Functional Neurological Disorder (FND)

Many neurologists and psychologists now recognise that people with Conversion Disorder do not necessarily have any history of trauma or psychological issues. Some have reported this percentage to be as high as 30% of patients with NO conversion happening. 

The DSM5 has relabelled Conversion Disorder to 'Conversion Disorder (Functional Neurological Symptom Disorder), however the leading neurologists in the world who work in this field use the label 'Functional Neurological Disorder' or FND for all Functional Disorders.

Within this umbrella of Functional Disorders, there are a myriad of labels including the more common NEAD, PNES, CD, SD, Functional Dystonia. These labels cover almost as many myriad of functional symptoms.

While acknowledging the existence of these labels for different symptoms, we will not define them here at this stage, but instead say that FND is the umbrella term that we believe should be used instead of these other labels.

New DSM5 Definition of Somatoform Disorders

The current DSM5 manual - scroll down to page 10: http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf

The original definitions as they appeared in the DSM IV appear below, and remain for clarification purposes.

Old DSM IV Definition of Somatoform Disorders

Somatoform disorders are a range of subconscious and unintentional reactions where the body turns stress or an emotional or psychic conflict into physical symptoms, often but not always in motor and/or sensory areas that are usually under full conscious control.

Soma means the body. The label Somatoform Disorder is the umbrella label given to several conditions related to physical symptoms that come from stress and/or an emotional misunderstanding or psychic conflict but that have no anatomic cause, ie doing lots of tests will never find a cause for these symptoms.

Sometimes there can be a symbolic connection to a past or current conflict, eg if something is to frightening to look at, the person may not be able to see, or if a burden is too heavy to bear, they may get shoulder or back pain. There may be a subconscious belief that it is more bearable to accept the physical symptoms rather than the emotional conflict.

In general terms, a symptom can be defined as a Somatoform symptom if it is not accounted for by any other mental health diagnosis or medical tests, or it is in excess of what one would reasonably expect from any existing physical condition. The label of Disorder is given when these symptoms occur in defined quantities, in defined numbers of body systems/areas, for a defined period of time, according to whichever method of definition might be used (eg DSM III, IV, IV-R, or ICD-10 - see below).

Because Somatoform Disorders are produced by the subconscious mind, there is no conscious awareness that the symptoms are not real. The symptoms are not intentionally produced or feigned (as they are in Factitious Disorder or Malingering).

Conversion Disorder

Conversion Disorders mainly involve one symptom in one body system. The symptom can be quite spectacular in it's effect on functioning, eg suddenly being unable to walk or suddenly becoming effectively blind or deaf, or suddenly losing all ability to process any sensory input from one part of the body.

There is often an indifference to their symptoms.

MultiSomatoform Disorder

This is similar to, or a sub-threshold of, Somatisation Disorder, but only requires one or more physical symptoms that are not accounted for by any other mental health diagnosis or medical tests, or are in excess of what one would reasonably expect from an existing physical condition. The distress or impairment in social, occupational or other important areas much have been occurring for more than six months.

Somatisation Disorder

Somatisation Disorder involves many symptoms in many body systems, beginning before the age of 30 years. They must occur over a period of several years, and result in treatment being sought, or result in significant impairment occurring in social, occupational or other important areas of functioning.

Also required for this diagnosis is that each of the following criteria are met:

1. Four Pain Symptoms - a history of pain in at least four different sites or functions, eg head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse or during urination.

2. Two Gastrointestinal Symptoms other than pain, eg nausea, bloating, vomiting (other than during pregnancy), diarrhea, or intolerances to several different foods.

3. One Pseudo-Neurological Symptom not limited to pain, eg impaired coordination or balance, paralysis, weakness, difficulty swallowing or lump in the throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures, dissociative symptoms such as amnesia, or loss of consciousness.

Hypochondriasis, Malingering, Faking and Feigning

Although Hypochondriasis often presents symptoms that are similar to other forms of Somatoform Disorders, here the person believes that they have a serious, undiagnosed disease.

People with Somatoform Disorders are very frequently accused of being Malingerers. The frequent response is that they why would anyone in their right mind deliberately give themselves this disorder, this level of disability, this intense level of pain and suffering. They all say with intense conviction in closed forums where they can safely and honestly express their innermost thoughts and feelings, that they would do anything and everything in their power NOT to have this disorder and to get their old lives back.

It is our contention that Hypochondriasis, Malingering, Feigning are NOT Somatoform Disorder and should not be included here at all. True Somatoform sufferers do NOT consciously fake their symptoms for any reason, they do NOT malinger, they do NOT seek secondary gain or any other gain than to get their normal lives back.

To accuse a person with Somatic Symptoms of feigning, faking, malingering or seeking any kind of gain other than getting their lives back to normal is insulting, rude and extremely disrespectful. It is also extremely harmful to the person, and will most likely set back any chances of recovery significantly.

Body Dysmorphic Disorder

Body Dysmorphic Disorder is a disorder where the person is excessively concerned about or preoccupied by something they think is wrong with their body. This disorder causes sufficient stress to interfere with work and/or normal life.

Munchhausen

In this case, the person is aware of the symptoms, but has a compulsive need to be in the care of health professionals.

DSM III, DSM III-R, DSM IV and ICD-10 Definitions

There are four commonly accepted methods of defining Somatoform Disorders, DSM III, DSM III-R, DSM IV and ICD-10. However, there has been considerable debate over the past few decades about precisely defining this not-well understood group of disorders.

The main consensus is that none of these different definitions are one hundred percent correct, with the DSM IV definition being possibly a little too rigid, leaving people out when perhaps they should be included within one of the Somatoform Disorder categories. The DSM III definitions appear to be more generally accepted as being more accurate in the way they define these disorders.