Introduction
Functional neurological disorder (FND) sits at the intersection of neurology and psychiatry, characterized by symptoms such as weakness, seizures, and sensory disturbances. In recent years, public understanding has evolved alongside renewed scientific interest, yet stigma, misrepresentation, and uneven access to care persist. This article distills a mixed-methods study that analyzes discussions about FND on X (formerly Twitter), combining social network analysis with content analysis to reveal who shapes the conversation, how narratives unfold, and what this means for patients, clinicians, and researchers.
Why X as a Focus for FND Discourse?
Social media platforms like X facilitate rapid information exchange and community formation around health topics. The study used search terms such as “functional neurological disorder,” “FND,” “#FND,” and “conversion disorder” to collect English-language posts with substantial visibility. By examining original posts, replies, and reposts over two months in 2024, researchers aimed to identify influential voices and the themes driving online discourse about FND and related conditions like ME/CFS and long COVID.
Network Structure and Key Influencers
Network visualization revealed two dominant communities: a group centered on long COVID/ME/CFS and another comprising mainly FND-focused content. Interestingly, voices from long COVID/ME/CFS often exhibited stronger connectivity and wider reach, sometimes amplifying anti-FND sentiment. In contrast, the FND-centric cluster was smaller but denser, with professional content-makers and patient advocates contributing to a more specialized dialogue.
Influence was assessed using degree centrality (how many direct interactions a user has) and closeness centrality (how quickly a user can reach others in the network). Notably, the most prominent accounts by these metrics were frequently not traditional FND professionals or organizations; several top influencers expressed skepticism about FND within a broader health-context debate. This underscores the complexity of online authority: credibility is as much about network position as it is about expertise.
Content Themes: What People Talk About
A reflexive thematic analysis of 1,104 posts identified six core themes:
- Conflict — battles over diagnosis and the legitimacy of FND, with meta-debates about the risk of diverting attention from other conditions.
- Deception — concerns about pseudoscience, “gaslighting,” and the cry of “rebranding hysteria.”
- Mistreatment and Harm — issues around misdiagnosis, gendered stigma, and abusive online interactions.
- Symptom Experience — personal narratives of living with FND and comorbid challenges.
- Knowledge — calls for clearer explanations of terms like “functional” and “psychosomatic,” and the sharing of new research resources.
- Support — messages of solidarity, advocacy, and campaigns for better care and funding.
The study found that while some content aimed to educate and support, a significant portion of highly viewed posts expressed skepticism toward FND, often framed within broader debates about biomedical vs. psychosocial models of illness. This polarization risked validating stigma and shaping public perceptions in ways that could affect patient experiences and policy.
Implications for Stakeholders
For clinicians and researchers, the findings highlight the need for proactive, evidence-based engagement on social media. Positive potential exists in using X to share updates, debunk myths, and spotlight patient-centered resources. For patient communities, the study emphasizes the value of building credible, well-connected networks to counter misinformation and reduce harm from online narratives. Finally, platform moderators and policymakers should consider the health implications of algorithmic amplification and seek ways to promote accurate, empathetic health communication while safeguarding user privacy.
Limitations and Future Directions
Limitations include reliance on self-declared roles, a two-month observation window, and exclusion of non-English content. Future work could compare multiple platforms, incorporate qualitative interviews with key influencers, and track how online discourse relates to offline care-seeking and policy changes.
Conclusion
The online discourse around FND on X reveals a dynamic, contested space where long COVID/ME/CFS communities often exert substantial influence. By mapping networks and themes, this study provides a blueprint for understanding how medical narratives are formed online and how clinicians, researchers, and patient advocates can respond with accurate, compassionate, and accessible information.
