Misdiagnosis of an underlying medical condition as Conversion Disorder/Functional Neurological Disorder (CD/FND), 2020, van der Feltz-Cornelis et al

Andy

Andy

Retired committee member
Undetected medical conditions can be misdiagnosed as Conversion Disorder/Functional Neurological Disorder(CD/FND). Although misdiagnosis is considered a rare occurrence since the introduction of improved diagnostic imaging procedures [1–3], there is no recent estimate of this. We therefore conducted a study to explore how often a medical condition was misdiagnosed as CD/FND in a sample of consecutive outpatients referred for treatment to the Clinical Centre of Excellence for Body Mind and Health (CLGG); a tertiary mental health centre for Somatic Symptom Disorders and Related Disorders (SSRD). Patients had been diagnosed with CD/FND elsewhere. We systematically explored the type and duration of CD/FND, psychiatric and somatic comorbidity, early childhood trauma, childhood sexual abuse, stressful life events, use of medication, family history of CD/FND and demographic factors in all patients. We evaluated which of these predictors were associated with misdiagnosis.
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Paywall and first page preview, https://www.sciencedirect.com/science/article/abs/pii/S0163834320300645
Not available via Sci hub at time of posting
 
I think there needs to be a complete separation of true Conversion Disorder, psychogenic along the lines of a psychological trauma like sexual abuse as a child or being in a crappy war resulting in PTSD, from a functional neurological symptom disorder that may have no identifiable psychological or psychogenic causal factor, in other words a neurological disorder like MS, Parkinson's etc. which neurologists take responsibility for, and can bill for under insurance, rather than as they did with me and look at my movements as atypical and then refer me immediately to psychiatry to take their hands off my case or receive kickbacks from psychiatry because psychiatrists need all the more or less "normal" people to fill their caseloads and research agendas. As well, people with a traumatic brain injury who are long-haulers get dumped into this CD/FND category with a normal MRI and continuing symptoms but as a result of the TBI are now a psychiatric case within the DSM so that when they go to the ER for some other ailment, psychiatric disorder is there on the chart right there in print. Ridiculous.
 
Old thread on here but a recent example from Reddit (r/fnd) —

Oh yeah, I’ve experienced a ton of doctors with giant egos misdiagnosing me with FND (I have myasthenia gravis not FND; per the outpatient FND doctor I saw, “if you have any functional symptoms, they are very secondary to whatever primary disorder you have going on and neuromuscular (the specialists who treat MG) need to manage your care”. But even the inpatient doctors from the same hospital system didn’t listen to that and still misdiagnosed me with FND when I developed further complications. That time the FND misdiagnosis turned out to be severe BPPV that PT and OT noticed and I was cured after several Epley maneuvers and migraines with brainstem aura. My husband put my symptoms into ChatGPT for that one, I suggested it to the doctor and they were willing to try a migraine medication and it worked. My outpatient migraine neurologist at a routine follow up then confirmed that those were migraines.
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@rvallee will probably appreciate the ChatGPT aspect!
 
Mithriel said:
Is it just me, or do people who experienced sexual abuse as children not have enough to cope with without being fobbed off with an FND diagnosis instead of having a proper suite of investigations when they get ill?
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Indeed. Sadly for all the faux words there are plenty here who have an attitude of ‘damaged’ and ‘fix yourself’ to even the most heinous, everyone else was responsible for it other than the victim - including society - crimes

it’s gross but people like that think they aren’t the ones with the mental problem ti be fixed - survival if the luckiest and nastiest hey. Same people tend to struggle to draw or acknowledge lines between actions snc consequences and I’m always curious how much of that is madness/stupidity and how much is selfish convenience because we let them get away with it.

so yep people who been through hell ie the most vulnerable do indeed tend to get targeted and used by lots of systems . The most disgusting side of society my we are looking at here - and it’s all because noone is actually battling for those targeted making these people scared they will be shown up or shouted at by a parent who turns out to be well-connected, and truth - if their treatment harms they just lie and immorally use what they’ve been through against them to weaken their testimony. Truth of the world even if people would actually listen to them they can be made to feel they would be doubted because they don’t feel they’ve any power of testimony vs a doctor.

