How functional neurological disorder is both 'all in your head' and beyond it
By the time many people with functional neurological disorder arrive in our clinic, they have heard the five words "It's all in your head" more times than they can count. They are told their brain scan was normal. Their electroencephalogram, a test that measures the brain's electrical activity, is reassuring. "The good news is you don't have epilepsy," they're told.
Functional neurological disorder remains both a mystery within and beyond the realm of the brain. Many individuals who suffer from this condition have been told "it's all in your head," after receiving reassuring test results. However, a series of debilitating symptoms persist, leaving patients feeling uncertain and misunderstood.
Dr. Laura Strom, a neurologist, has witnessed this pattern repeatedly at a multidisciplinary clinic dedicated to treating functional neurological disorder. The condition has long posed challenges for diagnosis and treatment, leaving patients with few answers and limited options for care.
Neuroscience now offers a new perspective on functional neurological disorder. It suggests that the brain's networks responsible for movement, attention, emotions, body awareness, and sensory processing are intricately connected, constantly communicating and creating our thoughts, perceptions, and actions. Miscommunication or disruption in these networks may be one of the central causes of the condition.
One leading theory, predictive processing, proposes that the brain constantly makes predictions based on past experiences, information from surroundings and internal signals to create our everyday experiences. When new information contradicts these predictions, the brain updates its expectations. However, disruptions in this process might contribute to the disorder's symptoms.
While there is no single cause for functional neurological disorder, factors like injury, illness, pain, or stress may make the brain rely more on prior predictions, making it difficult to adjust predictions when new information is encountered. For instance, after an injury heals, the brain may continue to predict that a movement or activity is unsafe, leading to persistent weakness or difficulty walking despite no ongoing harm to the body.
Despite its prevalence, access to specialized care for functional neurological disorder remains limited. This condition exists in a "treatment desert," likely due to a mismatch between the supply of specialists and the demand for their services, as well as limited funding. Additionally, many health care professionals receive little to no training on the disorder during their education. Consequently, delayed diagnosis is a significant consequence of this lack of understanding.
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