No exaggerated tremor severity perception in functional tremor, 2022, Huys, Edwards et al

Abstract

Background

Symptoms of functional neurological disorder tend to be variable, yet patients often report them being present constantly and of permanently severe intensity. Furthermore, they typically worsen when they are mentioned or during clinical examination. Such phenomena are sometimes interpreted as indicating symptom exaggeration or even fabrication.

Methods
To test the notion of inaccurate symptom perception or reporting, we directly compared subjective to objective tremulousness of reaching movements in people with a functional action tremor, people with an organic action tremor and healthy controls. Identical subjective and objective measures were used, thus eliminating any potential metacognitive confounders. Furthermore, we assessed both immediate perceptual experience with a real-time perceptual task, offering the most direct comparison; and near-time retrospective reports as the latter contribute to peoples’ overall judgement of their condition.

Results
There was no significant difference in subjective compared to objective tremor severity between the three groups for either the real-time or retrospective conditions.

Conclusion
People with functional tremor do not perceive or report their tremor in an exaggerated manner, compared to people with an organic tremor or healthy controls. We propose that symptom exacerbation through attentional mechanisms provides an alternative explanation for findings that are frequently attributed to ‘exaggeration’.

Paywall, https://link.springer.com/article/10.1007/s00415-022-11265-x

 

Is it not possible then that people with functional tremor have an undiagnosed organic tremor?

 

@John Mac

Agreed.

 

Uh... I mean... wow. Children can see through that nonsense. Easily. Obviously, if symptoms are considered exaggerated, it's someone saying that, it's not the universe having some sort of alarm about them, they are "exaggerated" according to someone, someone saying that, for reasons. So that if someone says something is exaggerated when it's not, it's that evaluation that is obviously false.

Again, with the blatant showing that medicine is completely unable of self-examination if it involves any blame or fault, that even dealing with something so obvious they literally cannot find even the possibility that they could simply have been wrong, the most obvious explanation, literally the default.

Exaggeration, just as much as beauty, is in the eye of the beholder. The beholder is wrong, but here is simply able to insist otherwise. There are two loci of attention here: the patient's and the physician's. The patient is reporting things and the physician is interpreting. Although it's possible for patients to exaggerate, and sometimes it's sadly necessary simply to emphasize as otherwise symptoms are dismissed entirely, the determination of what is appropriate vs exaggerated is 100% the physician's as this is what gets written down.

Seriously, though, this paper could be replaced entirely with this meme:

 

Ironically, more or less the same problem with "lie detectors". They are detecting something alright, just not lies.

Polygraphs aren't used in happy fun time settings, they are used antagonistically by design, to catch liars in a bind, who may have unrelated things they'd rather keep secret, or simply knowing that by virtue of their every reaction being judged, they may end up on the wrong end of someone wanting to catch someone for something, anything.

Personally, I find it completely normal for people to be "nervous", if we want to call being especially alert with that label, when in a context where everything we say and do will be judged, because there can be serious consequences from that judgment. It can sometimes take months, years, to get a single consult, and there may not be another chance for years after that. The stakes are so damn high for us, everything depends on those few minutes.

Especially in the context of chronic illness, where physicians act like both judge and prosecution, they so badly want to trip us that they will make mistakes simply because that mistake means they're right. I remember one time I had some spasticity issues with one hand that happened around the time of a GP appointment. I presented it wrong because I was already so exhausted by then, but my GP dismissed it saying she had seen that hand be OK, even though she pointed at the wrong one. Medicine is heavily judgmental and patients quickly realize that they can say all the right things and be perfectly truthful and still be failed. Not fail, be failed. We know who holds all the power in this relationship and that this process is often final, sometimes with long-term consequences.

This would be OK if it hadn't been misused exactly the same way for decades. But it has. Frankly, I find that dealing with physicians is a lot like dealing with the police in a context in which they can and will give us trouble just because they can. It has nothing to do with guilt or hiding anything, it's that we know that the process is not fair, that we can be faulted for things we didn't even do and that the consequences can be all the way up to deadly, which the physician will often never even know about, to them we're just 15-30 minutes out of a single day, nothing more.