Functional Neurological Disorder (FND)

FND, also known as conversion disorder, is classified as a psychological condition and listed in the Diagnostic and Statistical Manual of Mental Disorders. There is a large gender bias towards females (60%-75%) and predisposing factors include, trauma or psychiatric symptoms, somatic symptoms, illness exposure, symptom monitoring and neurobiological factors. The ‘Sick role’ and secondary gain is claimed to reinforce and maintain FND (see here for more details). The term functional was chosen after research (conducted by Sir Simon Wessely) showed patients were less likely to create conflict concerning a psychosomatic diagnosis (almost certainly due to being unaware they’d been given one). It means one thing to patients and another to colleagues. This is a particularly unscrupulous and mendacious method of determining diagnostic terminology that shames the medical profession, a profession that prides itself on living by the words ‘do no harm’. 

Functional Neurological Disorders (FND’s) is the name given for symptoms in the body which appear to be caused by problems in the nervous system but which are not caused by a physical neurological disease or disorder. Health professionals sometimes call these disorders ‘medically unexplained’, psychosomatic or somatisation. We prefer the term ‘functional’ which just means that the body is not functioning quite as it should. Although often considered inexplicable or mysterious, they can actually be easily understood as interference with normal brain function by the emotional centres of the brain.’ (Sheffield Teaching Hospital NHS Trust)

Symptoms include sensory issues, concentration problems, memory, fatigue, motor issues and dissociation or functional seizures. Management commonly involves physiotherapy or CBT. FND is a diagnosis ME patients should be wary of, and dispute given their neurological disease is effectively being reclassified as a psychosomatic one, since treatment is ineffective and even harmful as it fails to consider the medical risks of an incorrect diagnosis (see Medically Unexplained Symptoms).

CASE STUDY

A recent example is of a woman in her 40’s initially bed bound from flu for three months and subsequently diagnosed with fibromyalgia and ME, improved enough with rest to attend a chronic fatigue clinic where she was immediately given antidepressants and CBT which turned her into a zombie (her own words). Following completion of their programme of ‘lifestyle management’, to which she stuck diligently, a letter was send to her GP to say that she was in recovery, a few weeks later she had a heart attack. Her recent visit to a neurologist at Kings Hospital has now given her a diagnosis of FND, what deleterious effect could recommended treatment have to her? She blames herself for not being better yet as the CBT has told her to keep pushing through the symptoms.

What more could I have done to help myself? No amount of positivity can take away the pain I feel.