Review Functional neurological disorder and functional somatic syndromes among sexual and gender minority people: A scoping review 2023 Lerario, Perez et al

[Andy]

Objective
To describe the current literature on functional neurological disorder and functional somatic syndromes among sexual and gender minority people (SGM).

Methods
A search string with descriptors of SGM identity and functional disorders was entered into PubMed, Embase, Web of Science, PsycInfo, and CINAHL for articles published before May 24, 2022, yielding 3121 items entered into Covidence, where 835 duplicates were removed. A neurologist and neuropsychiatrist screened titles and abstracts based on predefined criteria, followed by full-text review. A third neurologist adjudicated discrepancies. Eligible publications underwent systematic data extraction and statistical description.

Results
Our search identified 26 articles on functional disorders among SGM people. Most articles were case (13/26, 46%) or cross-sectional (4/26, 15%) studies. Gender minority people were represented in 50% of studies. Reported diagnoses included fibromyalgia (n = 8), functional neurological disorder (n = 8), somatic symptom disorder (n = 5), chronic fatigue syndrome (n = 3), irritable bowel syndrome (n = 2), and other functional conditions (n = 3). Three cohort studies of fibromyalgia or somatic symptom disorder reported an overrepresentation of gender minority people compared to cisgender cohorts or general population measures. Approximately half of case studies reported pediatric or adolescent onset (7/13, 54%), functional neurological disorder diagnosis (7/13, 54%), and symptom improvement coinciding with identity-affirming therapeutic interventions (7/13, 58%).

Conclusion
Despite a methodologically rigorous literature search, there are limited data on functional neurological disorder and functional somatic syndromes among SGM people. Several studies reported increased prevalence of select conditions among transgender people. More observational studies are needed regarding the epidemiology and clinical course of functional disorders among SGM people.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0022399923003483

 

[Saz94]

Wait wait this is just homophobia and transphobia???

Why did someone decide "we need to find out whether these illnesses we don't believe in are more common in the gays"???

 

[Midnattsol]

Wait wait this is just homophobia and transphobia???

Why did someone decide "we need to find out whether these illnesses we don't believe in are more common in the gays"???

At least in Norway there is some overlap between "trans people are actually depressed/anxious and if we cure their mental health issues they will not be trans" and "everything is FND" healthcare workers.

 

[Ash]

Yeah @Sarah94 they are really dusting off this old mouldy chestnut. Never too late to re-launch a campaign of discrimination and destruction against an already marginalised minority population.

 

[Sean]

At least in Norway there is some overlap between "trans people are actually depressed/anxious and if we cure their mental health issues they will not be trans" and "everything is FND" healthcare workers.

That is a big red flag about the mindset we are dealing with.

 

[SNT Gatchaman]

sexual and gender minority people (SGM)

Why is it necessary to stigmatise and belittle a group as a minority? It is a universal aspect of humanity and always has been (also other species, some of which have fascinating variation from the normative-assumed definitive binary).

While the classification of FDs [Functional Disorders] is complex and subject to ongoing debate, diagnoses encompassing distinctive patterns of symptoms remain prominent, including FND (previously conversion disorder) and functional somatic syndromes (FSS) such as irritable bowel syndrome (IBS), fibromyalgia, and chronic fatigue syndrome (CFS).

Again with the diagnostic creep. I guess the more they keep including these diagnoses in their framework, the more this literature will be redundant when their various biological bases are demonstrated.

A range of psychological and cognitive mechanisms are thought to contribute to FD symptomatology, including biased attentional processing, catastrophizing, alexithymia, and dissociation, while altered interactions between the brain and specific organ systems (e.g., visceral hypersensitivity, gutbrain axis, heart-brain axis) may contribute especially to particular phenotypic subtypes.

Keeping on saying it, as if there's any evidence or even internal logical consistency.

Interestingly, relevant factors in FD development and chronicity such as adverse life experiences, chronic stress, and stigma in healthcare settings are also disproportionately experienced by SGM people. Accordingly, SGM people may be at increased risk of FDs compared to their cisgender, heterosexual peers and existing research may be limited.

It is interesting isn't it? Any possibility your research has any role in this? I do agree that "existing research may be limited" though. Limited by poor methodology, claims not supported by evidence etc.

4. Functional neurological (conversion) disorder

I might have expected a move away from using the term "conversion disorder" in the rest of the paper.

But they do recognise the limits of the literature —

The overall literature was small and of low methodological quality, consisting mostly of case reports and cross-sectional studies

Eg —

A single case report described an adult male with ACR-diagnosed fibromyalgia and symptom onset during a period of increased internal conflict over male-male sexual fantasies. His condition gradually improved after disclosure of his conflict to providers and eventual engagement in his desired sexual behaviors.

Yep, that was definitely causation.

Alternatively though —

Regarding CFS and IBS diagnoses, two case-control studies based on rigorous case definitions reported no significant group differences in the proportion of sexual minority versus heterosexual people with these diagnoses