Crimson Publishers Publish With Us Reprints e-Books Video articles

Full Text

Advances in Complementary & Alternative medicine

Time for a New Model of Functional Neurological Symptom Disorder (FNSD)

Iram Zehra Bokharey1*, Urusa Fahim2 and Zarish Shireen3

1Chief Clinical Psychologist, Department of Psychiatry, Mayo Hospital, Pakistan

2Academic Dean Humanities & Social Sciences, Kinnaird College for Women, Pakistan

3Assistant Psychologist, Department of Psychiatry, Mayo Hospital, Pakistan

*Corresponding author: Iram Zehra Bokharey, Chief Clinical Psychologist, Department of Psychiatry & Behavioral Sciences, Mayo Hospital, Lahore, Pakistan

Submission: June 10, 2022;Published: August 26, 2022

DOI: 10.31031/ACAM.2022.07.000664

ISSN: 2637-7802
Volume 7 Issue 3


This paper explores the dearth of research on Functional Neurological Symptom Disorder (FNSD) and proposes that it is necessary to come up with regionally relevant scholarly research on FNSD. This will help create models and coalesce it with conceptual yardsticks closer to our socio-cultural context. This can also help to create regionally rooted scholarship to carry out the much-needed therapeutic interventions.

Keywords:Functional neurological symptom disorder; Etiology; Psychoanalytic


Functional Neurological Symptom Disorder (FNSD) or Conversion Disorder, previously known as hysteria, has perhaps the longest recorded history amongst all psychiatric disorders, spread over 4000 years [1,2]. FNSD is quite common in Pakistan and other South Asian countries especially India [3,4], Bangladesh [5], and Nepal [6], whereas the prevalence of FNSD tends to be quite low in industrialized countries as compared to developing countries [7,8]. FNSD tends to be more common in certain demographies such as among the people with low socioeconomic status, limited literacy, residents of rural areas as well as among females and youth [4,9,10]. This psychiatric disorder disrupts the motor and sensory functionality such as blindness, aphonia, paralysis, pseudo seizures, difficulty in swallowing and walking etc. [1]. However, despite the frequent occurrence of FNSD (especially in South Asia) the available empirical evidence on this very important topic is rather scarce. This neglect is not limited to the area of research only, mental health professionals in Pakistan have yet to develop any indigenous theoretical model of FNSD or any approach for therapeutic intervention aligned to the cultural and social context of Pakistan. The most influential etiology of Conversion Disorder was outlined in the psychoanalytic theory put forward by Freud [2] over 100 years ago in Vienna, in a social, cultural and religious context that was quite different from the present-day context of Pakistan and other countries where it is common. Freud, along with other historians of hysteria or FNSD indicated that the clinical picture tends to vary with ethnicity and culture [2]. The prevalence of FNSD has been on the wane in industrialized and Western countries, and their claim that FNSD is “a fertile source of clinical error” [11] seems farcical in our part of the world. On account of this disparity, it is assumed that cultural factors tend to play a role in its etiology [4,12]. One of the possible reasons is that the developing countries have stronger institutions of religion as well as family and thus require an individual to conform to a certain set of rules, causing emotional suppression [1,12]. FNSD is deemed as a mechanism used by individuals as a non-verbal communication of the subconscious mind [13], as well as to exhibit distress around family conflicts and unexpressed emotions [12]. At times, even professionals lack adequate knowledge to deal with FNSD [14,15] hence there is a growing need to enhance awareness around it so that effective management can be planned. There is a general dearth of research on FNSD in both the global North and the global South but in the latter; the disorder is more prevalent than in the former. Another reason for the paucity of empirical evidence could be that there have been suspicions surrounding the existence of FNSD because it occurs without any underlying neuropathology [11,2]. However, in our part of the world, it’s still very much alive and kicking [16]. Furthermore, attention should also be brought to the role of xenobiotics and chronic global diseases on mental health in developing countries. The kind of changes in diet and lifestyle that are required to influence mental health must also be studied for positive impact [17-19]. In order to better serve the patients, the practitioners must stop relying on imported Western models and superimposing them on mental health patients in Pakistan as these interventions maybe a “hit or miss”.


