Awareness, Misconceptions, and Cultural Beliefs About Functional Neurological Disorders: A Cross-Sectional Study

Functional Neurological Disorder (FND) is a common and disabling neuropsychiatric condition that remains highly stigmatized, partly because of misconceptions regarding symptom legitimacy and causation. This study assessed awareness, perceptions, cultural beliefs, and intended actions toward FND among healthcare providers (HCPs) and the general population in Saudi Arabia.

A cross-sectional, self-administered online questionnaire was distributed across Saudi Arabia in Arabic and English. The misconception composite was defined as endorsement of any supernatural cause or endorsement ("yes" or "sometimes") that patients fake or exaggerate symptoms. Because belief in voluntary control is conceptually adjacent to the fabrication component, a sensitivity analysis restricted the outcome to supernatural attribution alone.

Of 326 participants (88 HCPs and 238 general-population respondents), overall awareness of FND was 27.3% and was higher among HCPs than the general population (44.3% vs 21.0%, p < 0.001). Only 31.9% correctly identified FND as a real neurological disorder occurring without structural damage. The misconception composite was present in 29.4%, with no difference between HCPs and the general population (27.3% vs 30.3%, p = 0.600). At least one supernatural cause was endorsed by 17.5%, more often by the general population than HCPs (21.4% vs 6.8%, p = 0.002); the evil eye was most frequently cited (13.2%). Mixed causal models were the most common explanatory framework (44.2%). In the restricted-outcome regression, female sex was associated with lower odds of supernatural attribution (OR 0.45, 95% CI 0.23-0.89, p = 0.021), whereas belief in voluntary control was not (OR 1.43, 95% CI 0.61-3.39, p = 0.414). HCPs were more likely to accept an FND diagnosis for a family member (60.2%), whereas the general population was more likely to seek a second medical opinion (68.9%).

Awareness and understanding of FND were limited in this sample of healthcare providers and general-population respondents in Saudi Arabia. Supernatural and biomedical explanations frequently coexisted rather than competed. Educational strategies should therefore be culturally responsive, address uncertainty and intentionality-related stigma, and engage with existing explanatory models while clearly communicating an evidence-based FND diagnosis.