Functional neurological disorder is a feminist issue

Caoimhe McLoughlin¹, Ingrid Hoeritzauer¹, Verónica Cabreira^{1

2}, Selma Aybek^{3

4}, Caitlin Adams^{5

6}, Jane Alty^{7

8}, Harriet A Ball^{9

10}, Janet Baker^{11

12}, Kim Bullock¹³, Chrissie Burness¹⁴, Barbara A Dworetzky¹⁵, Sara Finkelstein^{6

16}, Béatrice Garcin¹⁷, Jeannette Gelauff¹⁸, Laura H Goldstein¹⁹, Anika Jordbru²⁰, Anne-Catherine Ml Huys²¹, Aoife Laffan²², Sarah C Lidstone²³, Stefanie Caroline Linden²⁴, Lea Ludwig²⁵, Julie Maggio^{16

26}, Francesca Morgante^{27

28}, Elizabeth Mallam²⁹, Clare Nicholson³⁰, Mary O'Neal¹⁵, Suzanne O'Sullivan³¹, Isabel Pareés^{32

33}, Panayiota Petrochilos³⁴, Susannah Pick³⁵, Wendy Phillips²¹, Karin Roelofs^{36

37}, Rachel Newby³⁸, Biba Stanton³⁹, Cordelia Gray⁴⁰, Eileen M Joyce⁴¹, Marina Aj Tijssen⁴², Trudie Chalder⁴³, Maxanne McCormick⁴⁴, Paula Gardiner^{45

46}, Indrit Bègue⁴⁷, Margaret C Tuttle^{6

48}, Isobel Williams⁴⁹, Sarah McRae⁵⁰, Valerie Voon^{51

52}, Laura McWhirter⁵³

Affiliations

¹ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
² Neurology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
³ Department of Clinical Neuroscience, Hopitaux Universitaires de Geneve, Geneva, Switzerland.
⁴ Department of Clinical Neuroscience, Inselspital Universitatsspital Bern Universitatsklinik fur Neurologie, Bern, Switzerland.
⁵ Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁶ Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁷ College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
⁸ Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
⁹ Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK.
¹⁰ Neurology, North Bristol NHS Trust, Westbury on Trym, UK.
¹¹ Randwick Specialist Centre, Private Practice, Randwick, New South Wales, Australia.
¹² College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
¹³ Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California, USA.
¹⁴ Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK.
¹⁵ Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹⁶ Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹⁷ Department of Neurology, Hopital Avicenne, Bobigny, France.
¹⁸ Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹⁹ Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
²⁰ Faculty of Humanities, Sport and Educational Science, University of South-Eastern Norway, Kongsberg, Norway.
²¹ Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²² Neurology, St. James's Hospital, Dublin, Ireland.
²³ University Health Network and the University of Toronto, Toronto, Ontario, Canada.
²⁴ Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
²⁵ Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany.
²⁶ Department of Physical Therapy and Functional Neurological Disorder Unit and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
²⁷ Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
²⁸ Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy.
²⁹ The Rosa Burden Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
³⁰ Therapy Services, National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
³¹ Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
³² Movement Disorders Program, Neurology Deparment Hospital Ruber Internacional, Madrid, Spain.
³³ Movement Disorders Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain.
³⁴ University College London Hospitals NHS Foundation Trust, London, UK.
³⁵ Section of Cognitive Neuropsychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
³⁶ Donders Institute for Brain Cognition and Behaviour: Donders Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.
³⁷ Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.
³⁸ Neurology, Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
³⁹ Neurology, King's College Hospital, London, UK.
⁴⁰ Neurology Psychotherapy Service, Sheffield Teaching Hospital, Academic Neurology Unit, The University of Sheffield, Sheffield, UK.
⁴¹ Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK.
⁴² Expertise Center Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
⁴³ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK.
⁴⁴ Physician assistant/patient with FND, FNDRecovery.com, -, Monument CO, USA.
⁴⁵ Psychological Therapy in Primary Care, University of Dundee, Dundee, UK.
⁴⁶ enhance-cbt.com therapist, NeuroSpecialist Physiotherapist, Stirling, UK.
⁴⁷ Department of Psychiatry, Geneva University Hospitals, Geneve, Switzerland.
⁴⁸ Department of Psychiatry, Functional Neurological Disorder Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁴⁹ Neuropsychology, Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK.
⁵⁰ Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK.
⁵¹ Psychiatry, University of Cambridge, Cambridge, UK.
⁵² Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
⁵³ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK laura.mcwhirter@ed.ac.uk.

