Managing FND Symptoms: Completing a Five Areas Assessment

Getting a diagnosis of Functional Neurological Disorder (FND) can be a challenging experience, often leaving individuals feeling overwhelmed and confused about the nature of their condition. Navigating through the complexities of managing FND symptoms requires a proactive approach to understanding one's unique experience. Regardless of where you find yourself on your journey with managing FND symptoms, gaining insight can be empowering.

One valuable tool in this process is the Five Areas Assessment, written about in “Overcoming Functional Neurological Symptoms: A Five Areas Approach”, by Chris Williams. The Five Areas Assessment widely used method for examining the impact of FND symptoms on various aspects of your life. By delving into five key areas, this assessment provides a comprehensive framework for evaluating how these aspects influence your FND symptoms. These five areas typically include your physical health, emotions, thoughts, behavior, and the impact on daily activities.

Understanding the Five Areas Assessment and learning how to apply it to your life can offer valuable insights into the interconnectedness of your symptoms and the broader context of your well-being. This assessment encourages a holistic perspective, recognizing that FND symptoms affect not only the physical aspect of health but also the emotional, cognitive, and behavioral dimensions.

Embarking on this self-assessment journey may be made more manageable by seeking support from a healthcare professional or involving a trusted loved one. Their guidance can contribute to a more thorough exploration of your symptoms. Moreover, sharing this information with someone close to you can create a supportive environment that enhances your ability to cope with the challenges posed by FND symptoms.

The Five Areas Assessment serves as a valuable tool for introspection and understanding the multifaceted nature of FND symptoms. Embracing this approach can empower individuals to actively engage in their healthcare journey, and help to foster resilience.

Conducting your own Five Areas Assessment:

Step 1: Mapping out your symptoms

The first crucial step toward gaining control and insight is to meticulously map out the nuances of your unique symptoms. This process involves a thoughtful examination of the FND symptoms you are encountering. Taking the time to explore and document these details can be instrumental in creating a comprehensive understanding of how these symptoms manifest in your daily life.

Begin by answering a series of questions designed to provide clarity and structure to your observations:

What is the symptom? Clearly define the nature of each symptom you are experiencing. Whether it's a motor function issue, sensory disturbance, or cognitive challenge, providing a detailed description can be helpful.

When did it first start? Establishing a timeline is essential for discerning patterns or triggers associated with the onset of your symptoms. Identify when each symptom initially manifested, allowing you to track any changes or developments over time.

How often do you have it? Document the frequency of each symptom occurrence. Understanding whether symptoms are constant, or have specific triggers can contribute to a better understanding of their impact on your daily life.

What helps? Explore and write down any strategies or interventions that alleviate or mitigate your symptoms. Identifying effective coping mechanisms or support systems can be invaluable for developing tools for symptom management.

What makes it worse? Equally important is recognizing factors that exacerbate your symptoms. This could include specific activities, environments, or stressors that contribute to the escalation of your symptoms. Identifying these triggers empowers you to make informed decisions about your lifestyle and daily activities.

Which symptoms are worsened by stress or mood? Stress and low mood can often amplify certain symptoms, and understanding these connections allows for a more holistic approach to managing FND symptoms.

By systematically addressing these questions, you create a detailed map of your symptoms that serves as a foundation for further exploration and discussion. This structured approach not only aids in self-awareness but also lays the groundwork for informed decision-making in your journey toward managing FND symptoms.

Step 2: Understanding Your Thinking

When attempting to unravel the complexities of FND symptoms, the journey can be fraught with overwhelming emotions and apprehensions about the future. It's not uncommon for individuals to experience feelings of fear and uncertainty, prompting well-intentioned yet unhelpful advice from friends and family such as "just don't think about it." However, dismissing or suppressing thoughts about FND symptoms often proves counterproductive, as attempting to avoid them can paradoxically intensify their presence. Part of understanding your thinking is to understand how certain thoughts might not be helping, but rather harming you. Here are some examples of unhelpful thinking styles that might be negatively impacting you:

Catastrophizing: Magnifying the severity of symptoms or foreseeing the worst possible outcomes can heighten stress and anxiety, exacerbating the impact of FND symptoms on mood and behavior.

