How to explain Functional Neurological Disorder (FND) to a patient

From the Guidelines

Functional Neurological Disorder (FND) should be explained to patients as a genuine medical condition where the brain has difficulty sending and receiving signals correctly, despite normal structural brain health. Begin by reassuring the patient that FND is real and not "all in their head" or imaginary. Explain that their symptoms—which may include seizures, weakness, movement problems, or sensory changes—occur because of a problem with how the nervous system functions rather than structural damage. Use the analogy of a computer with software problems rather than hardware damage. Emphasize that FND is common, affecting many people, and that it can improve with proper treatment. Discuss how stress, trauma, or other medical conditions may trigger or worsen symptoms, but clarify that this doesn't mean they're making up their symptoms or can control them voluntarily. Focus on the positive prognosis, explaining that many patients improve with appropriate treatment, which may include physical therapy, psychological approaches like cognitive behavioral therapy, and sometimes medication for specific symptoms. Avoid suggesting the condition is psychiatric, as this can feel dismissive, while acknowledging the mind-body connection in all health conditions. This approach helps build trust and engagement in the treatment process, as supported by the occupational therapy consensus recommendations for FND 1.

Key Points to Emphasize

• FND is a real medical condition, not imaginary or "all in their head"
• Symptoms occur due to a problem with nervous system function, not structural damage
• FND is common and can improve with proper treatment
• Stress, trauma, or other medical conditions may trigger or worsen symptoms, but this doesn't mean the patient is making up their symptoms or can control them voluntarily
• Treatment may include physical therapy, psychological approaches, and sometimes medication for specific symptoms

Approach to Explanation

• Use a biopsychosocial aetiological framework to explain FND, as recommended by occupational therapy consensus guidelines 1
• Focus on education, rehabilitation within functional activity, and the use of taught self-management strategies, as central to occupational therapy intervention for FND 1
• Emphasize the importance of a multidisciplinary approach to management, including occupational therapy, as integral to the treatment of FND 1

From the Research

Explaining FND to Patients

To explain Functional Neurological Disorder (FND) to patients, it is essential to approach the conversation with sensitivity and clarity. The following points can be considered:

• FND is a condition characterized by neurological symptoms that lack an identifiable organic cause 2.
• The symptoms can consist of motor, sensory, or cognitive disturbances, and are not deliberately produced 2.
• FND is a common presentation in emergency and acute medical settings, and its diagnosis should rest on clear positive evidence, typically from a combination of physical signs on examination or the nature of seizures 3.
• The treatment of FND typically involves a multidisciplinary approach, addressing each of the neurological symptoms and underlying psychological factors via a mixture of medical management, psychotherapy, and supportive interventions 2.

Key Points to Discuss with Patients

When discussing FND with patients, the following key points can be covered:

• The diagnosis of FND is not a diagnosis of exclusion, but rather a rule-in diagnosis with available treatments 4.
• FND can cause severe disability in some individuals, but early diagnosis and access to evidence-based rehabilitative and/or psychological treatments can promote recovery 4.
• Rehabilitative interventions, such as physical and occupational therapy, are treatments of choice for functional motor symptoms, while psychotherapy is an emerging evidence-based treatment across FND subtypes 4.
• It is essential to involve a multidisciplinary team in the treatment of FND, including specialists with expertise in neurological diagnosis 3.

Importance of Clear Communication

Clear communication of the diagnosis and treatment plan is crucial when explaining FND to patients. This can help to:

• Destigmatize the disorder and promote a better understanding of the condition 4.
• Encourage patients to engage with their treatment plan and work towards recovery 3.
• Foster a positive and supportive relationship between the patient and healthcare team 2.