A meta-ethnographic synthesis of the experiences of stigma amongst people with functional neurological disorder
Open accessAbstract
PURPOSE: Functional neurological disorder (FND) causes many neurological symptoms and significant disability. It is often misunderstood by medical professionals and the public meaning stigma is regularly reported. The aim of this review was to synthesise the qualitative findings in the literature to develop a more in-depth understanding of how people with FND experience stigma to inform future interventions. METHOD: This review used a meta-ethnography approach. Five databases were searched (PsycINFO, Web of Science, CINAHL, MEDLINE, and EMBASE) in February 2021 and updated in July 2022 for qualitative papers in FND. Included papers were critically assessed using the critical appraisal skills programme (CASP) checklist. Data were analysed and synthesised utilising meta-ethnography. RESULTS AND CONCLUSION: Sixteen papers were included in the final synthesis. Four major themes emerged: stigmatized by delegitimization; stigmatized by social exclusion and rejection; coping with stigma; and stigma and identity. The results identified negative, stigmatizing attitudes towards people experiencing FND symptoms in a variety of contexts including healthcare and other social institutions. The effects of stigma led to further exclusion for participants and appeared to trigger coping styles that led to additional difficulty. Stigma is a key part of the illness experience of FND and needs to be addressed.
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A meta-ethnographic synthesis indicated that stigma towards people with FND was a central part of their experience, experienced in all aspects of their lives from psychological experience to interactions with wider society.
“A meta-ethnographic synthesis, combining multiple qualitative studies to identify overarching themes, indicated that stigma towards people with FND was a central part of their experience (18), highlighting how stigma was experienced in all aspects of their lives from their own psychological experience to their interactions with wider society.”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [18]
Experiencing stigma is a common consequence of chronic illness and is perceived as a constant threat by some individuals impacted by it, which has been documented with patients with FND.
“Experiencing stigma is a common consequence of chronic illness and is perceived as a constant threat by some individuals impacted by it (32) which has been documented with patients with FND (17, 18).”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [18]
The authors argue that participants must manage both their illness and the associated stigma.
“The authors argue that participants must manage both their illness and the associated stigma.”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [18]
Research on people with FND highlights the personal costs of stigma, showing how individuals try to cope with it.
“Research on people with FND highlights the personal costs of stigma, showing how individuals try to cope with it (18).”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [18]
Research with FND patients highlights that psychological explanations of FND appear closely associated with notions of identity.
“Research with FND patients highlight that psychological explanations of FND appear closely associated with notions of identity (18).”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [18]
Exclusively psychological explanations added to the sense of delegitimization which often comes in the form of not being believed, according to cited authors.
“These authors found that exclusively psychological explanations added to the sense of delegitimization which often comes in the form of not being believed (18)”
From A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD). (2025) · cites this paper as [18]
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BackgroundRegnath, F., Biersack, K., Schröder, L., Stainer, M.-C., von Werder, D., Pürner, D., Haslinger, B. A., & Lehnen, N. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111694 · Cited by 9 · see citing works
The role of neuropsychology in the care of patients with functional neurological symptom disorder
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“…Carson, 2017), dichotomizing mind/brain conceptualizations (Rawlings & Reuber, 2018), and judgment/stigma about “ medically unexplained illnesses ” (Foley et al., 2022), has led to a great deal of avoidance and “ passing the buck ” occurring amongst clinicians (Barnett et al., 2022; Ducroizet et…”
Trastornos neurológicos funcionales (TNF): unificando el dualismo mente-cerebro
Marín‐Medina, D. S., Arenas-Vargas, P. A., Arias-Botero, J. C., Gómez-Vásquez, M., & González, C. A. S. (2024) · Acta neurológica colombiana · doi:10.22379/anc.v40i4.1888 · Cited by 8 · see citing works
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“…people and their parents in other functional symptom populations, such as none-pileptic seizures [22,36], highlighted that individuals diagnosed with FND reported feeling misunderstood and dissatisfied with psychological explanations for the disorder, experiences of stigma and self-stigma [37,38].”
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“These individuals also have to face unique challenges from both physical and social environments [30,50], leading to their withdrawal from social scenes.”
