Exploring the Experiences of Neurologists and Patients Undergoing the Diagnostic Journey for Functional Neurological Disorder

Waring, Rebecca

Abstract

This thesis portfolio comprises three parts:
Part One: Systematic Literature Review
Background: Functional Neurological Disorder (FND) is a distressing condition with no confirmed cause. There are approximately 8000 new cases in the UK alone per year. It is a positive diagnosis, with tests available to identify clinical features that are distinctive to FND. Until 2013 it was thought to be caused by psychological distress alone, however this is no longer the case. This review aimed to explore the experiences of patients as they interacted with health care systems during the process of being diagnosed with FND. Method: Five databases were searched: Academic Search Premier, CINHAL Complete, Medline, APA PsycArticles and APA PsycInfo resulting in 11 qualitative and one mixed-methods papers to review. The papers were quality assessed before a narrative synthesis was conducted to provide a narrative of the patients’ experiences. The narrative included three chapters of before, during and after diagnosis. There was uncertainty and stigma as outdated assumptions about the psychological cause of FND was directed towards them. However, there could be times of validation and relief if they were able to speak to a health care professional that understood their condition.
Part Two: Empirical Paper
Background: In the UK, neurologists are the clinicians most likely to diagnose Functional Neurological Disorder (FND) with research suggesting that approximately 30% of neurology patients have FND. There is little understanding of the impact this area of their work has on neurologists, or the meaning they make of their experience. Without this knowledge, the effect it may have on neurologists’ wellbeing and job satisfaction, or the healthcare experience of patients with an FND diagnosis, cannot be identified.
Method: Semi structured interviews were held with ten UK based neurologists who have experience of diagnosing FND. The interview transcripts were analysed using interpretative phenomenological analysis (IPA).
Results: Superordinate themes of system failure, diagnosis and identity matters were developed. Within these superordinate themes were subthemes covering areas including: lack of FND services, time constraints for consultations, whether FND should be part of a neurologist’s role, the importance of the doctor-patient relationship, the use of resources, communication difficulties, the meaning of identifying as a neurologist, and the problematic language often used when referring to FND patients.
Discussion: Underpinning all the themes was the widely held view that FND is a psychological issue and, as such, can attract the same stigma that other mental health issues often attract. Additionally, as medical professionals, neurologists do not see conditions they understand to have a psychological cause as within their remit. This view is problematic as the etiology of FND is still unknown, it does not necessarily have a psychological cause and to assume otherwise is incorrect and can be very unhelpful. The societal narrative around mental health influences not only the neurologists but the systems around them which impacts on the provision of FND services and training.
Part Three: Appendices

Citation

Waring, R. (2025). Exploring the Experiences of Neurologists and Patients Undergoing the Diagnostic Journey for Functional Neurological Disorder. (Thesis). The University of Hull. https://hull-repository.worktribe.com/output/5089168

• Thesis Type: Thesis
• Deposit Date: Mar 26, 2025
• Publicly Available Date: Mar 28, 2025
• Keywords: Clinical psychology
• Public URL: https://hull-repository.worktribe.com/output/5089168
• Additional Information: Clinical Psychology; Faculty of Health Sciences; University of Hull
• Award Date: Feb 13, 2025