so yep some aren’t necessarily in it too truly help. And have very strange attitudes to those harmed. Just like someone overworked with flu you get some bosses in denial that’s why someone ends up really ill for a long time, but wayyy more extreme. At best it feels there are lots ‘dealing with’ them and no bystanders as we should being incredibly protective of those who’ve been through that - but often the opposite

‘society’ stinks when you look too close
 
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SNT Gatchaman said:
Old thread on here but a recent example from Reddit (r/fnd) —



@rvallee will probably appreciate the ChatGPT aspect!
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Funny isn’t it when you develop another term that happens to be best treated with offering nothing of any use how popular it can suddenly become.

it’s almost like the term is a massive cover-up for all the real reasons they don’t want to provide healthcare to someone.
 
Andy said:
Paywall and first page preview, https://www.sciencedirect.com/science/article/abs/pii/S0163834320300645
Not available via Sci hub at time of posting
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Seems to at least saying the right things about how serious this is and how you can’t trust this diagnosis to the point re evaluation is warranted

I think there is a case to be out as well that it’s a discrimination issue because all the suggestions of narratives and demographics by people in charge of FND are selling bigotry under the guise of it being medical history. Ie this targets the most vulnerable

I’m glad they used the term untreated for long periods of time and someone at least starts to mention the consequences directly caused

I also think somehow people think that impact is dismissible so no harm no foul tgat people lost years of their life unnecessarily and financial consequences associated with that or have worse disability than they would have.

ti the point I get the sense this sort of stuff is seen as a legal loophole where no one in that situation can/could claim gif those consequences- and the FND ideas allows for further muddying if the water.

surely the law needs to change because I guess this is one of the tails wagging the dog here
 
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Another reddit thread in r/FND: Misdiagnosed

I was released 2 weeks later as a patient of Jon Stone and diagnosed with FND- all further investigation was cancelled. I relearned how to walk without sensation and have regained mobility but there’s no change in sensation (I could poke a needle in my bum cheek or leg and not feel it) unfortunately not much change with toileting either. I continued to push for more tests and they found a “myelopathy” in my spine which is causing the numbness- not FND. I spent months staring at my legs, begging them to work, to feel, to reconnect and it was all nonsense. What I’m struggling with now, though, is the lack of movement to find out what is really causing this (I’m in the UK) I seem to be passed from waiting list to waiting list with months of no communication and this lump in my spine, ruining my life, that nobody seems able to tell me anything about.
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A comment —

Yep very very similar,I'm UK based as well.

Landed in hospital over a year ago with suspected stroke,that was all clear so released after a week.

Walking was weird but could I cope until a couple of months in something went wrong,i lost near control of bladder and spent ages relearning it. (They say UTI but I disagree,it was something more)

After that I slowly lost sensation over the year, going from my waist and it just being patchy now down to my toes completely on my right.
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Edit 2.5: Oh and I've been refused mobility aids like orthotics splinting ect on the NHS as my symptoms "aren't real"
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Another —

They told me for five years it was FND. I kept pushing and begging for further testing and it turned out that I had Parkinson’s.
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Another —

Hi another one here in the UK. You're far from alone, unfortunately. There's quite a few of us.
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WTH is going on here in the UK that's causing people to be over-diagnosed (and subsequently ignored) with FND? I know we should take things on the internet with a grain of salt, but there's too many similar stories for there not to be some truth behind this.
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SNT Gatchaman said:
Another reddit thread in r/FND: Misdiagnosed



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Another —
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Creepy

they are right wth

another one for the journos looking for scandals - although I think it would be better with this to connect it with the ‘functional’ initiatives/sell ‘in general’ too because the more you think of realise it’s not ‘just’ x symptoms the less justifiable and more policy-related it starts to look, even if the source turns out to be a number of enthusiastic HCPs like the ‘stoners’ and maybe some gastro-mind people and the pain psychs or whatnot fir the ‘functional’ other stuff.

turned out to be Parkinson’s , 5yrs on, jeez poor person. it just feels like one of those things air traffic control would be logging as a miss and near miss etc
 
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