Functional Neurological Disorder (FND) : a patient's guide

including Functional/Dissociative (non-epileptic) Seizures,  Functional Movement Disorder and other functional symptoms

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neurosymptoms.org

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Louise 15th March 2019

I have been told by a doctor about a "functional block" between brain and body and directed to this website, but cannot find any information about it. This is in relation to episodes similar to dissociative seizures, but with clear awareness throughout but an inability to respond eg total body limpness, breathing stops. Brain is saying to breathe, open eyes, squeeze hand, but body does not respond. Preceded by chest pain, racing heart, bowel response. I can't find any symptoms like this on this site, there is no dissociation at all with the episodes.

 

REPLY. I cant provide help on diagnoses for individuals, sorry. In general terms dissociative attacks/seizures and panic attacks are different, although share similar mechanisms in the brain.  Many people with dissociative attacks dont experience any dissociation, although 'body does not respond' may in fact be depersonalisation. There are attacks which can have features of panic attacks like fast breathing, chest pain etc but in which people dont experience fear (so called 'panic without panic'). There are also dissociative attacks where people have no warning and experience no symptoms of panic attack at all. What they all have in common is that somewhere in the brain there is a 'red alert' going off which the brain and body is trying to deal with in various ways. Typically there is no particular reason for it at that moment, ie the person isnt necessarily stressed when it starts, but the attack itself is stressful. More information on these pages (1 and 2 ) about attack treatment.

 

 

Alison, 6th March 2019

I was hoping to get a better understanding as to the classification of FND as it is classified in the DSM 5 under somatic disturbances. This makes it clear in my mind it is a mental health disorder however I don’t feel I relate to that, I’m finding to hard to know if I have a mental health issue or a physical health issue or both. Many thanks.

 

REPLY. This is a common and understandable question.  FND is in DSM-5 which is the American Psychiatric Associations Diagnostic Manual. However those in the field are clear that FND is a disorder which is at the interface between neurology and psychiatry and in fact challenges the distinction between mind and brain. There has been a long battle to get FND recognised in both neurological and psychiatric classifications - thus far with only partial success. You can read an article we wrote about that here

 

However regardless of what DSM says, those of us in the field are pushing for this unified approach. FND now appears much more routinely in neurology journals, conferences, textbooks and curriculums, when previously it was invisible in those spaces. In answer to your specific question, its a disorder of the nervous system, leading to involuntary and real symptoms. To me the question is really hard to answer because there are no neat division in the nervous system between mind and brain. People with anxiety and depression have many brain changes. People with MS and Parkinsons commonly get psychological symptoms. Eventually we hope the World Health Organisation will catch up and amalgamate neurological and psychological disorders.

PS DSM also contains diagnoses like Dementia, Tourettes syndrome

 

Alison, 27th February 2019

Hi, I have a question rather then feedback. I’ve just been diagnosed with FND so learning a lot at the moment. I was relieved to know there was nothing structurally or degeneratively wrong with me! I would like to be clear, and I’m not clear, how FND is different to ‘anxiety with somatic symptoms’. I am talking to people about FND and have been asked questions around this line, I’d like to have a clearer answer. I’ve been suggesting it might be about symptom presentation ??? Thanks, Alison.

 

REPLY: This is a good question which I can answer as its generic rather than specific. Anxiety comes in many forms, generalised anxiety, panic disorder, agoraphobia, social anxiety etc. Its often thought of as a purely psychological cognitive problem - "I feel worried most of the time", "I cant keep a lid on worry" etc - but the diagnostic criteria for it that psychiatrists use for generalised anxiety contain several physical symptoms - fatigue, poor concentration, muscle tension, difficulty with sleep, feeling restless.

 

The definition of a panic attack includes even more physical symptoms occurring as an episode: Four or more of palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking;  sensations of shortness of breath or smothering; feeling of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, lightheaded, or faint;  paresthesias (numbness or tingling sensations); chills or hot flushes  - as well as several cognitive/emotional ones: derealization (feelings of unreality) or depersonalization (being detached from oneself);fear of losing control or going crazy; fear of dying

 

FND describes symptoms that relate to the voluntary motor and sensory nervous system - limb weakness, movement disorders, blackouts, visual problems etc - these are not part of the definition of anxiety. Although tingling and trembling is part of the definition of panic, they present in a different way that wouldnt generally be confused with FND.

 

Anxiety and panic are common in patients with FND, and its also possible to have physical symptoms of anxiety without feeling that anxious, but even with that, a large proportion of patients with FND just dont have an anxiety disorder (or any psychiatric disorder). So in some cases, depending on the symptom and severity of anxiety it makes sense to look at things from an anxiety perspective, in others it really doesnt, and in others two diagnoses, FND AND Anxiety need to be made and the way in which they interact discussed.

 

Ultimately the diagnostic "boxes" we have are imperfect. Diagnostic labels are helpful if they help people understand their symptoms better and/or direct them towards better ways of managing or treating them. Its often the case that people need to understand how these different diagnostic labels overlap with each other.