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Disability, distress and delayed access to care in functional neurological disorder: cross-sectional study from an
Rebecca St L Moss1,2, Matthew J Lennon2,3, Sravan Anne2
1Discipline of Psychiatry & Mental Health, https://ror.org/03r8z3t63UNSW Sydney, New South Wales, Australia.
Background:
Functional neurological disorder (FND) is a common condition, but there remain substantial gaps in our understanding of its effects, particularly on severity of disability and health status.
Aims:
To characterise disability, quality of life and psychological and somatic symptom comorbidity in individuals with FND attending a specialist multidisciplinary clinic in Australia.
Method:
We conducted a cross-sectional analysis of patients assessed at an FND clinic in Sydney, Australia, between August 2022 and February 2025. We assessed disability (World Health Organization Disability Assessment Schedule (WHODAS 2.0)), health-related quality of life (EQ-5D five-level version (EQ-5D-5L), 36-Item Short Form Health Survey), psychological distress (Depression Anxiety and Stress Scale-21, Kessler Psychological Distress Scale (K10)) and somatic symptom severity (Patient Health Questionnaire-15 (PHQ-15)).
Results:
The cohort (N = 105) was predominantly female (74.3%), with a mean age of 35.4 (s.d. = 13.3) years. Functional seizures (46.7%) and functional weakness (45.7%) were the most common presentations. Only 33.7% were employed; 42.9% were unable to work because of FND. The average delay from diagnosis to clinic assessment was 356 days (s.d. = 463). WHODAS 2.0 scores indicated high levels of disability, exceeding international norms for both physical and mental illness. EQ-5D-5L scores were low, with 15.8% reporting a health state rated as 'worse than death'. Psychological distress and somatic symptom severity were high: 49.5% scored in the K10 'very high' range and 54.5% had high PHQ-15 scores.
Conclusions:
FND is associated with significant functional disability, poor quality of life and high levels of psychological and somatic symptom comorbidity. Delays in accessing appropriate care and high rates of vocational disruption highlight the need for earlier diagnosis and better access to integrated, multidisciplinary FND services in Australia.
