Diagnostic labels in functional disorders 2026 Novak

[Andy]

Abstract​

Diagnostic labels in functional disorders are explored with particular reference to functional neurological disorder (FND). Use of the term ‘functional’ is discussed, and is compared with alternative terminology. Relevant considerations including avoidance of inaccurate nomenclature and dualist labels, and the impact of diagnostic label choice on individual patient experience and broader service provision are considered.

Open access

 

[rvallee]

The term ‘functional’ is also considered appropriate by patients. In 2002, for example, 86 patients’ opinions of the term ‘functional’ were compared with their opinions of synonyms including ‘psychosomatic’ and ‘medically unexplained’: in the context of functional weakness, ‘functional’ weakness was perceived by patients as having far fewer negative connotations, and as being less offensive, than the alternatives.2

Philip Morris re-branded as Altria following the tobacco-cancer trials, then back again to Philip Morris International. Always the same company. Half of papers try to pretend otherwise, sometimes they will tell the truth and admit they are synonyms. This is like trying to find the perfect slur, one that means the same thing as the original but has that "oh, I didn't meant it that way". All of this is politics in a complete imbalance of power wielded in secret, behind closed doors.

They are discussing branding and marketing, about a shady concept that is more than a century old. This is never a legitimate thing.

The term ‘medically unexplained’ is another inaccurate label. Functional symptoms are in fact not unexplained: there is an established and continually expanding evidence base for the mechanisms involved in symptom generation. These include, but are not limited to: variability in interoceptive sensitive and accuracy (awareness of internal bodily states),6 in predictive coding (how brains predict what is going to happen based on prior beliefs and new sensory input),7 and in levels of self-directed attention,8 dissociation,9 the effects of heightened sympathetic drive, and associations between these mechanisms and neurodivergence.

Yeah, literally of all of this is speculative.

Standardised terminology is beneficial for patients and clinicians and facilitates population-level work. Despite its limitations, ‘functional’ is a non-dualist and non-stigmatising term that is already well-established in neurology and some other specialties; extending it to other specialties would improve clarity

And this is straight up bullshit. Most patients see through the lies, and so do most physicians. All of this is theatre, everyone knows the play is an act, but the show must go on.

 

[Lou B Lou]

BMJ December 21st, 2002

'What should we say to patients with symptoms unexplained by disease? The “number needed to offend”
Jon Stone, Wojtek Wojcik, Daniel Durrance, Alan Carson, Steff Lewis, Lesley MacKenzie, Charles P Warlow, Michael Sharpe


'.... We calculated an “offence score” for each diagnosis as the proportion of patients who endorsed one or more of the following connotations, which we deemed offensive: “putting it on,” being “mad,” or “imagining symptoms.” We then used this value to calculate a “number needed to offend”—that is, the number of patients who can be given this diagnosis before one patient is offended....'


'Many diagnostic labels that are used for symptoms unexplained by disease have the potential to offend patients. Although “medically unexplained” is scientifically neutral, it had surprisingly negative connotations for patients. Conversely, although doctors may think the term “functional” is pejorative, patients did not perceive it as such. As expected, “hysterical” had such bad connotations that its continued use is hard to justify, although it is the only term in this list that specifically excludes malingering.

Diagnostic labels have to be not only helpful to doctors but also acceptable to patients. Many of the available labels did not pass this basic test, but “functional” (in its original sense of altered functioning of the nervous system3) did. This label has the advantage of avoiding the “non-diagnosis” of “medically unexplained” and side steps the unhelpful psychological versus physical dichotomy implied by many other labels. It also provides a rationale for pharmacological, behavioural, and psychological treatments aimed at restoring normal functioning of the nervous system.4 We call for the rehabilitation of “functional” as a useful and acceptable diagnosis for physical symptoms unexplained by disease.'

What should we say to patients with symptoms unexplained by disease? The “number needed to offend” - PMC

pmc.ncbi.nlm.nih.gov

 

[NelliePledge]

It’s not the name it’s the concept

 

[bobbler]

BMJ December 21st, 2002

'What should we say to patients with symptoms unexplained by disease? The “number needed to offend”
Jon Stone, Wojtek Wojcik, Daniel Durrance, Alan Carson, Steff Lewis, Lesley MacKenzie, Charles P Warlow, Michael Sharpe


'.... We calculated an “offence score” for each diagnosis as the proportion of patients who endorsed one or more of the following connotations, which we deemed offensive: “putting it on,” being “mad,” or “imagining symptoms.” We then used this value to calculate a “number needed to offend”—that is, the number of patients who can be given this diagnosis before one patient is offended....'


'Many diagnostic labels that are used for symptoms unexplained by disease have the potential to offend patients. Although “medically unexplained” is scientifically neutral, it had surprisingly negative connotations for patients. Conversely, although doctors may think the term “functional” is pejorative, patients did not perceive it as such. As expected, “hysterical” had such bad connotations that its continued use is hard to justify, although it is the only term in this list that specifically excludes malingering.

Diagnostic labels have to be not only helpful to doctors but also acceptable to patients. Many of the available labels did not pass this basic test, but “functional” (in its original sense of altered functioning of the nervous system3) did. This label has the advantage of avoiding the “non-diagnosis” of “medically unexplained” and side steps the unhelpful psychological versus physical dichotomy implied by many other labels. It also provides a rationale for pharmacological, behavioural, and psychological treatments aimed at restoring normal functioning of the nervous system.4 We call for the rehabilitation of “functional” as a useful and acceptable diagnosis for physical symptoms unexplained by disease.'

What should we say to patients with symptoms unexplained by disease? The “number needed to offend” - PMC

pmc.ncbi.nlm.nih.gov

A very important article to be keeping hold of the reference to given some who doubt the intention of certain individuals and

Certain words and how they are used deliberately as double-speak

Given the list of authors here which I think also deserve some highlighting