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Peer-reviewedCC BY-NC 4.0Neuropsychiatric Disease and Treatment

Awareness, Misconceptions, and Cultural Beliefs About Functional Neurological Disorders: A Cross-Sectional Study

  • Sohaila Alshimemeri1
  • Kholoud Alnakshabandi2
  • Ghada Alghubaini1
  • Raghad Almuslih3
  • Samah H Alkhawashki2
  1. 1Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  2. 2Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  3. 3Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract

Aim: Functional Neurological Disorder (FND) is a common and disabling neuropsychiatric condition that remains highly stigmatized, partly because of misconceptions regarding symptom legitimacy and causation. This study assessed awareness, perceptions, cultural beliefs, and intended actions toward FND among healthcare providers (HCPs) and the general population in Saudi Arabia.

Methods: A cross-sectional, self-administered online questionnaire was distributed across Saudi Arabia in Arabic and English. The misconception composite was defined as endorsement of any supernatural cause or endorsement (“yes” or “sometimes”) that patients fake or exaggerate symptoms. Because belief in voluntary control is conceptually adjacent to the fabrication component, a sensitivity analysis restricted the outcome to supernatural attribution alone.

Results: Of 326 participants (88 HCPs and 238 general-population respondents), overall awareness of FND was 27.3% and was higher among HCPs than the general population (44.3% vs 21.0%, p < 0.001). Only 31.9% correctly identified FND as a real neurological disorder occurring without structural damage. The misconception composite was present in 29.4%, with no difference between HCPs and the general population (27.3% vs 30.3%, p = 0.600). At least one supernatural cause was endorsed by 17.5%, more often by the general population than HCPs (21.4% vs 6.8%, p = 0.002); the evil eye was most frequently cited (13.2%). Mixed causal models were the most common explanatory framework (44.2%). In the restricted-outcome regression, female sex was associated with lower odds of supernatural attribution (OR 0.45, 95% CI 0.23–0.89, p = 0.021), whereas belief in voluntary control was not (OR 1.43, 95% CI 0.61–3.39, p = 0.414). HCPs were more likely to accept an FND diagnosis for a family member (60.2%), whereas the general population was more likely to seek a second medical opinion (68.9%).

Conclusion: Awareness and understanding of FND were limited in this sample of healthcare providers and general-population respondents in Saudi Arabia. Supernatural and biomedical explanations frequently coexisted rather than competed. Educational strategies should therefore be culturally responsive, address uncertainty and intentionality-related stigma, and engage with existing explanatory models while clearly communicating an evidence-based FND diagnosis.

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Cite

BibTeXRIS
BibTeX
@article{alshimemeri2026awareness,
  title = {{Awareness, Misconceptions, and Cultural Beliefs About Functional Neurological Disorders: A Cross-Sectional Study}},
  author = {Sohaila Alshimemeri and Kholoud Alnakshabandi and Ghada Alghubaini and Raghad Almuslih and Samah H Alkhawashki},
  journal = {Neuropsychiatric Disease and Treatment},
  year = {2026},
  month = oct,
  doi = {10.2147/ndt.s624218},
  url = {https://doi.org/10.2147/ndt.s624218},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Awareness, Misconceptions, and Cultural Beliefs About Functional Neurological Disorders: A Cross-Sectional Study
AU  - Sohaila Alshimemeri
AU  - Kholoud Alnakshabandi
AU  - Ghada Alghubaini
AU  - Raghad Almuslih
AU  - Samah H Alkhawashki
PY  - 2026
DA  - 2026/10/26
JO  - Neuropsychiatric Disease and Treatment
DO  - 10.2147/ndt.s624218
UR  - https://doi.org/10.2147/ndt.s624218
AB  - Aim: Functional Neurological Disorder (FND) is a common and disabling neuropsychiatric condition that remains highly stigmatized, partly because of misconceptions regarding symptom legitimacy and causation. This study assessed awareness, perceptions, cultural beliefs, and intended actions toward FND among healthcare providers (HCPs) and the general population in Saudi Arabia.  Methods: A cross-sectional, self-administered online questionnaire was distributed across Saudi Arabia in Arabic and English. The misconception composite was defined as endorsement of any supernatural cause or endorsement (“yes” or “sometimes”) that patients fake or exaggerate symptoms. Because belief in voluntary control is conceptually adjacent to the fabrication component, a sensitivity analysis restricted the outcome to supernatural attribution alone.  Results: Of 326 participants (88 HCPs and 238 general-population respondents), overall awareness of FND was 27.3% and was higher among HCPs than the general population (44.3% vs 21.0%, p < 0.001). Only 31.9% correctly identified FND as a real neurological disorder occurring without structural damage. The misconception composite was present in 29.4%, with no difference between HCPs and the general population (27.3% vs 30.3%, p = 0.600). At least one supernatural cause was endorsed by 17.5%, more often by the general population than HCPs (21.4% vs 6.8%, p = 0.002); the evil eye was most frequently cited (13.2%). Mixed causal models were the most common explanatory framework (44.2%). In the restricted-outcome regression, female sex was associated with lower odds of supernatural attribution (OR 0.45, 95% CI 0.23–0.89, p = 0.021), whereas belief in voluntary control was not (OR 1.43, 95% CI 0.61–3.39, p = 0.414). HCPs were more likely to accept an FND diagnosis for a family member (60.2%), whereas the general population was more likely to seek a second medical opinion (68.9%).  Conclusion: Awareness and understanding of FND were limited in this sample of healthcare providers and general-population respondents in Saudi Arabia. Supernatural and biomedical explanations frequently coexisted rather than competed. Educational strategies should therefore be culturally responsive, address uncertainty and intentionality-related stigma, and engage with existing explanatory models while clearly communicating an evidence-based FND diagnosis.
SN  - 1176-6328
SN  - 1178-2021
ER  -