Dr. David Perez

But how you got there, I think, varies patient to patient.

Yeah, that's where you want to think about biological factors, psychological factors, social, cultural, spiritual factors.

The piece there that maybe I just want to spend a moment on to dispel is this notion that childhood maltreatment or adverse life experiences are a definitive and required risk factor for the development of functional neurological disorder.

Okay.

That's not true.

It's a complex history.

It's received many different terms and labels, psychogenic illness, medically unexplained symptoms, physical problems related to a wandering womb.

The other framing that has been fairly pervasive is this notion of conversion disorder, the sense that there is psychological conflict

and that psychological conflict is being converted into physical symptoms with thoughts that if you addressed the psychological conflict, then the physical symptoms might resolve.

So that's a really significant oversimplification, and both neurology and psychiatry have this shared origin story of an interest in functional neurological disorder.

But as the history evolved,

the fields of neurology and psychiatry separated.

This separation, what it did was create a big gulf and a big gap for patients who kind of didn't quite fit into the lens of one discipline or the other.

That's right.

That approach of a diagnosis of exclusion is not how we do it today.

I think there's been a couple of pivotal things.

One is this use of a rule-in approach.

that it's no longer a diagnosis of exclusion, it's no longer a medical mystery, that there are signs we can look for to diagnose this condition with confidence and clarity.

The other pieces, too, were a removal of this notion that somehow physical symptoms, functional neurologic symptoms, began in the context of a psychological stressor.

It turns out, actually, now there's an increasing literature to suggest