PMID: 36977553
PMCID: PMC10511956
DOI: 10.1136/jnnp-2022-330192

Review

Functional neurological disorder is a feminist issue

Caoimhe McLoughlin et al. J Neurol Neurosurg Psychiatry. 2023 Oct.

. 2023 Oct;94(10):855-862.

doi: 10.1136/jnnp-2022-330192. Epub 2023 Mar 28.

Authors

Affiliations

¹ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
² Neurology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
³ Department of Clinical Neuroscience, Hopitaux Universitaires de Geneve, Geneva, Switzerland.
⁴ Department of Clinical Neuroscience, Inselspital Universitatsspital Bern Universitatsklinik fur Neurologie, Bern, Switzerland.
⁵ Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁶ Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁷ College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
⁸ Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
⁹ Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK.
¹⁰ Neurology, North Bristol NHS Trust, Westbury on Trym, UK.
¹¹ Randwick Specialist Centre, Private Practice, Randwick, New South Wales, Australia.
¹² College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
¹³ Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California, USA.
¹⁴ Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK.
¹⁵ Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹⁶ Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹⁷ Department of Neurology, Hopital Avicenne, Bobigny, France.
¹⁸ Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
¹⁹ Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
²⁰ Faculty of Humanities, Sport and Educational Science, University of South-Eastern Norway, Kongsberg, Norway.
²¹ Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²² Neurology, St. James's Hospital, Dublin, Ireland.
²³ University Health Network and the University of Toronto, Toronto, Ontario, Canada.
²⁴ Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
²⁵ Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany.
²⁶ Department of Physical Therapy and Functional Neurological Disorder Unit and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
²⁷ Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
²⁸ Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy.
²⁹ The Rosa Burden Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
³⁰ Therapy Services, National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
³¹ Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
³² Movement Disorders Program, Neurology Deparment Hospital Ruber Internacional, Madrid, Spain.
³³ Movement Disorders Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain.
³⁴ University College London Hospitals NHS Foundation Trust, London, UK.
³⁵ Section of Cognitive Neuropsychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
³⁶ Donders Institute for Brain Cognition and Behaviour: Donders Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.
³⁷ Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.
³⁸ Neurology, Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
³⁹ Neurology, King's College Hospital, London, UK.
⁴⁰ Neurology Psychotherapy Service, Sheffield Teaching Hospital, Academic Neurology Unit, The University of Sheffield, Sheffield, UK.
⁴¹ Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK.
⁴² Expertise Center Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
⁴³ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK.
⁴⁴ Physician assistant/patient with FND, FNDRecovery.com, -, Monument CO, USA.
⁴⁵ Psychological Therapy in Primary Care, University of Dundee, Dundee, UK.
⁴⁶ enhance-cbt.com therapist, NeuroSpecialist Physiotherapist, Stirling, UK.
⁴⁷ Department of Psychiatry, Geneva University Hospitals, Geneve, Switzerland.
⁴⁸ Department of Psychiatry, Functional Neurological Disorder Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁴⁹ Neuropsychology, Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK.
⁵⁰ Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK.
⁵¹ Psychiatry, University of Cambridge, Cambridge, UK.
⁵² Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
⁵³ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK laura.mcwhirter@ed.ac.uk.

PMID: 36977553
PMCID: PMC10511956
DOI: 10.1136/jnnp-2022-330192

Abstract

Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people with FND continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. There is abundant evidence that disorders perceived as primarily affecting women are neglected in healthcare and medical research, and the course of FND mirrors this neglect. We outline the reasons why FND is a feminist issue, incorporating historical and contemporary clinical, research and social perspectives. We call for parity for FND in medical education, research and clinical service development so that people affected by FND can receive the care they need.

Keywords: conversion disorder; functional neurological disorder; neuropsychiatry; somatisation disorder.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Comment in

Functional neurological disorder is a feminist issue.
Gadama Y. Gadama Y. J Neurol Neurosurg Psychiatry. 2023 Oct;94(10):873. doi: 10.1136/jnnp-2023-331597. Epub 2023 May 5. J Neurol Neurosurg Psychiatry. 2023. PMID: 37147118 No abstract available.

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Functional neurological disorder is a feminist issue

Affiliations

Functional neurological disorder is a feminist issue

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

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