Functional and Dissociative Neurological Symptoms : a patient's guide

Worry / Panic

Anxiety and Panic are common in patients with functional and dissociative neurological symptoms. However, many patients with functional and dissociatiev neurological symptoms are not anxious (or depressed)

Anxiety and panic are also very common in Epilepsy and other neurological conditions too=,

This website is not designed to cover these symptoms in detail. Some links are provided below

A few things are worth getting straight though in relation to functional symptoms:

• If you have anxiety or panic attacks, this does not mean it is the cause of your symptoms. You may feel sensitive when doctors or others ask you how you are feeling, but a good doctor should always ask this, regardless of your diagnosis. For example, patients with multiple sclerosis can suffer from anxiety and depression. When they do, their quality of life is generally not as good so its important to do whatever is possible to improve them. The situation with functional symptoms should be no different.

• Admitting to anxiety or panic attacks does not mean you are ‘mental’ / ‘off your head’ / ‘weak willed’ or any of the other things that some people (perhaps even you!) think. There is a lot of stigma out there for these kinds of problems and it is not always easy to deal with. See 'All in the mind' for more about this.

• The commonest cause of anxiety or worry in patients with functional symptoms is worry about the symptoms themselves. What are they due to? Why doesn't anyone seem to believe me? Am I going mad? Will I become disabled in the future? Just because the worry is about the symptoms does not mean it isn't "worry". Sometimes anxiety about health is an overwhelming problem in itself.

Many patients do not realise what constitutes a diagnosis of anxiety or panic attacks. Here are the widely used criteria for making a diagnosis of these conditions from the American Psychiatric Association (DSM-IV)

I put them her so that you can have a look at the symptoms and decide for yourself whether this an angle worth exploring.


A. At least 6 months of "excessive anxiety and worry" about a variety of events and situations. Generally, "excessive" can be interpreted as more than would be expected for a particular situation or event. Most people become anxious over certain things, but the intensity of the anxiety typically corresponds to the situation.

B. There is significant difficulty in controlling the anxiety and worry. If someone has a very difficult struggle to regain control, relax, or cope with the anxiety and worry, then this requirement is met.

C. The presence for most days over the previous six months of 3 or more (only 1 for children) of the following symptoms:
1. Feeling wound-up, tense, or restless
2. Easily becoming fatigued or worn-out
3. Concentration problems
4. Irritability
5. Significant tension in muscles
6. Difficulty with sleep
D. The symptoms are not part of another mental disorder.

E. The symptoms cause "clinically significant distress" or problems functioning in daily life. "Clinically significant" is the part that relies on the perspective of the treatment provider. Some people can have many of the aforementioned symptoms and cope with them well enough to maintain a high level of functioning.

F. The condition is not due to a substance or medical issue


A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:

1) palpitations, pounding heart, or accelerated heart rate
2) sweating
3) trembling or shaking
4) sensations of shortness of breath or smothering
5) feeling of choking
6) chest pain or discomfort
7) nausea or abdominal distress
8) feeling dizzy, unsteady, lightheaded, or faint
9) derealization (feelings of unreality) or depersonalization (being detached from oneself)
10) fear of losing control or going crazy
11) fear of dying
12) paresthesias (numbness or tingling sensations)
13) chills or hot flushes


A) Both (1) and (2)

(1) recurrent unexpected Panic Attacks
(2) at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
(a) persistent concern about having additional attacks
(b) worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
(c) a significant change in behavior related to the attacks

B) The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

C) The Panic Attacks are not better accounted for by another mental disorder


A) anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd, or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.

B) The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.

C) The anxiety or phobic avoidance is not better accounted for by another mental disorder,

.. Feeling wound-up, tense, or restless, easily becoming fatigued or worn-out, concentration problems, irritability, significant tension in muscles and difficulty with sleep... are all core features of excessive worry or anxiety...