How are Functional Neurological Disorders (FND) diagnosed?

What you will find in this article:

• How do physicians diagnose FND? How to recognize FND in us?
• Healthcare system limitations preventing the timely and accurate diagnosis of FND

If you read and watched my story you may recall that I said: "The second time I experienced functional symptoms I understood on my own what was happening." And this is one of the most important concepts that we will try to learn today: How can we recognize functional symptoms in ourselves? If we have a functional neurological symptom, or a functional neurological disorder, how can we help our doctors, and all the other healthcare professionals, make the right diagnosis? Because there are certain features of our experience, that if we share, it will make things much easier for all parties involved. So, let us get started:

How doctors diagnose FND? How to recognize functional symptoms in us? There are three main pillars, three characteristics, three factors, for diagnosis, and the three of them must be present.

1. The symptoms, the discomforts, are intermittent, fluctuating and variable. 

The symptoms come and go because they represent a dysfunction, a malfunction, or intermittent failures in the transmission of the information, between the connections of the mind, the body, and the emotions.

 Holocene students and patients tell me all the time that they have “good days and bad days”. Day by day, moment by moment, week by week, the symptoms fluctuate, and that's relatively rare in organic diseases, particularly when present for months or years, because usually, chronic organic problems manifest with constant symptoms. 

The symptoms may change overnight in severity, characteristics, or symptom type. One day, the pain is in the knee, the next day is in the lumbar region, the following week is in the stomach, subsequent years are more characterized by muscle tensions, and during other moments the heart can be the source of worries and distress, perhaps with palpitations, or a strange sensation in the chest, or maybe patients can notice a bit of speech problems. Fluctuation, and variability are also present.

 2. The physical examination is normal, minimally abnormal, not explaining the patient’s symptoms or it can demonstrate the intermittent, fluctuating, and variable dysfunction. 

When the neurologist performs the neurological examination, the results can be normal, or perhaps a minor abnormality is found, that may represent another disease, because as we said, comorbidity is common. Patients may have two or three different problems happening at the same time. For example, in the case of organic diseases, it is not uncommon for patients to have high blood pressure, obesity, and diabetes, all affecting one person. This is actually very common in medicine, especially as we get older, we accumulate health problems, such as a 20- or 40-years old car, which may have flat tires, a crack in the windshield, and a scratch in the paint. This is an important concept to remember because the physical examination when abnormal, could be due to another already known problem.   

A good physical examination performed by an experienced neurologist often demonstrates variations and fluctuations in the way the body is functioning, for example, in the level of muscular relaxation, the strength, the movements, the sensation and so on. The dysfunction may be present during the doctor’s appointment, and he could notice it and even point it out to the patient.

 3. Test or investigation results are usually normal, or they may have anomalies that are called accidental discoveries, minor anomalies, or minor deviations from the mean of normality, but those do not justify, and do not explain, the way the body is feeling and functioning.

 This is a vital concept to remember too, because when doctors put too much weight on the test results, and pay more attention to that, as opposed to the patient’s history and physical examination, is when misdiagnosis most commonly occur, usually followed by unnecessary treatments, interventions, and even surgeries! It is very important for patients to ask their physicians if the abnormal result is linked to their symptoms, or is incidental? 

Let us pause now for a moment and think, especially if you are dealing with some physical symptoms that doe not yet have a clear diagnosis: Do your symptoms fluctuate? How about the characteristics, the qualities, and the type of symptom? Does your body function well sometimes, and other times not so much? When you go to the doctor, what do they say about the physical examination, and the test results? Does your doctor take time to explain in detail what he or she is finding? Does it all make sense, or does your doctor seem puzzled and confused? You can also ask your doctor to be honest about what he or she knows and does not understand.

Bring your self-knowledge forth, advocate for yourself and share with your doctor what you know about the human body, functional neurology, and the healthcare system. For doctors to make the diagnosis in a timely manner, they need a high index of suspicion, they really need to suspect that the possibility of functional illness and FND are common, that these conditions happen very frequently, and they often co-exist with other neurological problems. The formulation of a good differential diagnosis is always good practice in medicine, and the more conditions the doctors think about, the higher the chances that they will make the right diagnosis. Make sure your doctor listens to you. Nowadays, functional illnesses are so common that we all need to keep in mind this possibility, with the same frequency that we consider structural problems.

