An Exploration of How [FND] Is Discussed on X (Twitter): Mixed Methods Study Using Social Network and Content Analysis 2025 McLoughlin et al

[Sean]

I wondered if I was included in this category.

It's bizarre accusation to make, isn't it. All professions & professionals are 'self-declared'. WTF are the various medical colleges if not self-declared (and self-regulating, very poorly at times)?

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This study could provide a template for assessing how other stigmatized conditions are perceived on the web.​

Be careful what you wish for.

I find it offensive and disgusting beyond words how they are shamelessly exploiting the stigmatisation angle to promote themselves, given the profession's central role in creating and entrenching that sitgmatisation.

 

[SNT Gatchaman]

And "self-declared" professionals is such a clumsy piece of propaganda it is laughable.

To be fair they are using that term for themselves as well.

Of these 58, only 10 were from self-declared professionals associated with FND, while 19 were from self-declared professionals associated with other conditions.

I think "self-declared" here just means the profile claims "Dr" or "Prof" etc and details their professional expertise, but it's just a Twitter account and doesn't link to a definitive identity or regulatory authority for absolute confirmation.

 

[Hutan]

Some of this stigma is driven by older paradigms of FND such as conversion disorder, “medically unexplained,” or “hysteria.” In the last 25 years, the disorder has been repositioned as one at the interface of neurology and psychiatry, where “brain” is just as important as “mind.”

There's not much difference in how these 'older paradigms of FND' differ from the current paradigm. The treatment is still the same. They can reposition all they like, it's still old wine in new bottles.

On the current version of FND:

can present in varying ways including weakness, paralysis, seizures, and cognitive and sensory symptoms

It is described as a disorder involving abnormalities within and across areas implicated in attention, emotion processing, movement, and a sense of agency

I wonder if the student understands how vague that is. In the hands of an incompetent, lazy and bigoted health professional, a definition like that can make a very wide range of health conditions liable to be labelled as FND.



Here's the paragraph on ME/CFS and Long Covid in the Introduction (paragraphs added):

FND may exist with other problems—common comorbid symptoms of FND include fatigue, cognitive symptoms such as attention and concentration difficulties, and sleep disturbance [1]. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID, while distinct conditions, also share these core symptoms. Myalgic encephalomyelitis (ME) is typically diagnosed by features of debilitating fatigue, postexertional malaise, nonrefreshing sleep, and cognitive difficulties [7], while long COVID shares similar features [8]. There are further commonalities; FND, ME/CFS, and long COVID are often associated with significant disability, but not yet diagnosed by a distinct laboratory or radiological test, and are the subject of much debate [9].

Such debate has only heightened since the emergence of long COVID, with its associated chronic fatigue [10-12]. Some clinicians and researchers argue that a functional disorder paradigm may explain some cases of long COVID and ME/CFS [13,14], and some take the stance that it does not [15,16]. Some clinicians and researchers consider that these interrelated conditions have become inappropriately conflated and misunderstood, and FND has gotten mixed up and misrepresented in this debate [17,18]. These issues heighten vulnerability for patients with these conditions, turning to social media for information and support.

That's extraordinarily fence-sitting and vague.

The Introduction of the paper noted earlier that FND involves abnormalities in attention. In the first sentence of that quoted paragraph, 'cognitive symptoms such as attention' is noted only as a common co-morbid symptom of FND. And then the next sentence suggests that ME/CFS and LC share 'these core symptoms'. So, which is it? Are abnormalities in attention a key part of the definition of FND, being a core symptom, or just a common co-morbidity?

Fatigue, concentration difficulties and sleep disturbance are also listed as common comorbid symptoms of FND in the first sentence, but in the second sentence they are core symptoms shared with ME/CFS and LC.

It seems that this paper is non-committal on whether ME/CFS is an FND - it says some clinicians and researchers say 'that a functional disorder paradigm may explain some cases of Long Covid and ME/CFS' and some say that it does not. Even the sentence noting that some clinicians and researchers think there has been inappropriate conflation of the conditions and misunderstanding is made equivocal by referring to the conditions as 'interrelated'.

Some clinicians and researchers consider that these interrelated conditions have become inappropriately conflated and misunderstood, and FND has gotten mixed up and misrepresented in this debate [17,18].

Here's a definition of interrelated:

connected in such a way that each thing has an effect on or depends on the other:

• Anxiety and depression are often interrelated.

