Beyond "buzzwords"-updated recommendations for evaluating patients presenting without la belle indifference and diagnosing functional neurological symptom disorder: A case report.

Abstract

La belle indifference-absence of psychological distress despite presence of significant neurological symptoms-is often highlighted in current literature as a key diagnostic criterion for functional neurological symptom disorder. However, as exemplified with this case, functional neurological symptom disorder may present without la belle indifference more commonly than previously believed. A distressed 60-year-old female presented with abdominal pain, then suddenly lost ability to speak and developed rapid, rhythmic mandible movements. Multidisciplinary examination including diagnostic evaluation of the heart, head, and neck was largely unremarkable. Following her extensive evaluation, it was revealed that she had experienced similar symptoms previously, during times of high psychological stress. A diagnosis of functional neurological symptom disorder was established, and her symptoms resolved with minimal intervention. To best serve our patients, clinicians are encouraged to perform thorough history collection and physical examination prior to obtaining costly and time-consuming diagnostic studies whenever possible. By asking about risk factors of functional neurological symptom disorder early in the patient encounter, clinicians may be able to reduce unnecessary diagnostic testing, thus minimizing patient exposure to potential risks associated with extensive diagnostic evaluation and decreasing healthcare costs.