In functional neurological symptom disorder, physical symptoms that resemble those of a nervous system (neurologic) disorder develop. The symptoms can follow mental factors such as conflicts or other stresses.
People may complain that an arm or leg is paralyzed or that they have lost their sense of touch, sight, or hearing.
Many physical examinations and tests are usually done to make sure symptoms do not result from a general medical condition.
A supportive, trustful doctor-patient relationship can help, as can hypnosis and psychotherapy, including cognitive-behavioral therapy.
Functional neurological symptom disorder is a form of somatization, in which mental factors are expressed as physical symptoms.
Functional neurological symptom disorder sometimes follows stress and interpersonal conflict, which people with this disorder experience as (convert into) physical symptoms. People do not do this intentionally and are not aware they are doing it. They experience their symptoms just as though they were caused by a general medical condition.
Although functional neurological symptom disorder tends to develop during late childhood to early adulthood, it may appear at any age. The disorder appears to be more common in women, although the gender gap between men and women does close in the very young and old.
Symptoms of Functional Neurological Symptom Disorder
The symptoms of functional neurological symptom disorder—such as paralysis of an arm or leg or loss of sensation in a part of the body—suggest nervous system dysfunction. Other symptoms may resemble a seizure or involve problems with thinking, difficulty swallowing, or loss of one of the special senses, such as vision or hearing.
Often, symptoms begin after some distressing social or psychological event. Symptoms are not consciously produced. That is, people are not faking their symptoms. Symptoms are severe enough to cause substantial distress and/or interfere with functioning.
People may have only 1 episode in their lifetime or episodes that occur sporadically. Usually, the episodes are brief.
Diagnosis of Functional Neurological Symptom Disorder
A doctor's evaluation, based on standard psychiatric diagnostic criteria
A physical examination and sometimes medical tests to evaluate for general medical conditions
Doctors first check for physical, particularly neurologic, disorders that can account for the symptoms by taking a thorough medical history, doing a thorough physical examination, and doing tests.
The key to the diagnosis is that symptoms do not match those caused by any neurologic disorder. For example, the person may tremble and think that the trembling is caused by a seizure disorder. But when the person is distracted, the trembling disappears. If people are having a seizure, distractions do not stop the trembling.
Also, for doctors to diagnose functional neurological symptom disorder, the symptoms must cause substantial distress and interfere with functioning.
Once doctors determine that the symptoms do not match those caused by any neurologic disorder, they consider the diagnosis of functional neurological symptom disorder. The diagnosis is made based on all the information from the evaluation.
Treatment of Functional Neurological Symptom Disorder
Supportive, trustful doctor-patient relationship
Hypnosis
Psychotherapy
A supportive, trustful doctor-patient relationship is essential. The most helpful approach may involve collaboration of a primary care doctor with a psychiatrist and a doctor from another field, such as a neurologist. Allied health professionals, such as physical therapists, may also be a part of the care team.
Sometimes having the doctor explain that functional neurological symptom disorder is a legitimate psychiatric disorder and that it can be managed is a helpful therapeutic intervention. It validates the person's symptoms as genuine, establishes confidence in the diagnosis based on positive findings, fosters a partnership with the doctor, and provides a clear rationale for having the condition managed by a team of health care professionals.
The following treatments may help:
Psychotherapy, including cognitive-behavioral therapy, is effective for some people.
Physical therapy can help some people.
Medications
Hypnosis may be used during short-term therapy designed to teach people to control how stress and other mental states affect their bodily functions.
Medications are not usually indicated for functional neurological symptom disorder unless the person has another psychiatric disorder that could benefit from treatment. Depression, anxiety, and posttraumatic stress disorder are just some of the psychiatric disorders that could occur with functional neurological symptom disorder. All of these disorders should be treated, and different treatment approaches for these disorders may involve the use of medications.
More Information
The following English-language resource may be useful. Please note that The Manual is not responsible for the content of this resource.