There is a dire need to carry out research in countries where FNSD is more prevalent so as to develop indigenous and culturally appropriate models of conceptualisation as well as therapeutic intervention in order to help our patients in a comprehensive fashion. This would go a long way to serve our patients adequately in their particular socio-cultural context.


  1. Bokharey, Iram Z, Rahman NK (2013) Development of an indigenous symptom checklist for conversion disorder. Pakistan Journal of Clinical Psychology 12(1).
  2. Reynolds EH (2012) Hysteria, conversion and functional disorders: a neurological contribution to classification issues. Br J Psychiatry 201(4): 253-254.
  3. Ghosh JK, Majumder P, Pant P, Dutta R, Bhatia BD (2007) Clinical profile and outcome of conversion disorder in children in a tertiary hospital of north India. J Trop Pediatr 53(3): 213-214.
  4. Lakhani S, Sharma V, Desai NG (2022) Qualitative content analysis of cultural formulations of clients suffering from conversion disorder in North India. Indian J Psychiatry 64(1): 73-79.
  5. Roy S, Roy GK, Begum M, Karim ME, Akhter MS, et al. (2014) Psycho-social stressors and life events of the patients with conversion disorder: a study in a tertiary care hospital in northeast zone of Bangladesh. Bangladesh Journal of Psychiatry 28(2): 41-44.
  6. Shakya R (2005) Epidemic of hysteria in a school of rural eastern Nepal: a case report. Journal of Indian Association for Child and Adolescent Mental Health 1(4): 20-24.
  7. Hashmi AM, Mazhar N, Malik AK (2012) The burden on her soul: Conversion disorder in developing countries. Annals of King Edward Medical University 18(1): 9.
  8. Kring A, Johnson S, Davison GC (2012) Abnormal Psychology, Wiley Global Education, London.
  9. Fink P, Hansen MS, Oxhoj ML (2004) The prevalence of somatoform disorders among internal medical inpatients. Journal of Psychosomatic Research 56(4): 413-418.
  10. Ali S, Jabeen S, Pate RJ, Shahid M, Chinala S, et al. (2015) Conversion disorder-mind versus body: a review. Innovations in Clinical Neuroscience 12(5-6): 27-33.
  11. Stone J, Warlow C, Carson A, Sharpe M (2005) Eliot Slater's myth of the non-existence of hysteria. J R Soc Med 98(12): 547-548.
  12. Bokharey IZ, Fahim U, Tahir K (2021) Family conflicts are bitter splits that hurt: a qualitative inquiry toward understanding the impact of family issues in functional neurological symptom disorder. Frontiers in Psychology 12: 1814.
  13. Girouard E, Savoie I, Witkowski LC (2019) Functional neurological symptom disorder: A diagnostic algorithm. Behavioural Neurology 2019.
  14. Ndukuba AC, Ibekwe RC, Odinka PC, Muomah RC, Nwoha SO, et al. (2015) Knowledge of conversion disorder in children by pediatricians in a developing country. Niger J Clin Pract 18(4): 534-537.
  15. Fobian AD, Elliott L (2019) A review of functional neurological symptom disorder etiology and the integrated etiological summary model. J Psychiatry Neurosci 44(1): 8-18.
  16. Micale MS (2019) Approaching hysteria, In Approaching Hysteria, Princeton University Press, USA.
  17. Martins IJ (2021) Introductory chapter: sugar intake and global chronic disease. In Sugar Intake-Risks and Benefits and the Global Diabetes Epidemic. Intech Open.
  18. Martins IJ (2017) Nutrition therapy regulates caffeine metabolism with relevance to NAFLD and induction of type 3 diabetes. J Diabetes Metab Disord 4(1): 1-9.
  19. Martins IJ (2017) Apelinergic system defects with relevance to mental disorders in diabetes. World J Psychiatry Ment Health Res 1(1): 1001.

© 2022 Iram Zehra Bokharey. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.