Drop attacks as a subtype of FND: A cognitive behavioural model using grounded theory, 2021, Revell, Stone et al

[Empire builders busy empire building]

Highlights

• A grounded theory approach explored idiopathic drop attacks.
• Our proposed model is consistent with current cognitive behavioural models of FND.
• A main precipitating factor of a fall related to another cause was identified.
• External triggers, anxiety, rumination and dissociation are maintaining factors.
• For many, idiopathic drop attacks may be best understood as a form of FND.

Abstract

Idiopathic drop attacks are falls to the floor, without warning, and without loss of consciousness, for which the cause is uncertain. They are poorly studied but recent research suggests that many idiopathic drop attacks may be usefully considered within the spectrum of functional neurological disorder (FND).

The aim of this study was to test a cognitive behavioural model of idiopathic drop attacks, in order to inform formulation and treatment. Interviews and diaries were completed by seven individuals experiencing drop attacks, and were analysed using a grounded theory qualitative data approach.

Through the coding and synthesis of data into themes, a proposed cognitive behavioural model was identified, with a main precipitating event in all cases being a fall related to another cause, such as a mechanical fall or a fall due to medical reasons. Additional precipitating factors identified included situational triggers, high levels of stress, and dissociation. A maintaining cycle of thoughts, emotion and behaviour is outlined.

Our proposed theory is consistent with current cognitive behavioural models of FND. A cognitive behavioural understanding of drop attacks when considered part of FND aids formulation in clinical practice, and suggests that cognitive behavioural therapy interventions for FND may also be applicable in this population.

Open access, https://www.sciencedirect.com/science/article/pii/S2589986421000654

 

So my ME brain has totally read this as "Dog attacks as a subtype of FND". I guess I shouldn't give them ideas though.

 

Sorry but this just made me really angry. This happened to me once. I ended up falling down the stairs (top of the staircase a great place for this to suddenly happen!). I didn't seek treatment. I subsequently developed hearing loss and we don't know if it had anything to do with all of that. In any case, this is terrifying.

 

"External triggers, anxiety, rumination and dissociation are maintaining factors."

Sorry (part 2!) but "rumination" as a "maintaining" factor?

Is this a term that comes up a lot in this kind of literature, or is it just this paper?

 

As far as I understand the 'logic' behind the FND construct, rumination is an important part of the theory. They believe that unnecessary focus on the symptoms that they have decided are 'functional' is enough to maintain those symptoms, or at least make the patient believe that they still have those symptoms. Which is why the answer is always CBT, as they believe changing how the patient thinks about their symptoms will be enough to get rid of their symptoms - and why the whole idea is so dangerous for PwME.

 

Low Vitamin B12? Dehydration? Nutritional deficiencies? Malnutrition? Sleep deprivation? If doctors refuse to believe that nutrient levels are important to human life then of course the cause of falls will be "uncertain".

I'm afraid my brain saw the word "bear" between "drop" and "attacks". I have no idea why. Australian folklore isn't something that crops up in my life very often.

 

Ah hah! It's obvious that you have been subconsciously excessively ruminating on your fear of dangerous marsupials and that the solution is a course of Cognitive Bear-havioural Therapy!! Naturally if it doesn't work then it's your fault, not any fault with the theory...

 

The authors seem to want it all ways at once: ‘rumination’ is focusing too much, but dissociation could be characterised as not focusing enough.

Anything and everything could be co opted into justifying this dubious logic.

 

Sign me up!!

 

A little bit off topic but @Andy how do you survive the discovery of all these monstrous doings?

It is horrific. This one stimulated my gag reflex. The creep factor in these BPS ers going after patients who have falls.

I want to break down every sentence of this piece and explain why it’s lies falsehood inaccurate misleading or just wrong but I can’t bare to cast my eyes over it one more time.

 

I'm just largely used to it now, I think, which isn't necessarily a good thing. If I didn't think it was important that we know as much as possible about what they are claiming then I would certainly do my best to avoid it all.

 

Yeah. We have to know don’t we?
It will be inflicted upon us whether we recognise it or not. Too inefficient to try to address the consequences without examining the process.

I find this reality deeply unpalatable. I am glad you have attained the detachment necessary for this purpose.

Would that perhaps fall under the category of psychological resilience? I think so yes I do.

 

It’s frustrating that these folk take their ideas and use them to malign individuals facing issues that are clearly not just ruminations of the mind.

Surely there is enough work helping people who are genuinely struggling to cope with reality, without trying to label every poorly understood condition as effectively self-perpetuated?

An individual close to me has a few issues with reality. The person is ageing and has developed strong notions about:
a) weight gain (insists on being bought increasingly huge clothing despite not gaining an ounce)
b) vitamin deficiency diseases (despite no signs or symptoms & the care home providing excellent meals)
c) blindness (despite later telling us about a book being read)

There is no doubt in this case that there is a lot of rumination going on, and an inability to recognise that the issues fixated upon are not in fact real.

An extended course of CBT had no effect. (Which actually makes me wonder if this issue is a downstream effect of something pathophysiological rather than an issue within the individual’s personal control.)

I just don’t get it. If CBT doesn’t do much for this sort of problem (which it was surely designed to help), then why is there a push to apply CBT in other situations?

 

Ok, i can’t get over the title.

Drop attack treated with grounded theory.

Geez. can’t make that stuff up. Let me tell you, people who faint, they find the floor on their own No need for ‘grounding’

Edit to add:

Says everything we need to know. Hysteria again.

 

They have come up with a story of how drop attacks could fit their theory, no more, no less. Classic confirmation bias. It would be just about acceptable to suggest it is worth exploring CBT in this population if the results in similar populations were good but they are not, they are abysmal.

Alongside htis, there is more and more acknowledgement of OI as a medical condition which is more plausible than rumination and the obvious similarity of drop attacks to cataplexy which is a known brain disease often associated with narcolepsy.

For any credibility they should say why rumination is a stronger theory than brain damage.