The FND Puzzle: Piecing Together Clinical Understanding and Lived Experience.

Abstract

This thesis attempts to piece together clinical understanding of functional neurological disorder (FND) and the lived experiences of individuals with FND. Chapter One presents a systematic review and narrative synthesis that explores the knowledge of healthcare professionals regarding FND. 41 papers met the inclusion criteria. The extracted data were synthesised into themes that explored healthcare professionals’ knowledge, education and training, use of terminology, perceptions of FND, diagnosis, beliefs around the aetiology of FND, and approaches to treating and managing FND. The findings indicate inconsistencies and limitations in healthcare professionals’ education, knowledge, use of terminology, and clinical approaches. Consequently, healthcare professionals report low confidence and comfort in their recognition and management of FND. It is therefore proposed that improved education and guidelines, which transcend cultures and disciplines, are necessary to improve clinicians’ knowledge of FND and, in turn, improve patient outcomes. Chapter Two is an exploration of the post-diagnostic perspectives of people with FND in their attempts to seek support in the NHS. Interpretative phenomenological analysis was used to analyse interview data. Four interconnected themes were generated: ‘The complexity of a diagnosis’, ‘Deserted with a diagnosis’, ‘Journey towards disillusionment’, ‘Specialist support: a positive ending?’, highlighting the complex post-diagnostic experiences related to support seeking in the NHS. The clinical implications of these accounts are discussed, and recommendations for future research are outlined. Chapter three suggests theoretical and clinical implications from the synthesis of both papers and makes recommendations for practising clinicians in Wales, in relation to FND in the NHS. The thesis concludes with personal reflections on the research process.

Date of Award	22 Sept 2025
Original language	English
Awarding Institution	Bangor University
Supervisor	Lucy Piggin (Supervisor)