Why does FND mainly affect women? A consideration of gender imbalance in neuropsychiatric disease, 2026, Bradlow et al

[forestglip]

Why does FND mainly affect women? A consideration of gender imbalance in neuropsychiatric disease

Spoiler: Authors

Bradlow, Richard; Von Der Weid, Laure; Zwickl, Sav; Cheung, Ada; Kanaan, Richard

[Line breaks added]

Background
Functional neurological disorder (FND) is a common and disabling neuropsychiatric condition in which women comprise approximately 75% of cases. This paper examines whether the gender imbalance seen in FND is unique among neurological and psychiatric conditions and explores the biological, psychological, and social contributors to this disparity.

Methods
A narrative review was conducted using MEDLINE, PsycINFO, and Web of Science. Gender ratios were compared across depression, anxiety, post-traumatic stress disorder, schizophrenia, eating disorders, Parkinson’s disease, and multiple sclerosis. Evidence regarding sex hormones, early life trauma, gender-based social determinants, and diagnostic biases were synthesized thematically.

Results
Amongst the psychiatric and neurological conditions reviewed, FND shows a pronounced female predominance (approximately 3:1), placing it amongst the most gender imbalanced disorders in our sample, with only eating disorders showing a larger female predominance.

Biological factors (particularly the influence of estrogen and progesterone on stress reactivity, neuronal excitability, and agency), may heighten female vulnerability. Social determinants (increased exposure to trauma, socioeconomic inequality, and gender norms) further contribute to this risk.

FND shares clinical and demographic similarities with other internalizing disorders and conditions linked to dissociation and trauma. The literature suggests FND emerges from a bidirectional interaction between gonadal hormones and psychosocial stressors.

Conclusions
The marked gender imbalance in FND arises from the interplay of biological vulnerability and gendered social adversity. Understanding these intersecting influences is essential for reducing stigma and guiding future research, diagnosis, and treatment. The findings support the need for a gender-sensitive, biopsychosocial approach to FND care, and investigation.

Web | DOI | PDF | Psychological Medicine | Open Access

 

[rvallee]

They really never got over Freud at all, uh? Not even a little bit. He could read this right now and not even need to have anything explained to him, other maybe than database, there is nothing new here, this is pure "women be hysterical, amirite?" All completely circular, too.

The findings support the need for a gender-sensitive, biopsychosocial approach to FND care, and investigation.

In what universe does any of this follow that? Complete delusional fantasy stuff. Good grief, might as well publish the Chicken paper in a loop. Or the dude who shows how "you can tell it's an aspen tree because of the way it is".

Truly the first group of professionals who could, right now, be replaced with LLMs and it would be an improvement. Not even kidding.

 

[Utsikt]

So many phrases that imply knowledge and causality, and so little evidence to back it up..

 

[Turtle]

"Misdiagnoses of FND are rare and the effects are likely minimal" the authors say.

Be critical even when it concerns your own results.

 

[Arnie Pye]

Based on the corresponding author's email address he is a student. I wonder if the others are all students too.

My quotes are from the paper being discussed.

If they are all students I would guess that they are toeing the line on FND whether they believe it or not. They don't want to upset the people who mark their essays and exams. I wonder if they have ever questioned what they've been taught about the mental health of women. It seems that almost everyone in psychology and psychiatry believes that all women are anxious and depressed. And instead of trying to treat this honestly they often seem to just want to spread the diagnosis to men.

It continues to be uniquely stigmatized as essentially a disorder of women (McLoughlin et al., 2023), with the diagnosis itself seen by many as an expression of misogyny (Micale, 1995).

(My bold)

The reasons behind this gender imbalance are unknown, with biological, psychological, and social explanations suggested (Chouksey & Pandey, 2020). Biologically, sex hormones might contribute to the imbalance (Martel, 2013), which is supported by the female preponderance increasing substantially after menarche and reducing after menopause

What happens to women at menarche? They bleed. What happens at menopause? They stop bleeding.

And what are the main consequences of bleeding regularly? Low iron, iron deficiency, anaemia.

And yet doctors have created reference ranges where low levels of ferritin are in range, and if they aren't in range all the patient needs is 8 weeks worth of iron supplement to be fine and dandy. And yet many, many women absorb iron poorly so their results stay low in range. And nobody in psychology or psychiatry ever seems to think there might be a connection.

 

[MrMagoo]

"Misdiagnoses of FND are rare and the effects are likely minimal" the authors say.

Be critical even when it concerns your own results.

The effects of misdiagnosis may be minimal “to the medics”

 

[Felis Catus]

Why did we decide to label women more than men with FND? The arguments that allowed us to build a career in neuropsychiatric disease

Background
Functional neurological disorder (FND) is a common and disabling neuropsychiatric condition which we invented and thought it was a good idea that women comprised approximately 75% of cases. This paper examines whether the gender imbalance seen in FND is unique among neurological and psychiatric conditions and explores how we could misinterpret biological, psychological, and social factors to explain it without saying it was all fabricated.

Methods
A narrative review was conducted using a drink of choice, mostly gin. Gender ratios were compared across other diseases for the sake of doing it. Evidence regarding sex hormones, early life trauma, gender-based social determinants, and diagnostic biases was invented. Quite frankly, we didn't give a * about any of that but we had to sit in the office to justify our salaries, so why not.

Results
Amongst the psychiatric and neurological conditions reviewed, FND shows a pronounced female predominance (approximately 3:1), placing it amongst the most gender imbalanced disorders in our sample. That was quite unexpected given that during the analysis we blinded the way the dataset was created to hide the fact that the ratio was there from the start by our own design.

Next, we wrote a tale presenting it as a matter of fact to say that biological factors (particularly the influence of estrogen and progesterone on stress reactivity, neuronal excitability, and agency), may heighten female vulnerability. Social determinants (increased exposure to trauma, socioeconomic inequality, and gender norms) further contribute to this risk. None of it makes much sense but if you do a good exercise in putting the ideas together, they eventually stick and propagate.

Our fabricated diagnosis and its criteria shows that FND shares clinical and demographic similarities with other internalizing disorders and conditions linked to dissociation and trauma. We think you could go as far to say that the existing literature suggests FND emerges from a bidirectional interaction between gonadal hormones and psychosocial stressors. Very convenient.

Conclusions
The marked gender imbalance in FND arises from design but could be presented as the interplay of biological vulnerability and gendered social adversity. Misunderstanding these intersecting influences is essential for our career prospects and guiding future research in the wrong direction, misdiagnosis, and mistreatment. The findings support the need for a gender-sensitive, biopsychosocial approach to FND care, and investigation, with funding hopefully awarded to those with the best imagination and highest motivation to ruin, pardon, influence people's lives.