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Functional Illnesses (FI) and Functional Neurological Disorders (FND) Perpetuating Factors

fnd fnd information fnd terms functional disorders functional illnesses functional neurological disorders (fnd) perpetuating factors questionnaire research Apr 08, 2022

What you will find in this article:

  • Definition of Perpetuating Factor
  • Types of perpetuating factors
  • Examples of perpetuating factors
  • Known functional illnesses perpetuating factors described in the medical literature
  • Self-reflection exercises
  • Self-study and research questionnaire so you can discover your own perpetuating factors and contribute to the scientific understanding of FND and FI: Self-assessment questionnaire


Hello community,

Today I would like to reflect on the perpetuating factors of functional illnesses (FI) and Functional Neurological Disorders (FND).

Let's start by reviewing the definition of "perpetuating factor" of any illness. These are elements that contribute to the disease remaining present, and therefore the existence of these factors prevents the improvement and the cure of the functional disease.

Perpetuating factors can be grouped into two categories, depending on their origin: #1) Internal, that is, they come from within, and inhabit our organism, such as, for example, a specific way of thinking, feeling, and acting, which is harmful and against our recovery, and #2) External, originated or dependent on our environment, including the people around us, our home, our work, wellness professionals, the healthcare system, and the society where we are inserted, in general.

Perpetuating factors are not only present in functional diseases, but they can also affect organic problems, such as heart, muscle, lung diseases, etc. Let's look at one specific example:

Imagine a patient with Type 2 Diabetes Mellitus or with problems caused by elevated blood sugar levels, due to resistance to insulin, so they are unable to metabolize all the sugar in the body. If this diabetic person does NOT follow a proper diet, low in sugars and carbohydrates, and does NOT take the necessary medications to keep the blood sugar at normal levels, and on the other hand, they eat sweets in excess, and lead a sedentary lifestyle, the person will suffer from uncontrolled diabetes, and the disease will not improve, on the other hand, over time it will worsen, causing disastrous health consequences with the passing of the years, such as Diabetic Retinopathy (loss of vision) or Diabetic Neuropathy (nerve damage).

So, with the above example we are also analyzing another important characteristic of the Internal perpetuating factors; they are formed #1) By Omission, that happens when we do NOT perform the behavior necessary to improve ourselves, for example, "do not take medications", "do not exercise", or #2) By Commission, or when we adopt harmful behaviors and thoughts, in this case "eating excessively”.

In this way we can begin to imagine the importance of understanding and correcting the perpetuating factors of your functional disease, since through that work of self-study and self-reflection you can prevent worsening, you can promote the cure of your own disease, and prevent recurrence once you reach healing.  

The study of perpetuating factors is so important that scientists and clinicians around the world have been investigating it, studying it, and trying to understand it for decades. Some of the perpetuating factors - also known in the medical literature as "negative prognosis factors” - of functional diseases, already known and described in the literature are:

  1.  Long time to receive the correct diagnosis: it is important then that you maintain an open and honest communication with your doctors, considering functional diseases and reaching the proper diagnosis as quickly as possible.
  2.  Prolonged duration of the disease: the longer you have had the disease, the more difficult it will be to cure yourself. But beware! Improvement and healing ARE possible! The sooner you start the right treatment, the higher your chances of fully recovering.
  3.  Late start of appropriate treatment: related to factor #2 described above.
  4.  Expectation or belief that the disease has no improvement or cure: you must be careful with what you hear and believe, and what you think about the disease, because you can create negative self-suggestions! That's why it's so important to engage in individual, or group educational conversations where true understanding is established.
  5.  Lack of attention to psychological health: psychological health is born in the brain and is related to the well-being of the body as well. How do you feel emotionally and psychologically when your body is sick, when you have diarrhea, or a broken bone? The relationship is undeniable. We have to give the deserved attention to our psychology and have a comprehensive and holistic approach taking into account our entire organism – physical body, mind, emotions, environment – in order to heal ourselves from functional diseases.
  6.  Evaluation by multiple physicians and specialties: be very careful if your doctors are referring you to other specialists! Ask carefully if this referral is absolutely necessary, since each visit to a health professional creates a possibility of iatrogenic damage and triggering more confusion than benefit if they are not well informed about FND and FI.
  7.  Receiving Social Security Benefits: this is a polemic issue that I think we should study together. Science believes that by providing social benefits to patients with functional diseases they can, subconsciously, accommodate themselves in the role of the patient, but, on the other hand, how will they improve without social and health system assistance? How should patients and healthcare professionals address this piece of evidence?
  8.  Be involved in a litigation process: These types of situations are very stressful for anyone! And stress plays a negative role in functional diseases.
  9.  Having other uncontrolled illnesses, such as anxiety, or depression: as we reviewed in factor #5, above mentioned.

 Let's take a pause now, and perform some self-reflection exercises:

  1. Which of the above factors do you think are Internal, External or Mixed?
  2. Which of them apply to your specific case?
  3. Taking into consideration your personal experience, do you think there are other perpetuating factors that affect you, and they have not been mentioned above?

After decades of experience working with patients with functional diseases, and after facing my own symptoms in the years 2004 and 2010, I can assure you that the list of perpetuating factors is much larger than the one I shared above, which simply represents those elements that have been recognized and described by the medical literature; and this is a problem. There are still many factors to discover and acknowledge, and that are affecting many of you. We also know that to cause significant changes in the Social Security and Public Health system, we must scientifically verify that there are other factors to be considered, and that is the work that we can do together today; entering into self-study, to then be able to create awareness in our community and foster positive social changes.

Let's then comprehensively study the perpetuating factors that have affected you. For this, I propose to use the methodology of the Four Bodies, studying the well-being of the mind, emotions, the physical body, and the spiritual or environmental fields. Think then, if the factors I describe below have played a role in maintaining the functional disease for your specific case. Take some time while you read each factor, and please fill out the self-reflection research form. Remember, together we can heal and create a healthier world! Let's get to work.

Perpetuating factors self-assessment

Once you identify the perpetuating factors for your case, the next question would be: What are we now going to do with that information? Well, now is when truly restorative work begins, and for this, the first step is to connect to your emotions, your thoughts, your will, the power of our verbal expression, and your behavior. Next, we will have to find harmony between all these parts of our being, because we must behave in a way that frees us from those perpetuating factors. This is a complex process, unable to be transmitted unidirectionally from me to you, but it is part of the self-discovery study that we review during our educational programs. Remember; the work of curing and preventing functional diseases is in your hands!

Thank you for taking another step in the direction of your health and full happiness!


Always here, at your service, working with you, for you,


Dr. Yadira Velazquez-Rodríguez

Neurologist and Clinical Neurophysiologist

Functional Disorders Healing Ally.


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