All-or-nothing thinking: Adopting an extreme, black-and-white perspective can limit your ability to see nuances in your experience. This rigid thinking style may lead to a sense of failure or hopelessness when faced with challenges.

Personalization: Assuming excessive responsibility for events or symptoms, attributing them solely to personal shortcomings, can result in heightened feelings of guilt or shame.

Overgeneralization: Drawing broad, sweeping conclusions based on isolated incidents may lead to a distorted view of reality and contribute to unwarranted negative emotions.

Mind Reading: Presuming you know what others are thinking or assuming negative judgments can fuel social anxiety and withdrawal, impacting your overall well-being.

Engaging in unhelpful thinking styles can set off a chain reaction, influencing mood and behavior changes. Negative thoughts may lead to feelings of stress or anger, prompting a tendency to avoid activities that provoke stress. This avoidance can further hinder coping mechanisms and contribute to a cycle of reduced engagement with life. Are there any of these thinking patterns that you find yourself using? Talking through thinking styles with a healthcare professional, such as a therapist, can be very helpful in learning how to change your thinking styles and gain awareness of the patterns that you engage in.

Area 3: Exploring Feelings and Emotions

Understanding and navigating emotions is a deeply personal journey. Recognizing the diversity in emotional experiences, the Five Areas Assessment seeks to discern the intricate relationship between emotions and symptom exacerbation. By shedding light on these connections, individuals can gain valuable insights into the ways emotions impact their overall well-being.

Here are some reflection questions to guide you in identifying and understanding the connections between your emotions and the exacerbation of symptoms:

How do you experience emotions? Are you someone who easily identifies and expresses emotions, or do you find it challenging to decipher and articulate what you're feeling?

Do certain emotions trigger or intensify your symptoms? Consider whether specific emotions have an impact on the severity or frequency of your symptoms. Some individuals may notice that stress, anxiety, or sadness, for example, tend to coincide with an increase in FND symptoms.

Are there patterns in your emotional responses to symptoms? Explore if recurring emotional patterns are associated with the onset or escalation of symptoms. Recognizing these patterns can provide valuable insights into the emotional triggers that may contribute to the manifestation of FND symptoms.

How do you typically cope with intense emotions? Examine your coping mechanisms for dealing with strong or challenging emotions. Whether through seeking support, engaging in activities, or employing relaxation techniques, understanding your coping strategies is integral to emotional well-being.

Do your emotions influence your behavior and daily activities? Consider whether your emotional state has an impact on your behavior and the activities you engage in.

Are there emotions you find difficult to express or discuss? Explore any hesitations or challenges you may face in expressing certain emotions.

By reflecting on these questions, individuals can gain a deeper understanding of their emotional experiences within the context of their FND symptoms.
Area 4: Addressing Altered Behavior

The impact of negative thoughts and emotions can extend beyond the internal realm, manifesting in observable changes in behavior. Recognizing and understanding these behavioral shifts is a crucial aspect of the Five Areas Assessment.

Examples of Altered Behavior:

Reduced Activity: Negative thoughts and emotions associated with FND symptoms can lead to a reduction in overall activity. This behavioral change may manifest as a decreased interest in hobbies, social activities, or even routine daily tasks. Individuals may find themselves withdrawing from once-enjoyed activities due to concerns about symptom exacerbation or fear of judgment from others.

Avoidance: Avoidant behaviors often arise as a response to perceived threats or stressors related to FND symptoms. This may involve avoiding specific situations, places, or activities that are associated with heightened stress or discomfort. Over time, this avoidance can limit opportunities for personal growth and contribute to a cycle of fear.

