Table 2

Features of some common explanations offered by neurologists to patients for functional disorders and their associated problems

Strategy	Comments
1. Making no diagnosis: no neurological disease (includes the term ‘non-organic’)	The patient is likely to go elsewhere to seek a diagnosis
2. Making an ‘unexplained’ diagnosis, eg, these things are common in neurology and we don't really know why they happen	The patient is likely to go elsewhere to seek a diagnosis Many neurological disorders have known pathology ‘unexplained’ or ‘unknown’ cause, eg, multiple sclerosis/Parkinson's disease Neurologists should be familiar with functional disorders and be able to make a positive clinical diagnosis, eg, migraine/Parkinson's disease
3. Making an incomplete diagnosis—eg, telling someone with a 3-week history of functional hemiparesis triggered by migraine that they just have migraine39	This may be acceptable to the patient (and be easier for the neurologist) but leads to a missed opportunity to understand symptoms and their potential for reversibility
4. Trying to explain that the problem is psychological—eg, explaining that these symptoms are often ‘stress-related’	Likely to be rejected by most (80%) of patients Often equated by patients as an accusation that the symptoms are ‘made up’ or ‘imagined’ Many patients with these symptoms do not have identifiable stress or psychiatric disorder This is, however, consistent with referral for psychological treatment
5. Making a functional diagnosis	Consistent with a disorder of nervous system functioning Does not leap to conclusions about the cause Could be interpreted as something irreversible that cannot be improved with physical or psychological rehabilitation.