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Home / Treatment / Psychological therapy

Psychological therapy

Psychologists and psychiatrists who are familiar with the area can have a lot to offer people with FND

Psychologists working in general hospitals, rehabilitation, pain clinics or in a chronic fatigue service are likely to be familiar with this area. Liaison psychiatrists or Neuropsychiatrists will definitely be familiar with it.

Misconceptions about psychology / psychiatry and FND

There are a number of reasons why patients with FND can benefit from seeing a psychologist / psychiatrist

Many patients develop FND without being stressed. The symptoms may have happened out of the blue or in relation to a physical injury, and the only thing thats stressful is having the symptoms!

And there are also many people who develop FND at times of stress. But this does not mean the stress was the only factor or even the main one.

Of course life stresses, both recent and remote, makes everything worse, and it can be a major cause of FND in some people, but in many people it is not that important.

Many people understand why other people may need to see a psychologist / psychiatrist, but have trouble thinking of themselves as being someone that ever would. If you want to ‘pull out all the stops’ of treatment, you may have to leave aside your prejudices to do so.

People also sometimes think that if they see a psychiatrist or a psychologist, the discussion and ‘treatment’ will be like old fashioned psychoanalysis. The classic, (and mistaken view) is that the psychiatrist says ‘ tell me about your childhood’, you spill the beans on every secret you’ve ever had and then the psychiatrists tells you how you’ve ended up this way.

Seeing a psychiatrists or psychologist is rarely like this. Exploring things that happened in the past can be very helpful for some people. But those explorations usually come from someone who has got to know you.

As has been explained on the ’causes’ page, it can be very difficult to pinpoint the reasons why people get FND. Sometimes its enough just to say, ‘You have a vulnerability to FND and functional disorders, lets try to work out how we can get you better’

So why should I see a psychologist/ psychiatrist?

A common, and reasonable, question is, “How can talking about it actually help my symptoms?”

These are the common ways in which “talking about it” can help:

  1. Being able to spend longer understanding the nature of your condition – eg that it is common, not your fault, not imagined, not due to disease but a potentially reversible problem with the function of your nervous system. It can take a long time to get your head around that, a psychologist can help you to do it
  2. Talking about behaviours that might be getting in the way of your recovery – eg if you have chronic back pain and weak leg you may have pain which is worse on exercise. You may have been avoiding moving your back because you fear that you may be damaging your back further. By understanding you are making the pain temporarily worse but not damaging your back, this can help you experiment with moving your back more.
  3. Talking about thoughts that are getting in the way of recovery – eg. someone with dissociative seizures may find that they become really worried about whether they are going to have another attack. The more they anticipate the attack, for example in a supermarket or walking down stairs, the more likely it is to occur.
  4. Identifying feelings of low mood and worry. – eg your symptoms may have been going on for some time. You may have developed feelings of depression, anxiety or panic attacks. Less commonly other symptoms may be present like post-traumatic symptoms, obsessive thoughts or eating problems.
  5. Problem solving – many of lifes problems don’t have easy solutions. But some everyday hassles, like how to solve debt problems, or how to get help for a child who is being bullied may have solutions that you hadn’t thought of. One less problem on the list can help things overall
  6. Identifying traumatic events – some people with FND have experienced highly traumatic events which have made them more likely to have FND symptoms. THese may involve adverse experiences as a child or adult. Physical or sexual abuse for example probably promotes vulnerability to dissociation later in life. Trauma focused therapy may be helpful in that setting and many people with FND actively seek such help to talk through and process difficult experiences.

If you put these all together then you may be surprised how helpful ‘talking about it’ can be.

Psychologists and psychiatrists vary a lot in their approach. You may need to talk to your family doctor or neurologist about who might be most helpful to see.

This section will be upgraded at some point.

If you want to see what the evidence is for psychological therapy in FND here is a useful recent review. Gutkin et al.

https://jnnp.bmj.com/content/jnnp/92/1/36.full.pdf

Also, you can see what the outcome of the largest psychological therapy trial for FND was in this video from the CODES trial