The impact of socioeconomic status on the management of epilepsy: a qualitative study
Spooner, J., Bandyopadhyay, S., Baraka, M., & Sander, J. W. A. S. (2025) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2025.110685 · Cited by 6 · see citing works
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Connors, M. H., Kinder, J., Swift, E., Kanaan, R., Sachdev, P. S., & Mohan, A. (2024) · Journal of Clinical Neuroscience · doi:10.1016/j.jocn.2024.05.043 · Cited by 4 · see citing works
“Barriers to this include the lack of dedicated services [20 – 24]; uncertainty around the appropriate clinical speciality [25]; limited training in FND amongst neurologists, psychiatrists, and other clinicians [26 – 28]; and misconceptions and stigma within healthcare settings [29].”
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“FND symptoms and associated physical disabilities, emotional distress, psychiatric comorbidities and illness-related stigma have a profound and highly disabling impact on motor, sensory and cognitive function and overall quality of life 3,7–9 .”
Sofronas, M., Wright, D. K., Macdonald, M. E., Bitzas, V. B., & Carnevale, F. A. (2024) · Journal of Hospice and Palliative Nursing · doi:10.1097/njh.0000000000001054 · Cited by 3 · see citing works
A qualitative analysis of patients' day-to-day living with functional cognitive disorder (FCD).
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Diagnostik und Therapie funktioneller neurologischer Bewegungsstörungen
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“How do I explain something I don’t understand?”: Young people’s experiences of functional tics
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“Individuals with FND frequently encounter stigma and dismissal in healthcare [3,4].”
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The journey to diagnosis and care of functional neurological disorder (FND)
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“41,42 In addition, our study offers novel prospective insights into how different FMD subtypes may diverge in terms of clinical presentation, functional impairment, and outcomes.”
Correspondence: Inaccurate reference leads to tripling of reported FND prevalence
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An introduction to functional neurological disorders in the emergency department
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The journey to a diagnosis of Functional Neurological Disorder (FND)Preprint
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NUTRITIONAL THERAPIES FOR NEUROLOGICAL DISEASES: AN INTEGRATIVE REVIEW
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“Foley and colleagues [27] discuss this relationship with regard to the experience of stigmatization.”
Chan, Z., Ogden, J., Cummings, S., Garner, B., & Arbabi, M. (2025) · Psychology and Health · doi:10.1080/08870446.2025.2491589
“These findings reflect previous research highlighting how the symptoms of FND are disabling, distressing and unpredictable (Bailey et al., 2025; Carson & Lehn, 2016; Foley et al., 2022).”
Towards a Framework to Support Employees With Hidden Disabilities
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The Dawn of Functional Neurologic Disorder
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“Stigma and a lack of social support can increase psychological distress, decrease quality of life, and increase suicide risk (Foley et al., 2024; Oexle et al., 2018; Yanos et al., 2020).”
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Every time dualism is mentioned in clinical debate, a philosopher is thrown out of heaven
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“However, studies have reported that patients with FND are at best wary, and sometimes outright reject, psychological explanations because they perceive them as implying willfulness, blame, and stigma (Foley et al., 2024).”
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- Authors
- Foley, C., Kirkby, A., & Eccles, F. J. R.
- Affiliations
- Lancaster University (GB)
- Salford Royal Hospital (GB)
- Corresponding author
- Eccles, Fiona J. R.
- ORCID
- Eccles, Fiona J. R.
- Venue
- Disability and Rehabilitation
- Publisher
- Informa UK Limited
- Published
- 2022-12-15
- Volume
- 46
- Issue
- 1
- Pages
- 1-12
- ISSN
- 0963-8288 (ISSN-L)
- 1464-5165
- OpenAlex
- W4311577894
- Cited by
- 48
- References
- 58
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 16 · 2023: 3
- FWCI
- 5.73
- Type
- journal article
- Language
- en
- Update notices
- correction (2023-01-18)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Disability and Rehabilitation (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lancaster EPrints (Lancaster University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- conversion disorder, stigma, illness experience, delegitimization, social exclusion, coping with stigma, identity, clinician attitudes
- MeSH terms
- Anthropology, Cultural, Attitude, Conversion Disorder, Humans, Qualitative Research, Social Stigma
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