A Scoping Review of Functional Neurological Disorder in Sexual and Gender Minority People
Mackenzie Lerario1, Mark Fusunyan2, Christopher Stave3, Jeffrey Waugh4, Alison Wilkinson-Smith5, Valeria Roldan6, Alex Keuroghlian7, Jack Turban8, David Perez10, Tina Maschi1, Nicole Rosendale9
1Fordham Graduate School of Social Service and Greenburgh Pride, 2Department of Neuropsychiatry, 3Department of Library and Information Science, Stanford University School of Medicine, 4Department of Pediatrics, University of Texas Southwestern Medical School, 5Department of Pediatrics, Children’s Medical Center Dallas and UT Southwestern Medical School, 6Facultad de Medicina Alberto Hurtado, La Universidad Peruana Cayetano Heredia, 7Department of Psychiatry, Harvard Medical School and the Fenway Institute, 8Division of Child and Adolescent Psychiatry, 9Departments of Neurology and Weill Institute for Neurosciences, University of California San Francisco, 10Departments of Neurology and Psychiatry, Massachusetts General Hospital
Objective:
To report the literature regarding sexual and gender minority (SGM) people with functional neurological disorder (FND).
Background:
Minority stress and resilience theory describes the risks and protective factors that constitute social determinants of health and may increase neurological disparities among SGM communities. Little is known about the prevalence and experiences of SGM people with FND.
Design/Methods:
A search string with descriptors of SGM identity and functional somatoform disorders was entered into PubMed, Embase, Web of Science, PsycInfo, and CINAHL for articles that included SGM people diagnosed with FND, conversion disorder, or hysteria published before May 24, 2022, yielding 2940 items entered into Covidence. Two neurologists screened titles and abstracts based on predefined criteria, followed by a full-text review. A third neurologist adjudicated discrepancies. Eligible publications underwent data abstraction and statistical description.
Results:
Our search identified 4 published cases of presumed cisgender sexual minority (SM) people and 1 gender minority (GM) person with an FND or related diagnosis. GM people were overrepresented (5/106 [5%]) in a FND clinic sample compared to the general population (<1%). Among cases, predominant presenting symptoms included seizures (n=2), tic-like behaviors (n=1), swallowing dysfunction (n=1), or mixed presentation with disturbed consciousness (n=1). Initial diagnoses were made by electroencephalography (n=3) and clinical history and non-specific studies (n=2). No neurological exam data were reported. Stressors related to SGM experience preceded onset in 3 cases with improvement coinciding with discussion and/or affirmation of SGM identity in 3 cases.
Conclusions:
Despite a methodologically rigorous search, limited data exist on FND in SGM communities. The data support the relevance of minority stress and resilience theory within the broader context of a stress-diathesis framework. More research is needed to understand and address known barriers to SGM-affirming care, which may be further exacerbated by FND-related stigma.