Social Withdrawal: Negative thoughts and emotions linked to FND symptoms can lead to isolation and social withdrawal. Individuals may withdraw from social interactions, even with close friends and family, as a protective mechanism to shield themselves from potential judgment or scrutiny related to their symptoms. These behavioral changes can impact relationships and contribute to a sense of loneliness.

Safety Behaviors: Some individuals may develop safety behaviors as a way to cope with FND symptoms. These behaviors are often enacted to prevent or minimize discomfort and may include rituals, repetitive actions, or specific routines. While intended to provide a sense of control, safety behaviors can inadvertently reinforce the belief that certain situations are inherently threatening. For example, if someone experiences FND symptoms such as weakness or tremors during stressful situations, they might avoid those stress-inducing activities or environments to prevent the symptoms from occurring. While this avoidance behavior might offer temporary relief, it can also reinforce the belief that certain situations are dangerous or intolerable, which can contribute to the maintenance of symptoms over time.

Impaired Concentration and Memory: Negative thoughts and emotions can interfere with cognitive processes, leading to impaired concentration and memory. This behavioral change may affect work or academic performance and contribute to frustration.

Recognizing these altered behaviors is a crucial step in understanding the broader impact of FND symptoms on daily functioning. The Five Areas Assessment encourages individuals to not only identify these behaviors but also to explore the underlying thoughts and emotions that drive them. Seeking support from healthcare professionals, therapists, or support groups can further enhance the effectiveness of addressing behavioral changes associated with FND symptoms.
Area 5: Situation, Relationship, and Practical Problems

The impact of FND symptoms extends beyond individual thoughts and behaviors, seeping into the fabric of daily life, relationships, and practical circumstances. The fifth area of the Five Areas Assessment delves into these external dimensions, encouraging individuals to reflect on how FND symptoms influence their situation, relationships, and practical challenges.

Take a moment to read through some of these examples and reflect on if any of these apply.

Occupational Challenges: Consider how FND symptoms affect your ability to engage in work or daily activities. Are there specific tasks that have become more challenging due to symptoms? Reflect on any changes in productivity, or job satisfaction that may be linked to your symptoms.

Educational Impact: If you are a student, explore how FND symptoms impact your academic pursuits. This may involve assessing changes in concentration, memory, or participation in educational activities.

Financial Considerations: Examine how FND symptoms influence your financial situation. This could involve changes in employment status, income, or additional expenses related to healthcare and symptom management. Consider whether financial stressors contribute to your overall symptoms.

Relationship Dynamics: Reflect on how FND symptoms affect your relationships with family, friends, and colleagues. Are there challenges in communicating your experience to others? Consider how your symptoms impact social interactions, emotional connections, and the support you receive from those around you.

Social Isolation: Explore whether FND symptoms contribute to feelings of social isolation or withdrawal. Reflect on any changes in social activities, hobbies, or community engagement. Understanding the impact on your social life can help identify opportunities for connection and support.

Daily Functioning: Assess how FND symptoms influence your day-to-day activities and routines. This may include challenges in self-care, household tasks, or transportation. Reflect on any adjustments you've had to make to accommodate your symptoms and whether these changes impact your overall quality of life.

Practical Problem-Solving: Consider how you approach and navigate practical challenges associated with FND symptoms. Reflect on your problem-solving strategies, coping mechanisms, and the effectiveness of any accommodations you have implemented in your daily life.

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Taking the time to write out these reflections can be a powerful exercise in gaining clarity and identifying specific areas where FND symptoms are impacting your life. This process not only enhances self-awareness but also lays the groundwork for support. Additionally, discussing these reflections with healthcare professionals or loved ones can provide valuable insights and foster a supportive network for helping manage FND symptoms.

There are many therapists here at The Center for Growth who are ready to help you take the next step toward managing your FND symptoms.

You can self schedule an in-person or virtual therapy session at the Center for Growth by calling (215) 922- LOVE (5683) x 100.

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