Psychological Heterogeneity in Functional Neurological Disorders

  • Kathryn Harper

Student thesis: Doctor of Clinical Psychology


Neurological symptoms (e.g., seizures, movement disorders) that cannot be explained by organic disease or injury and that occur alongside evidence of preserved brain functioning are classified as Functional Neurological Disorders (FND). FND is a common diagnosis within neurology clinics and is associated with high levels of distress. Despite symptoms and features varying considerably between individuals, FND is often described as a homogeneous disorder and as such these differences are not considered within research and treatment. This thesis includes two studies that explored psychological heterogeneity within FND. In the first, a systematic review was conducted to identify all studies that utilised a data or formulation driven approach to identify psychological subgroups in this area. These were amalgamated in a narrative synthesis that captured five tentative subgroups: people with learning disabilities, low on distress, possible emotion suppression, dysregulated and distressed, distressed anxious/depressed™ and trauma. In the second, which aimed to develop professional consensus regarding heterogeneity within FND, a structured Delphi measure was developed based on the review findings and from information collected through several focus groups. Therapists working within the field underwent three Delphi Rounds with a view to reaching a consensus view about which groups of people with FND might have distinctive needs, and which treatments might only be used with certain people. Whilst some core elements of treatment were suggested to be suitable for everyone, the consensus was that treatment should be tailored to individual need. Future research is required to formulate the most significant variations and consider how these can be incorporated into clinical practice and research.
Date of Award31 Dec 2022
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorRichard Brown (Supervisor)

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