Every day, medical consultations are invaded by a plethora of patients with very diverse complaints, for which it is not possible to find, after a careful clinical history completed with the pertinent complementary tests, an organically based condition that can explain them. As Dr. Arias Gómez, Head of the Neurology Section of the Hospital de Conxo – CHUS, explains, this type of disorders are nowadays called psychogenic or functional disorders, and may present with symptoms that concern psychiatry, neurology and, in general, all medical specialties.
Types of functional disorders
Functional disorders are subdivided into four major subtypes:
- Dissociative disorders: these disorders cause symptoms of dysfunction of higher functions (dissociative amnesia and fugue, as main examples).
- Conversive disorders: give rise to neurological symptoms (paralysis, sensory disturbances, epileptic pseudocrisis, balance disturbances, involuntary movements, parkinsonisms…).
- Factitious disorders: very diverse disorders, in which the patient simulates, with florid symptoms and signs, multiple diseases, seeking medical attention from different professionals and in numerous centers; this behavior can endanger the physical integrity of the patients (operations for supposedly acute abdomens, invasive radiological studies…). Factitious disorders have received the name of Münchausen’s syndrome, after the famous Germanic baron, protagonist of a book of fantastic and impossible adventures; if it is a third person, who takes care of a child or a handicapped elderly person, who reports the factitious symptomatology, it is called “Münchausen by proxy”. When the factitious alterations are of the mental sphere (for example, clinically indicative of dementia), the factitious disorder is called Ganser’s syndrome.
- Simulation disorders: the patient consciously seeks to deceive the physician in order to obtain a benefit (compensation, pension, exemption from military service, etc.).
What is the origin of functional disorders?
The origin or development of functional disorders is a matter of controversy: the patient does not produce the symptoms and signs consciously but, in most cases, these are the expression of emotional conflicts more or less close, which remained unresolved and which act from the depths of the subconscious (limbic system); in this way they modify the function of other brain areas and cause inhibitions or stimulations, which escape the voluntary-rational control of the subject who suffers them.
We are dealing with very peculiar conditions that generate suffering and confusion in the patient and his or her environment, who almost always find it difficult to understand this physiological explanation of the conversion of an unconscious emotional conflict into a neurological or somatic disorder in general.
How are functional disorders diagnosed?
Psychogenic disorders of the neuropsychiatric area (dissociative and conversive) are a major cause of seeking medical attention. This is a difficult field, which often gives rise to conflicts and tensions in the doctor-patient relationship.
The diagnosis and detailed explanation of neuropsychiatric psychogenic disorders is the responsibility of specialists in neurology, who must also provide the relevant explanations for them. Such diagnosis should be meditated and reasoned; we should not insist on performing more and more tests, since such an attitude only generates mistrust and leads to chronify the condition and hinder its resolution. It is not a matter of saying that we do not know the cause of what is happening, nor of attributing obscure guilt to the patients. The diagnosis must be clear and the explanation will focus on the potentially reversible alteration of the functioning of the nervous system, since there is no structural damage. The support of psychiatric and psychological consultation is also helpful to treat comorbidities and to inquire into unresolved emotional conflicts.