty-one patients participated (91% of those eligible). The commonest categories of diagnosis made were: headache (19%), functional and psychological symptoms (16%), epilepsy (14%), peripheral nerve disorders (11%), miscellaneous neurological disorders (10%), demyelination (7%), spinal disorders (6%), Parkinson's disease/movement disorders (6%), and syncope (4%). Detailed breakdowns of each category are provided.

Conclusions
Headache, functional/psychological disorders and epilepsy are the most common diagnoses in new patient referral to neurological services. This information should be used to shape priorities for services, teaching and research.

Web | Clin Neurol Neurosurg | Paywall
 
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