Many experts in the field have argued for the conceptualisation of FND as a neuropsychiatric disorder, which is a framing that explicit embraces BOTH the neurologic and psychiatric/psychological aspects of this condition¹. The relevance of neurologic, psychiatric/psychological and psychosocial factors varies from patient to patient.

Some patients, and health professionals, feel dismay when they hear the word ‘neuropsychiatric’ . They think this means the whole problem is being framed as psychiatric.

It is also the case that there are many health professionals who DO still consider that FND is a purely psychiatric disorder, although its rare to find that view among those clinicians and researchers who work closely with the disorder.

FND does still appear in a Psychiatric Classification – DSM-5 – but so do a number of other conditions like dementia, and this classification has more to do with the kind of conditions that a psychiatrist might be asked to see, rather than trying to answer knotty questions of whether conditions are in the mind or brain.

In fact, in the new edition of the ICD-11 – FND appears as a heading in the Neurology Section linked to the psychiatry Section. Most people in the field believe that it doesn’t make sense to even have separate neurology and psychiatry sections since they are all conditions that affect the same organ, the brain.

The word neuropsychiatric when applied to FND is NOT being used as another way of saying ‘its all psychological’ . Parkinson’s disease, Tourette’s syndrome and migraine are other examples of conditions which are described as ‘neuropsychiatric’ because this approach of embracing neurologic and psychiatric aspects of the disorder helps in understanding and treating the disorder.  The word ‘neuropsychiatric’ is being used here to try to overcome wrong divisions between neurology and psychiatry, brain and mind. Language is so hard in this area, and when we are dealing with a disorder like FND that has been stigmatised for so long.

References:

1. Perez DL, Aybek S, Nicholson TR, Kozlowska K, Arciniegas DB, LaFrance WC. Functional Neurological (Conversion) Disorder: A Core Neuropsychiatric Disorder. J Neuropsychiatry Clin Neurosci 2020; 32: 1–3.