Make sure that your doctor asks you many questions, that they are attentive, really listening and paying attention to your answers, and that there is an open discussion about how symptoms behave, if they are connected to emotions, thoughts, what you believe about the symptoms, what is happening in your physical body, in your personal life, at work, with the family, in your social life, what your interpersonal realities are, and if possible even share your hopes, desires, mission, and what you believe your purpose in this life to be! Functional illnesses happen due to any adverse physical, environmental, spiritual, mental, or emotional event; everything needs to be considered, from head to toe, from inside out, from past to future, because all of this plays a role in how we feel, and who we are. This is the importance of the Four Bodies and their interconnection: the physical body, the mental body, the emotional body, and the spiritual body, which includes our society, nature, and the entire universe around us.

It's important for doctors and for people, for patients to know what I've said; that having a functional illness does not mean that you will not have other medical problems, on the other hand, comorbidities exist, and functional illnesses happen more commonly in patients who have organic diseases. And specially when FND coexists with other diseases, it is important to diagnose it and treat it appropriately, because when the functional component improves, the overall well-being is also magnified.

Talking now about healthcare system limitations in diagnosis, regretfully, there is still limited knowledge, understanding and awareness of FND in the world, and to solve this, doctors need to be curious. Curious about you, about what the condition means, and they need to be open to challenges, in order to achieve an early diagnosis. During subsequent articles we will review why early diagnosis is important.

A major problem in the healthcare system that has appeared with sub-specialization is that physicians rarely are looking at the human being from a holistic, integrative, comprehensive perspective that includes the assessment, understanding and perfecting of the Four Bodies: the physical body, the psychological well-being, which includes the mind, the emotions, and also the social, environmental, and spiritual aspects. Nowadays, usually, if someone feels physical discomfort they go to the internal medicine doctor, the orthopedist, the cardiologist, the neurologist, etc, depending on the body part that is bothering. If the same person is having difficulty understanding certain emotions, they seek a psychologist. If the person is diagnosed with depression, then she is sent to see a psychiatrist, and if that person is deeply unhappy, has lost his life’s mission and feels disconnected from spirit, he is sent to church, to talk to a guide, or a spiritual leader of the faith that the person practices, or perhaps he is sent to see a social worker, to look for a different job. Do you realize how many divisions, separations, barriers, and burden? In reality, is all connected. If you break a bone, you will feel sad, you may have to stop working, your boss may fire you, you may feel lost and disconnected from your life’s mission because you have been told that work is the center of life, you will be filled with worries, perhaps with insomnia, during the day with fatigue, you may be overwhelmed with emotions that are complex and difficult to sort out, your shoulders may feel heavy, due to the load of uncertainties that your nervous system is carrying. Do you see the connections? They are undeniable. That is why having a holistic approach and integrating, looking at the individual from the perspective of the Four Universal Bodies, is essential! That's why I am utilizing the scientific evidence to support what our ancestors have been saying for thousands of years with Shamanism and the shamanic method of the Three Worlds and the Four Directions; we must unify and rebalance the Four Bodies in order to cure functional neurological disorders.

Another problem of the healthcare system is that most physicians rely heavily on test results, because in modern societies and especially in developed countries, honestly, doctors rarely examine thoroughly patients nowadays. I know is not their fault, that they have an increasing pressure to meet schedule, to produce revenues, so they have very little time for each patient, and what they have in excess is a huge technological development, so they ask for all kinds of MRI, electroencephalograms, electrocardiograms, blood tests, x-rays and many more fancy investigations. What happens then is that, because we are not 100% perfect, but on the other hand our bodies have little things here and there that are different from the mean, or simply because we are getting older, the physicians often find some minor changes on the imaging and the doctor says is Multiple Sclerosis, or spondylosis, or sinusitis, or you name it! This happens because most doctors put a lot of weight on test results.

Let us remember well physicians reading this article; since medical school and throughout our carriers we have been taught that in medicine the history and the physical examination are the most important pieces of information, and that the results of the tests are only secondary in weight. Collecting a superb history and physical examination are the most important parts of your doctor’s role to obtain the correct diagnosis, and your doctor must have the time and the dedication to do this, so make sure you remind him or her whenever necessary 😊

Looking forward to our LIVE discussion!

Always, at your service,

Yadira Velazquez, MD

Functional Disorders Healing Ally