How Do I Explain the Diagnosis of Functional Movement Disorder to a Patient?

Functional movement disorders (FMDs) are common in neurological practice and a source of significant distress and disability. There is consensus that successful explanation which helps the patient feel confident that the diagnosis is correct is an essential platform for further treatment. Many doctors find delivering the diagnosis difficult. In these two short films, we explore why certain ways of approaching the explanation of an FMD can cause difficulties, especially failure to give an explicit diagnostic label, and a tendency to jump to a speculative etiological discussion about possible psychological factors instead of helping the patient understand the nature and mechanism of the movement disorder itself. Demonstrating the physical signs to the patient is often of key importance in helping the patient to understand that, first, the diagnosis is made positively and not just because the tests are normal. Crucially, it also shows the potential for symptom reversibility, which can then feed in to an understanding of how physiotherapy promotes automatic movement and "retrains the brain." Seeing the patient again is important in assessing the patient's confidence and readiness for therapy as well as calibrating your own communication skills.