FND at the intersection
Functional Neurological Disorder (FND) is a condition that sits at the intersection of neurology and psychology, challenging traditional medical paradigms. Yet, for many patients and clinicians, FND is more than a medical condition—it is a battleground of stigma, mistrust, and systemic shortcomings. This blog post explores the profound impact of stigma on both patients and clinicians, urging healthcare professionals to reflect on their role in breaking this cycle.Â
Patients with FND often describe their experiences in healthcare settings as invalidating and isolating.
These statements highlight a recurring theme: the delegitimisation of FND symptoms, which not only undermines trust but also exacerbates the emotional toll of the condition. When symptoms are dismissed as "just psychological," patients often feel as though their entire being is dismissed, leading to a sense of rejection and exclusion.
"I felt like I was being treated as if I was making it all up... that I was wasting their time"
(Foley, Kirkby, & Eccles, 2022)
"It wasn't just that they didn’t believe me, it was like they didn’t want to believe me"
(McLoughlin et al., 2024).
But stigma is not a one-sided issue.
Clinicians, too, face significant challenges when treating FND.
A clinician interviewed in a 2023 study remarked, "We’re frustrated, but it’s the system that fails us – we aren’t given the training or time to help"Â
(Samuels & Pretorius, 2023).
This frustration is compounded by a "culture of skepticism" that permeates healthcare settings, as noted in McLoughlin et al.'s 2024 review.
The lack of clarity surrounding FND—its diagnosis, treatment, and even its place within medical specialties—further fuels this skepticism.
As one clinician put it,Â
"The hardest part is the lack of clarity – we aren’t sure how to explain it, and that makes us avoid the topic"
(MacDuffie et al., 2020).
Hot potato?
This avoidance is perhaps best encapsulated by Kanaan RA’s striking observation: "The condition seems to have become a kind of clinical hot potato — passed between specialties, but never embraced by any"(Kanaan, 2018).
This fragmentation of care not only leaves patients feeling abandoned but also perpetuates a cycle of mistrust and poor outcomes.
So, how can clinicians begin to break this cycle?
Here are three actionable steps:
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Acknowledge the Reality of FND
   FND is not "all in the head," nor is it purely physical. It is a complex interplay of neurological and psychological factors. Acknowledging this complexity—and communicating it clearly to patients—can help rebuild trust and reduce stigma. Remember, as a clinician, your belief in the validity of a patient's symptoms can be transformative.
-
Invest in Education and Training Â
   Many clinicians report feeling ill-equipped to diagnose and treat FND. Addressing this gap requires a commitment to ongoing education, whether through formal training programs, webinars, or peer mentorship. By equipping yourself with the tools and knowledge to manage FND, you can provide more effective and compassionate care.
-
Foster a Collaborative Approach
   FND often requires a multidisciplinary team, including neurologists, psychologists, physiotherapists, and occupational therapists. Embracing this collaborative model not only improves patient outcomes but also alleviates the burden on individual clinicians. As the saying goes, "It takes a village"—and FND is no exception.
Breaking the cycle of stigma is not an easy task, but it is a necessary one. By reflecting on the experiences of both patients and clinicians, we can begin to create a healthcare environment that is not only more compassionate but also more effective.
Let this serve as a call to action: to listen, to learn, and to lead the way in transforming care for FND.