This idea of ME/CFC and LC being illnesses that are related to FND is reinforced a bit later in the paper:

in the context of discussions about FND on the web and related chronic illnesses

In the context of our study, influencers are individuals with expertise in FND and related chronic illnesses

I don't think the two references given for that statement, Davenport et al and Van der Feltz-Cornelis et al, suggest that there are interrelationships between the two 'conditions' at all. Both those papers do tend to equate FND with functional motor disorders only, ignoring the bundling of ME/CFS into the concept, and attempt to make clear distinctions between FND and ME/CFS.

I do think that paragraph does look a like a bit of a backtrack. It is looking like the authors are acknowledging that ME/CFS might possibly be a separate thing. That is of course a smart move if they are concerned that a biological basis for ME/CFS might eventually be found. The problem is that FND clinicians can leave an academic paper trail of accepting ME/CFS while continuing to pick off vulnerable people with ME/CFS as fodder for their empire-building.

 

[Hutan]

The natural human inclination of attention toward emotional or moral issues [26] can be harnessed to interact with algorithmic factors ultimately designed to capture user attention—in what has been dubbed the “human-algorithm interaction” [27].

On that point, we've seen FND proponents use various emotional/moral issues such as taking a feminist angle i.e. the suggestion that a supposed underfunding of FND is discrimination against women, because 70% of people diagnosed with FND are women.

Understanding both the narratives and the network structures in which these popular users operate is crucial for analyzing how credible information is hindered and how misinformation spreads or remains contained.

That's an extraordinary statement taken together with the following

To reduce the risk of bias, we aimed to ensure that the analysis remained grounded in the data, considering and reflecting on our existing assumptions throughout.

These authors have approached the study with a very firm idea of what they believe is credible and what is misinformation. There's little evidence of self-reflection.

While other conditions’ networks are mostly made up of patients, the FND community has a comparatively stronger presence of health care professionals compared with patients.

That speaks volumes. If the people selling something that has been around a long time are the only ones singing its praises and nearly everyone else is criticising it, maybe it isn't very good.

 

[Utsikt]

Everyone's already made the important points about this study. A funny subtle distinction I'll just note is that they say

Usually when people say a condition is stigmatized they mean the patients or that *having it* is stigmatized, here though it seems like they're complaining their diagnostic category itself is stigmatized lol

It seems like they might also be implying that being an FND professional is stigmatised.

 

[Jonathan Edwards]

It seems like they might also be implying that being an FND professional is stigmatised.

It's as bad as shoplifters being stigmatised.

 

[rvallee]

Ironic they used X/Twitter given that’s known for misinformation anyways.

And especially ironic that pretty much all patient advocacy had vanished from the platform at the time they did their study. Even more ironic they mention how two of the researchers themselves use twitter, and they're not even aware of that. Or ignore it because it's convenient for their narrative.

They did a social media analysis and they don't even know the basics of social media dynamics, are not even aware that anything COVID is throttled down and filtered by the algorithm, and that illness advocacy is completely isolated in bubbles, with basically no reach outside of mutual networks. They mention how social media promotes controversy, and how it might play against them spreading their gospel, but don't even realize that it would only work to benefit them, if the topic wasn't stifled by the algorithm.

 

[rvallee]

It seems that this paper is non-committal on whether ME/CFS is an FND - it says some clinicians and researchers say 'that a functional disorder paradigm may explain some cases of Long Covid and ME/CFS' and some say that it does not. Even the sentence noting that some clinicians and researchers think there has been inappropriate conflation of the conditions and misunderstanding is made equivocal by referring to the conditions as 'interrelated'.

All of which completely debunks the long-standing lie about this opposition coming from a "small vocal minority" of unhinged activists, or whatever, but it's not as if facts matter here. Even psychosomatic literature is filled with acknowledgement that this is simply false, that most patients subject to psychosomatic pseudoscience object to it because it conflicts with our experience of reality, and they are literally on record saying that using the term functional is precisely because it fools more people, at first, about meaning something else. It's not even some indirect admission.

It doesn't matter now, but they are putting in plain writing how they are fully aware of all the issues, and simply choose to do harm anyway. But they can feel confident that no accountability will ever occur because no one is actually responsible, and even in cases where tort is recognized, where the extensive record of deceit and ample knowledge of the damage they are doing can never be held accountable, because the entire industry is at best complicit, and justice and proper compensation are completely unrealistic because too many people would have to go to prison, and the damages amount in the trillions.

The operating word here is: impunity. This is what humans do when they know they can never be held accountable for what they do: they break things. Here the things they are breaking happen to be people, but from what they write of us, it's hard to see that they even recognize that.