Functional movement disorders : Exploring lived experiences and psychological interventions.

Bazydlo, Sylwia and Eccles, Fiona (2021) Functional movement disorders : Exploring lived experiences and psychological interventions. PhD thesis, Lancaster University.

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Abstract

This thesis examines issues related to functional movement disorders (FMD) and consists of three papers: a literature review, a research paper and a critical appraisal of the research process. The scoping literature review explored the characteristics of psychological interventions for FMD in research studies in the last 20 years. It found that FMD was conceptualised differently across the studies and interventions employed various techniques to target different assumed FMD mechanisms. The review identified that although psychological wellbeing, co-morbid physical symptoms and quality of life are important factors influencing and influenced by FMD, they are often not monitored in research studies. Acceptability of the interventions has also not been measured despite preliminary evidence of their low uptake and high dissatisfaction with psychological explanations of FMD. A number of recommendations have been made for future studies to improve design and evaluation of psychological interventions for this population. The research paper explored lived experiences of people with FMD. Ten semi-structured interviews were analysed using Interpretative Phenomenological Analysis. Three superordinate themes were generated: (1) The tug of war with the secret agent within: the power struggle with symptoms; (2) Navigating risks of disclosing the diagnosis: stigma and self-preservation (3) Pursuing hope, knowledge and treatments against helplessness and passivity. The findings indicate that people with FMD may face many internal and interpersonal battles whilst trying to maintain hope, a sense of control and identity. A sense of oppression, loss of control and stigma were explained in the context of discriminatory power distribution in the society and healthcare settings. Recommendations for research and clinical practice focus on facilitating patients’ empowerment and access to adequate treatments in FMD-informed services. The critical appraisal discusses the studies’ finding in the context of interpersonal and systemic power dynamics and reflects on the research process from critical theory perspective.